A service-based contract?

PSNC have announced that they plan to take a ‘service-based contract’ proposal to the Department of Health and Social Care in the next round of negotiations. This should be welcomed as a way of valuing and appropriately rewarding the added value that community pharmacy does, could and should add to medicines supply – its called pharmaceutical care.

Pharmaceutical care can be defined as the pharmacy’s contribution to the care of individuals in order to optimise medicines use and improve health outcomes (adapted from PCNE’s definition). This embraces supported self care, prescription medicines supply and their safe and effective use, and the advice and support related to healthy lifestyle interventions and services.

In England, we currently have a contractual framework that incentivises procurement and supply activity with MURs and NMS in adjacent silos; some of these incentives do not always drive the right behaviours or outcomes, e.g. Category M retained margin. Countries like New Zealand, some Canadian provinces and, to some extent, Scotland have built pharmaceutical care into the supply system, particularly for LTCs. It is the supply of medicines that drives interactions between patients and pharmacy teams and so it should not be separated but integrated and evidenced to leverage the major asset that is community pharmacy. These interactions are opportunities for interventions, they are not transactions – medicines are not simple commodities and it will be a sad and bad day for the pharmacy professions, healthcare and patients if that is all they become.

The move from where we are now to where this could take us will require not only changes to the contractual framework, remuneration and reimbursement systems, but, more importantly, will require a significant cultural shift for pharmacy and all involved in patient care and will require support well before we get into the detail of processes, systems and training.