The government has suggested it will consider proposals from the pharmacy negotiator to include a care plan service with pharmacists supporting patients with long-term conditions as part of a new Community Pharmacy Contractual Framework (CPCF).
The Pharmaceutical Services Negotiating Committee (PSNC) drew up proposals to enhance the role of pharmacy in the management of patients with long-term conditions (LTCs), such as diabetes and hypertension, at a meeting in January.
The PSNC told The Pharmaceutical Journal that the Department of Health and Social Care (DHSC) had indicated it was willing to consider the plans that would implement recommendations made by the Murray review in December 2016 and be based on the Community Pharmacy Future project undertaken in West Yorkshire.
The Murray review, commissioned by NHS England from The King’s Fund’s director of policy Richard Murray on provision of clinical services in community pharmacy recommended that medicines use reviews (MURs) be redesigned “to include ongoing monitoring and regular follow-up with patients”.
“Ultimately, MURs should evolve into full clinical medication reviews utilising independent prescribing as part of the care pathway,” the report said.
The PSNC said its care plan service proposals incorporated elements of the MUR service and new medicines service (NMS), and also clearly articulated the way in which community pharmacy services were helping to address key NHS targets, such as reducing waste and improving patient safety.
Full implementation of its proposals “would be a significant change for many community pharmacy teams”, PSNC acknowledged, so it is suggesting that they are implemented through staged changes to the current community pharmacy contractual framework.
A new care-focused package of services within the community pharmacy contractual framework would also require changes to funding delivery, PSNC added. More details of the proposed care service will be published soon with the initial focus on the design of services, with redesign of funding structures following, PSNC told The Pharmaceutical Journal.
Robbie Turner, RPS director for England, said: “The closer involvement of pharmacists working in the community pharmacy setting will help ensure people with long term conditions get the best outcomes from their medicines, reduce adverse events, minimise avoidable harm and un-planned admissions to hospital, while ensuring resources are used more efficiently to deliver the standard and level of care that people with LTCs deserve.
“The development of the community pharmacy contract to give pharmacists more opportunity to support the health and wellbeing of the communities they serve will help improve the capacity and capability of primary care and improve quality and support the safer use of medicines.”
The Community Pharmacy Future project in West Yorkshire, on which the PSNC’s proposals are based, involved 52 pharmacies with each developing individual tailored care plans for up to 20 patients aged over 50 years who had cardiovascular disease and/or diabetes, and were taking multiple medications.
At the outset patients had a one-to-one discussion with a pharmacist to identify their health goals. The pharmacist helped the patient draw up a Patient Care Plan setting out individual goals and steps to be taken to achieve them, supplied the patient with information guides and signposted them to suitable patient support groups.
Subsequent consultations assessed progress towards health goals, with the pharmacist checking the patient’s adherence to their prescribed medicines discussing medicines optimisation, looking at falls and pain management, and recommending changes to medication to prescribers where clinically indicated.
Also at its January meeting, the PSNC discussed DHSC proposals for changing the system for setting drug price concessions. Contractors have been facing cashflow issues due to the price and availability of generics and delays in granting concessionary prices, and PSNC has said contractors should not face unfair risks, and costs of supply problems should not be passed on to them.
PSNC said it will continue to press for immediate improvements to the price concessions system, but it “believes that forthcoming regulation on the disclosure of information on healthcare products will have an impact on managing price concessions, when a refined system can be established, which makes use of the increased data capture”.