Community pharmacy organisations have expressed significant concern over proposals from the Royal Pharmaceutical Society (RPS) to restructure the national pharmacy contract in England to promote more integrated working with GPs.
In a consultation published on 12 August 2015, the RPS and the National Association of Primary Care (NAPC) set out far-reaching proposals calling for a new contractual framework to incentivise GPs, community pharmacists and others to collaborate on care.
In an initial comment, the Pharmaceutical Services Negotiating Committee (PSNC), which negotiates the national contract on behalf of community pharmacy contractors, said any contractual changes must adequately protect pharmacies’ dispensing services, and urged the RPS “to consider very carefully the consequences of some of their suggestions”.
Pharmacy Voice, which also represents community pharmacies, warned against relying on national contractual changes to push through local integration.
In a statement, PSNC chief executive Sue Sharpe said that while the committee supports the underlying principles of the proposals, “changes must be brought about through evolution and development of the existing contractual framework and funding system rather than through major changes that are untested and unknown”.
“To bring about change, community pharmacy owners need the confidence to invest in their businesses and we are really concerned that this consultation document does not give sufficient assurances on this or recognise the importance of national funding and the essential protection it provides,” she said.
Sharpe said the PSNC disagreed with the RPS and the NAPC’s apparent suggestion to abandon national provider-based commissioning, and is “very concerned” by comments from RPS president Ash Soni, who said that community pharmacy has been straightjacketed by a “top-down” national contract.
“Far from being a straightjacket, for pharmacy owners the core contractual framework and its funding has been and remains a vital protection. It also ensures that all patients can access a reliable core service, including the dispensing of medicines from any pharmacy, anywhere in the country,” said Sharpe. “The PSNC will battle to protect this principle.”
Sharpe added that a core national contract did not hamper the service developments desired by the RPS and the NAPC, and has been “an enabler rather than an inhibitor”. She also refuted what she said was an inference that community pharmacy contractors and their teams were unwilling to change, and warned of “serious consequences” for vulnerable patients’ access to healthcare if, as suggested, the community pharmacy network were transferred into multidisciplinary care settings.
beth Wade, director of policy at Pharmacy Voice, says although the community contract needs to evolve with the NHS, “evidence suggests though that changes to contracts and funding systems do not always produce the intended consequences, not least because these are only ever one part of the picture”. She says equally as important was building relationships, overcoming professional barriers, improving patient information, and training and develo
Wade says the PSNC and NHS England are exploring how to integrate community pharmacy better with all parts of the health service while maintaining the essential medicines supply function. “This ongoing national dialogue is essential but we must avoid falling into the trap of seeing regulatory or structural change as the key that will unlock local integration,” she warns.
“Innovative primary care leaders are already working together to do the right thing for patients, making best use of existing local commissioning arrangements and establishing new provider vehicles to enable collaboration. It is this type of practical partnership working we should all be focused on and supporting right now,” she adds.
An RPS spokesperson says the Society would not be commenting on these statements at this time. After the consultation closes, the RPS and the NAPC will publish a report addressing all responses.