Community Pharmacy and GPs Working Together

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Community Pharmacy and GPs Working Together

• Drivers and Opportunities
• Dr David Jenner
• NHS Alliance PBC Lead

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PBC September 2007 the GP Perspective

• Much talk little action
• Lack of financial and referral data
• PCTs still failing to let go
• Budget information often scant
• Some hot spots of activity though
• But many GPs fat on the QOF and busy enough

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NHSA/Kings Fund Survey May 2007

• 73 committed to PBC
• 3 said PCT involved them in strategy
• 40 said PCT support a problem
• 53 said PBC had failed to improve patient care
• As of May 2007 70 had no agreed budget!
• (see www.nhsalliance.org)

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NHSA Survey July 2007

• As of 30/06/07 40 have no budget
• 60 rate support from PCTs insufficient to
  proceed with PBC
• 74 not receiving regular benchmarked activity
• 30 made saving last year
• 30 dont know!
• National MORI survey awaited

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You Cant Do Owt with Nowt

• PCTS are often the rate limiting step
• And do they and SHAs really want PBC to work?

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Community Pharmacy in PBC

• Pharmacists just dont commit much resource as
  yet
• You dont have registered lists
• You rarely have access to the notes
• You dont refer much to hospital
• As yet you prescribe little
• So maybe not surprising PCTs have gone to GPs
  first!

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GPs View of Pharmacists

• Bigger fish to fry and battles to win as yet
• E.G. PCTS! ,budgets, data, incentives
• GP access, pay rises, pensions
• So please dont be offended
• There are roles where we know you are value for
  money
• But we are PARANOID of competition

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Where Pharmacists Can Really Get Involved In PBC

• Managing the prescribing budget
• Working with primary care teams to avoid
  admissions
• Rapid access and response-you tend to be open
  longer than us
• Providing services you have business experience
  and often premises and capital
• Prevention Chlamydia screening

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With PBC

• Commissioning has to come before provision
• They have to be kept separate
• Commissioning is mainly about controlling
  secondary care spend
• What do pharmacists do to influence this?
• But prescribing budget still important

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Commissioning v Provision

• PCTS money
• Low risk-except in opportunity costs
• Everyones business
• Incentives for demand management
• No competition yet
• Partnership model fine

• Your money
• Clinical and financial risk
• Only for some
• Incentives is profit margin on delivery
• Lots of competition
• Needs new corporate vehicle (LLP,CLG)

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Its Collaboration on Commissioning

• But Will We Be Competing on
  Provision?

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And Should Pharmacists Work For Practices?

• Or With Them?

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Many Examples of Practice Pharmacists in Primary
Care

• Helping manage those at risk admission
• LTC management-running clinics
• Pharmacist led review of prescribing budgets
• Helping manage minor illness
• Working for OOH providers

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Example Mount View Practice Fleetwood

• Single practice scheme
• Started with prescribing savings
• Practice employed pharmacist
• Pharmacist led clinics
• Protocol development
• In house pain services
• Mental health nurses
• Led to 8 and 190k savings

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Mount View Practice

• In house dermatology GPSI clinic
• Reduced referrals by 33
• Nurse led LTC clinics (COPD,Diabetes,CHD)
• General medical referrals down 11
• Nurse/pharmacist led admission avoidance clinics
• Case management for thirty patients with highest
  admission rates
• Orthopaedics acute admissions down 11
• Medical admissions down 3
• 500k saving on secondary care in 2005/2006

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Learning Points

• Effective PBC involves commissioning and
  providing elements
• Need to save money to invest at first
• Single practices can make a difference alone
• Nurses, pharmacists and mental health workers are
  key team members
• PBC can improve practice services
• Charismatic leadership helps! (pharmacist!)

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How Can Community Pharmacy Be Involved?

• You need to have budgetary influence
• You need to show what you can do
• You are probably best collaborating with GPs than
  competing initially
• You could compete but without access to the
  records its tricky!
• The big boys (new Boots/Lloyds/Assura are better
  placed to compete)
• Prescribing savings are still there

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This Years Priorities

• Financial balance
• 18 week wait
• MRSA/clostridium difficile
• Reducing health inequalities
• PCTs need your help on these
• You can submit business plans too

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PBC Provision for Pharmacy

• Well placed to compete or bid for LESs
• Anything that helps achieve the 18 week wait but
  can you help here?
• Smoking cessation ,screening ,primary care access
  (but targets still around Drs!)
• Warfarin monitoring?
• Could you be employing GPs in future??
• Independent prescribers have an edge!
• But I think you need multidisciplinary teams

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Where We Could Work Together

• Managing prescribing budget
• Extended access and for minor ailments (notes
  access the issue)
• Managing long term conditions
• Care of complex ill and those in residential care
• Prevention, screening, compliance

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So For Community Pharmacy

• Get into bed with GPs and nurses
• Or set up to compete for LESs
• Be positive and bring ideas
• Understand the drivers
• Look at www.18weeks.nhs.uk and tell us what YOU
  can do
• Help make prescribing savings
• ? Get on the PEC of PCT and on board of PBC
  consortia

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What is Your Local Practice Doing About PBC?

• If nothing why not?
• Can you help ? Is there an opportunity
• Who are the KOLS (key opinion leaders)
• What is your PCT doing?
• Who is the lead there?
• What are the real challenges for the PCT this
  year and next?

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Be Wary of The Hippos!

• We are politically powerful
• We have the market share
• We are a very popular brand
• And we can move very fast when we want!
• We would love to work with you
• But not necessarily for you!

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And In Mark Britnells and PCTs Eyes

• Are we both just potential providers of primary
  care in future?
• Will compulsory competitive re-tendering become
  the norm?

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But If You Want to Compete

• You need access to the notes
• (CFH promise this but when???)
• You will need to employ GPs and nurses for
  mainstream activities
• But the big boys have venture capital
• You often have the premises and locations
• And you are open longer than we are!

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So Are You?
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So Are You?
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Or A
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We Are Watching with Interest!

• NHS AllianceHelping Patients PCTs Practices and
  Pharmacies Work Togetherwww.nhsalliance.org

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NHS Alliance Annual Conference

• Manchester 22nd-23rd November 2007