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Before the 2005–06 primary care trust (PCT) reconfiguration exercise, nearly two-thirds of PCTs had pharmacists appointed to their PCT Executive Committees (PECs).
In 2004, the NPA conducted a survey to capture the activities of PEC pharmacists and their successes in terms of promoting community pharmacy development. From the survey results, PEC pharmacists have been supporting PCTs in five broad areas by: - Supporting the introduction of new community pharmacy services;
- Supporting the clinical governance agenda for community pharmacy;
- Supporting the PCT as members of numerous PCT subcommittees, and inputting into the wider PCT agenda;
- Establishing regular communication between the PCT, the local pharmaceutical committee (LPC) and local community pharmacists;
- Networking with other PEC pharmacists in the area to ensure an efficient use of resources.
Table 1 describes examples of this support.
 Table 1. PEC pharmacists' support areas.
Impact of PBC
At the end of 2005 the NPA, in conjunction with Chemist & Druggist, conducted a small survey of PEC pharmacists to find out how they felt in the light of forthcoming PCT reconfigurations and the implementation
of practice-based commissioning (PBC)1. The overall feelings at that time were that the reconfiguration of PCTs and the introduction of PBC might have a negative impact on community pharmacy.
The reasons were:
- Losing established relationships within PCTs;
- The worries of reconfiguration for PCT staff, meaning they took their eye off the ball in terms of supporting and developing community pharmacy;
- The concerns over robust governance structures as PBC was implemented in order to ensure the open and transparent commissioning of services.
And now?
The pharmacy agenda for PCTs in 2006 continued to move at a fast pace with the ongoing implementation of the new pharmacy contract, and developments such as independent prescribing and ‘pharmacists with special interests in primary care’. It therefore continues to be essential for all PCTs to employ a PEC pharmacist. This is reflected in NHS publications such as an NHS Confederation fact sheet on the new pharmacy contract, which stated that all PCTs should “appoint a community pharmacist to the PEC to ensure input at a professional level”[2].
We know that the Government will push the 152 newly reconfigured PCTs very hard to ensure they are ‘fit for purpose’, particularly when commissioning services, and that commissioning decisions will take place at PEC level. However, in terms of PBC, it was unclear at the time of writing (summer 2006) what role the PEC would have. PBC ‘area commissioning forums’ (or equivalent) will be where decisions are made about redesigning local care pathways. Practice-based commissioners will be keen to prevent unnecessary hospital admissions by providing better support for people with long-term conditions in the community[3].
If PCTs and practice-based commissioners want to realise the potential for service redesign using community pharmacy, they must ensure multidisciplinary engagement both on PECs and PBC forums (or equivalent). Again, this is supported by NHS publications: for example a Primary Care Contracting bulletin entitled Multi-Professional Involvement in PBC deals with how PCTs should ensure that all healthcare professionals are actively engaged with PBC4.
It states that:
- There is much to gain from the involvement of other health professionals in PBC for governance; achieving priorities and targets; planning and development of services; maximising use of resources.
- Maximising involvement of other healthcare professionals will have greater impact on the emerging strategic context of primary care around care outside hospitals and the management of long-term conditions.
- Developing clinical leaders and better understanding of commissioning among a wider range of health professionals is important.
In addition, a publication from the NHS Alliance entitled The Future of Clinical Leadership in Primary Care and PCTs examines the possible implications of the PCT reconfiguration on PECs5. It states that “There is much evidence at a national and local level from both primary and secondary care that where there is effective linical engagement, then innovation, modernisation, quality improvement and patient focussed care flourish – and equally that they do not where it is absent.”
Therefore, joined up pharmacy involvement at all levels (i.e. GP practices, PBC forums and PCTs) is key to ensuring the successful ongoing development of community pharmacy. Pharmacists should ensure they have good relationships with their local practices, and local pharmacy leaders should ensure a place at the table on the PBC forums (where decisions will be made on service redesign), and on the PEC (where commissioning decisions will be made). It is also essential that all the pharmacists at these various levels regularly liaise with each other. And this is beginning to happen.
Conclusion
It has already been shown clearly that PEC pharmacists can support PCTs and the development of community pharmacy in order to improve patient care.
The developmental agenda for community pharmacy is already significant and will accelerate with increasing advances in the new pharmacy contract, and the implementation of independent prescribing and ‘pharmacists with special interests in primary care’. With the advent of PBC and the need for joined up pharmacy involvement at all levels, it has never been more crucial for all PCTs to employ a PEC pharmacist to advise and work with the PCT.
References1. Flex those PECs. Chemist & Druggist 28 January 2006; 18–19.
2. The new community pharmacy framework. NHS Confederation Factsheet September 2004; vol 1 (www.nhsconfed.org ).
3. Long-term conditions and practice-based commissioning – How can community pharmacy help? NPA Pharmacy Flyer Summer 2006; vol 20: 1–4 (www.pcc.nhs.uk/88.php ).
4. Practice Based Commissioning. Bulletin 3 – Multi-professional involvement in PBC. Primary Care Contracting February 2006; (www.pcc.nhs.uk/126.php ).
5. The future of clinical leadership in primary care and PCTs. NHS Alliance March 2006; (www.networks.nhs.uk/uploads/06/03/clinical_leadership.pdf ). |
