Memorandum by the Pharmaceutical Services
Negotiating Committee (WP 50)
INTRODUCTION
1. The Pharmaceutical Services Negotiating
Committee (PSNC) is the body that represents community pharmacy
on NHS matters in England and Wales.
1.1 PSNC is the body that has negotiated
a new contract for community pharmacies, with the Department of
Health and the NHS Confederation. The new contract is due to be
introduced on 1 April 2005.
1.2 PSNC believes that community pharmacy
has a valuable role to play in improving public health and is
pleased that community pharmacy is included as part of the Government's
Public Health White Paper.
1.3 Improving public health is not new to
community pharmacists and their teams. Indeed, due to the convenience
and accessibility of community pharmacies, many people visit their
pharmacy to acquire health information, to help them make choices
about their healthcare and to manage their own medical conditions.
1.4 The White Paper highlights that the
new pharmacy contract will allow PCTs to work with pharmacies
to shape services to meet local need and local demand for health
and it will give people support on healthy lifestyles (chapter
6, p 126). In particular, community pharmacy is highlighted as
a resource in the areas of smoking cessation (chapter 3, p 53)
(chapter 6, p 121), CHD and sexual health (chapter 6, p 146).
1.5 However, it is important to note that
community pharmacists' roles in terms of public health can extend
beyond these areas. It is hoped that this will be recognised in
the Department of Health's pharmaceutical public health strategy
that is currently being developed and is due to published in 2005.
RESPONSE TO
SPECIFIC QUESTIONS
ON THE
GOVERNMENT'S
PUBLIC HEALTH
WHITE PAPER
2. Will the proposals enable the Government
to achieve its public health goals?
2.1 The proposals in the White Paper are
an important step in helping to improve the health of the nation.
However, as recognised by Secretary of State for Health Rt Hon
John Reid MP, in the preface of the White Paper, people do not
want Government or any one else making decisions for them[91]
Instead, people want support in making choices.
2.2 Community pharmacy offers one of the
best places for these choices to be made. The non-threatening
environment of pharmacies together with their convenience and
accessibility should be fully appreciated.
2.3 The introduction of the new contract
will formalise many roles that pharmacists are currently undertaking.
One of the core themes of the contract is to improve public health.
From 1 April patients will be able to visit their pharmacy and
get advice on healthy lifestyles, one of the essential services
in the new contract that all pharmacies will provide. Pharmacists
will give advice on smoking cessation for example and other major
areas of public health concern. Pharmacists will also be involved
in six public health campaigns each year, organised by PCTs. Examples
of campaigns may include promotion of flu vaccination uptake or
educating the public about the appropriate use of antibiotics.
2.4 However, it is important to raise awareness
that community pharmacies will be offering advice on health promotion.
As Health Minister Rosie Winterton MP stated at an All Party Parliamentary
Pharmacy Group meeting, "Pharmacy's contribution to improving
the health of the population is already recognised by many. But
this needs to be given a higher profile." [92]
2.5 The new contract for pharmacy is designed
so that it is a rolling contract and in this way new services
can be developed according to need.
2.6 For example, although weight management
is not part of the current list of new contract services, it is
important to recognise that pharmacy has a role in helping prevent
and treat obesity, one of the key areas targeted by the Public
Health White Paper. There are examples of pharmacists already
carrying out weight management clinics. In Elora Chemist, South
Benfleet, Essex, a local weight management clinic combined with
CHD risk assessment has been established to provide the local
community with advice from their local pharmacist Bharat Patel.
Weight checks, weight management advice, blood pressure monitoring,
cholesterol and glucose testing are carried out and the service
aims to educate, advise and motivate individuals as they work
towards a healthier lifestyle. Patients attend the clinic once
a month and their progress is monitored. They are advised on healthy
eating, smoking cessation and physical activity. PSNC would like
to see weight management incorporated as a service in the contract
in the future.
2.7 As well as giving advice on health promotion,
pharmacists will have an important role in encouraging self-care.
The "support for self care" essential service in the
pharmacy contract will initially focus on self-limiting illness,
but support for people with long-term conditions is also a feature
of the service. The possibilities are endless and as the Government
decides which health conditions to target, new services within
the contract can be developed.
2.8 Self-care is fundamental to achieving
the Government's public health goals. Therefore the Government's
policy of encouraging self-care should be implemented in tandem
with any of the proposals in the Government's public health White
Paper. The recent publication of the Department of Health's guidance,
"Self Care—A Real Choice"[93]
highlights that self-care covers a wide spectrum of care, from
the care of minor-ailments and physical health through to long-term
conditions. In the recent Department of Health publication, "Supporting
People with Long Term Conditions",[94]
an example of a project in Greater Manchester is cited, where
pharmacists will be a first port of call for people managing their
long-term conditions. Pharmacists in this scheme will provide
accurate results for tests such as blood glucose, cholesterol
and anticoagulant status on site at the pharmacy.
2.9 One of the focal points of the White
Paper is children and young people. The role of pharmacists educating
children about public health issues and encouraging them to self-care
from an early age so that good practice continues into adulthood,
should be recognised. In Dorset, Roger King, Secretary of Dorset
Local Pharmaceutical Committee (LPC) visits schools to talk about
healthy living and the importance of a balanced diet and the health
risks associated with being obese. This role could be extended,
with pharmacists being able to treat children who are overweight
by giving them exercise prescriptions and advising their parents
on diet and nutrition.
3. Are the proposals appropriate, will they
be effective and do they represent value for money?
3.1 Pharmacists are a cost-effective resource
and are free at the point of use for patients. Although the White
Paper does refer to pharmacist's role in giving advice on CHD,
smoking cessation and sexual health, community pharmacy should
be considered in greater detail in the Government's proposals.
3.2 In the area of mental health for example,
community pharmacists have more contact with the general public
than any other health professionals, and are therefore well placed
to provide support in the care of those with mental health problems,
identify signs of relapse, help develop medicines taking concordance,
and provide an easily accessible resource for patients and carers.
3.3 The medicines use review (MUR) service
within the new contract will enable pharmacists to assess patients'
medication and any side effects or problems associated with its
administration. As a first port of call adults with mental health
problems should visit community pharmacists to learn about the
medication they have been prescribed and possible side effects.
If patients are aware of the side effects in advance they are
more likely to continue to take their medication. Relapse is five
times more common if the patient does not take their prescribed
medication. [95]Community
pharmacists should therefore be integrated into the Government's
proposals to improve mental health within the Public Health White
Paper.
3.4 Adverse reactions to medicines are implicated
in 5-17% of hospital admissions. The MUR service of the new contract
also aims to reduce the likelihood of drug reactions.
3.5 The MUR service is particularly important
for older people since 80% of people over 75 take at least one
prescribed medication, with 36% taking four or more medicines.
A study found that 28% of older patients are admitted to hospital
because of non-compliance or adverse drug reactions. Ensuring
that medication is taken properly and not wasted represents a
cost-saving to the NHS, helping to prevent adverse reactions and
reduce hospital admissions. [96]
4. Do the necessary public health infrastructure
and mechanisms exist to ensure that proposals will be implemented
and goals achieved?
4.1 The post of "Director of Public
Health" that has been established within PCTs in recent months
is encouraging and highlights that the issue is a focus of the
work of many PCTs. This illustrates that PCTs are more likely
to be in a position to implement the Government's proposals and
ensure that goals are achieved.
4.2 PSNC is encouraged by the establishment
of a "Public Health Network" by Harrow PCT and feels
that this practice could be rolled out across other PCTs. This
is where healthcare professionals including pharmacists meet on
a quarterly basis with other groups including school teachers,
environmental officers, students etc to discuss public health.
[97]
CONCLUSION
5. Community pharmacists already make an
important contribution to public health by providing appropriate
information, advice and support to a wide variety of people on
subjects ranging from contraception to medicines and alternative
treatments to healthy lifestyle issues. They also play a vital
role in sign-posting people to other appropriate health and social
care professionals. Community pharmacists however have a lot more
to offer.
5.1 There has been an increasing recognition
of the contribution that community pharmacy can make to improving
the publics' health and the need to integrate pharmacy into the
wider public health workforce in the UK.
5.2 PSNC looks forward to the pharmaceutical
public health strategy that is currently being developed by the
Department of Health and is due to be published later this year.
It is hoped that this will highlight opportunities to develop
and enhance the contribution that pharmacists can make to reducing
health inequalities by providing advice on health promotion, health
improvement and harm reduction.
5.3 Further details on local pharmacy services
and the new contract are available from the PSNC website at www.psnc.org.uk/contract
5.4 For further examples of how community
pharmacy can improve public health please refer to PSNC's response
to the Government's initial consultation on public health at:http://www.psnc.org.uk/uploaded—txt/PSNC%20response%20to%20Choosing%20Health%20consultation%20-%20May%2004.pdf
January 2005
91 Choosing Health, White Paper, Department of Health,
November 2004, p 5. Back
92
Health Minister Rosie Winterton MP, speaking at a joint all party
pharmacy group and all party group on men's health meeting, 19
April 2004. Back
93
Self Care-A Real Choice, Department of Health, January 2005. Back
94
Supporting People with Long Term Conditions, Department of Health,
January 2005. Back
95
NSF for Mental Health, Department of Health, Standard 4, care
planning and review. Back
96
Room for review: A guide to medication review, Medicines Management
Services programme and the Task Force on Medicines Partnership,
section 1. Back
97
Harrow's Public Health Network, http://www.harrowpct.nhs.uk/communityinvolvement/content.asp?id=53 Back
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