Pharmacy Complete

Leadership

By Leave a Comment

New Community Pharmacy Contractual Framework 2019-2024

The English community pharmacy funding settlement for the next five years has been announced the first time that we have agreed a multi-year settlement. The agreement, set out in the new Community Pharmacy Contractual Framework (CPCF) which commences on 1st October 2019, aims to build on the clinical skills of community pharmacists and their teams which must be seen as a positive step.

The Headlines

Funding:

  • The contract sum will remain unchanged at £2.592 billion until the end of 2023/24, £1.792bn for fees and £800m in retained margin.
  • The Single Activity Fee (SAF) will be £1.27 from August 2019 (currently £1.26).
  • Category M prices will increase by £15m a month from August 2019 to recognise that there was predicted to be a shortfall in margin in the current year.
  • Pharmacies will receive monthly transitional payments in the second half of 2019/20 and in 2020/21 to meet costs associated with changes such as integration into Primary Care Networks (PCNs), preparation for Serious Shortage Protocols (SSPs) and implementation of the Falsified Medicines Directive (FMD).
  • Establishment Payments will be phased out by 2020/21.
  • The Pharmacy Access Scheme (PhAS) remains at £24m a year.

Services:

  • A new NHS Community Pharmacist Consultation Service (CPCS) is introduced nationally as an Advanced service in October 2019. This will replace the current NHS Urgent Medicine Supply Advanced Service (NUMSAS) and local pilots of the Digital Minor Illness Referral Service (DMIRS). The new service will operate with a fee of £14 per consultation. Initially using referrals from NHS111, but piloting referrals from GP practices with an intent to implement nationally in 2020/21.
  • Medicines Use Reviews (MURs) will be phased out over the next two years with pharmacists working in PCNs undertaking Structured Medication Reviews (SMRs). Contractors will be able to deliver 250 MURs in 2019/20 and 100 in 2020/21.
  • New Medicine Service is retained with potential extension of therapeutic areas and funding.
  • Medicines reconciliation service as part of transfer of care.
  • Being a Healthy Living Pharmacy will become an essential requirement within the new framework from April 2020 to support the prevention agenda and will include:
    • Mandatory health campaigns aligned with equivalent campaigns in general practice under an integrated programme
    • Hepatitis C testing for people using needle exchange services
    • A testbed programme for:
      • detection of undiagnosed cardiovascular disease (hypertension, atrial fibrillation)
      • stop smoking support from secondary care referrals
      • point of care testing for minor illnesses to support AMR
      • vaccination and immunisation services
      • routine monitoring of patients, e.g. those taking oral contraception
      • activity complementing future PCN service specifications, e.g. early cancer diagnosis and health inequalities.

Pharmacy Quality Scheme (PQS) 

  • This replaces the Quality Payments Scheme (QPS) and pharmacies can earn additional payments for meeting quality criteria. Funding for the scheme will continue at £75m a year.
  • Some elements of the former QPS will become Terms of Service requirements from April 2020, e.g. Healthy Living Pharmacy.
  • The criteria include:
    • A collaborative approach to engage with PCNs
    • Activity complementing the GP QOF Quality Improvement module on safe prescribing, e.g. lithium safety audit, valproate in pregnancy, NSAIDs
    • Checking whether patients with diabetes have had their annual foot and eye checks with appropriate referrals
    • Reduction in sales of sugar sweetened beverages (SSB)
    • Training and assessment of look-alike, sound-alike (LASA) medicines with evidenced safety reporting action
    • Update previous risk review with recorded mitigations
    • Sepsis training with risk mitigation
    • All patient-facing staff are Dementia Friends and a Dementia Friendly environment standards checklist completed.
  • The 2020/21 PQS may include:
    • Suicide prevention training
    • Inhaler technique audit
    • Anticoagulation audit.

Transformation and Technology:

  • A range of reviews with the aim to free up capacity:
    • Legislation to permit wider hub and spoke dispensing
    • Original pack dispensing review
    • Better use of skill-mix
    • Different terms of service for online pharmacies.

The Commentary

Firstly, we should recognise that this will undoubtedly been a big task for PSNC to achieve and remains so as negotiations are ongoing.

It should be no surprise, but will be disappointing to contractors that the contract sum has been fixed at the current level for the five year deal which is less than in previous years against a backdrop of rising operating costs. With prescription numbers set to fall due to various deprescribing initiatives, the proportion of income associated with dispensing will also drop. Hence, those relying on volume alone and not adapting to a service-led contract will struggle to survive. One can only hope that new and sustainable funding will come through on the back of some of conceptual and testbed service opportunities and that the sector is ready, willing and able to deliver.

Unfortunately, the continued use of retained margin to deliver around 30% of funding will perpetuate an unfair averaging system where not all contractors can realise their full funding, and, in some cases, drive the wrong focus and behaviours. In addition, a consultation on a review of reimbursement was announced by DHSC which will impact on this.

The eventual loss of MURs is also disappointing. Yes, they needed reform (Murray Review), but a good consultation on safe medicines use adds enormous value to patients (see our previous Viewpoint article). Not to acknowledge and fund this provision of pharmaceutical care as an adjunct to medicine supply and support medicines optimisation is a lost opportunity for patients, the NHS and pharmacy. Structured Medication Reviews by pharmacists working in a PCN will add value, but will only reach a proportion of patients and misses the opportunistic interventions on adherence and healthy lifestyles which can improve patient outcomes. On a positive note, the New Medicine Service, that also adds value to patients and the health system, is retained and a medicines reconciliation service is to be added to support transfer of care.

The arrival of a national minor illness consultation service (CPCS) should be welcomed and quickly embraced, particularly when GP referrals are included; certainly all GPs we know welcome its coming. This is likely to be a big stream of work and funding in the future and pharmacy teams will need to be ready to deliver against expectations.

Embedding HLP in the contractual framework, rather than just in the quality scheme, should  be celebrated. Many contractors have fully adopted the organisational development, health promoting ethos and criteria which are the foundation of HLP; however, some have undoubtedly just ticked the box. The opportunity to develop the right knowledge and skills within the pharmacy team and deliver a healthy living environment and enhanced customer experience will pay dividends. There will also be new services to build on these foundations. Given the launch of the Prevention Green Paper with which the pharmacy contract is aligned, the opportunities for community pharmacy to be at the forefront of prevention are significant.

One comment I saw on Twitter called it a Curate’s egg, good in parts, less so in others. Undoubtedly true, but it’s what we’ve got and we will have to make the most of it whilst building relationships with PCNs to tap into the funding that will flow through there. Contractors will also need to develop their own business plan around non-NHS services to meet local needs.

We have developed a short animation which illustrates what the new contract means through the eyes of patients that use community pharmacy.

Pharmacy Complete is here to support contractors in ensuring they meet the HLP criteria and optimise the benefits that brings. We are also here to support the engagement with PCNs and development of a business plan for a sustainable future.

Helping you to help others

By Leave a Comment

Planning for a sustainable future

The announcement of the funding settlement for the remainder of the 2018/19 financial year will not be well received by pharmacy owners in England. That, together with reinstatement of the temporarily postponed Category M overspend recovery, will create further cashflow and sustainability challenges for many owners, particularly independents.

Unfortunately, this was predictable on the back of almost three lost years whilst the judicial review of the previously imposed and poorly implemented funding settlement was pursued rather than asking the right questions of the right people to understand where pharmacy could support the very challenged NHS and public health systems.

We have written many times about the need to change the contractual framework and the funding formula to incentivise the right behaviours and reward quality delivery through a fairer system that is not based on a non-existent average pharmacy that benefits a few and penalises many.

To support pharmacy contractors, Pharmacy Complete has developed a unique Business Development Programme. Planning for Growth enables owners and their managers to take control of their future by developing a robust business plan.

This course, which builds on our Leadership development programmes and the platform of Healthy Living Pharmacy, provides essential business knowledge, skills and tools at a time when community pharmacy can no longer wait for someone else to create their future business model nor be so dependent on the NHS for profitable income.

Pharmacy Complete – enabling pharmacy for a healthier future

By Leave a Comment

SMARTER Goals

Most of us have come across the acronym SMART when developing goals or making plans, but how many of us have made these goals and plans SMARTER?

So often our life or business goals are not sufficiently specific or measurable and many do not have an ‘achieve by’ timeline all of which are critical to achieving those goals. Even if these elements are all in place, we often fail to measure whether we are on track to achieve or have achieved the desired goals. This is where the ER in SMARTER comes in.

 

We use this approach in our Knowledge into Action workshop and MECC course for Health Champions where they are applied to healthier lifestyle goal setting. Our Business Development Programme course, Planning for Growth, also explores and supports the effective use of SMARTER goal setting when creating a business plan.

What gets measured, gets done!

By Leave a Comment

Beyond the JRs

The Judicial Reviews challenging the cuts have been dismissed. The judge’s view was that they were not unlawful and, in the context of the £22billion funding gap faced by the NHS, the cuts were inevitable. The Department of Health got a rap on the knuckles for poor process and limited disclosure of facts, but the fact is, the cuts are here to stay.

So what does that mean for community pharmacy owners? The pain has already been felt from the initial reduction in fees and the impact that has had on cashflow, but there is another pinch point to come in June which must be planned for. In our Viewpoint item in October 2016 we recommended 10 actions to take on things you can control, those still apply and are even more urgent (see below).

The positive is that over 11,000 pharmacies have engaged with the Quality Payment scheme although we have yet to see the detail. This is a clear signal that the sector is both willing and able to deliver these criteria. We hope that 100% deliver against all 4 of the gateway criteria and the 8 quality criteria by the November 24 claim date. Many pharmacies chose to delay achieving Healthy Living Pharmacy status knowing that they can claim in November; we can help you with that through our Complete HLP suite.

Community pharmacy has long been done to and not shaped its own destiny, either nationally or at individual business level. The time has come to create our own future both professionally and economically. At national level, unity and strong collaborative leadership will be critical if we are to realise the aspirations and opportunities in the Community Pharmacy Forward View, the Murray Review and the subsequent Making it Happen document.

At individual business level, where you are in control, every owner must develop their own plan to create a resilient business. Our 10 recommendations are a great place to start and we can support you in creating that business plan:

1.  Redefine your purpose – what you love doing, what you are good at, what there is a need for and what is more likely to result in generating new profitable income

2.  Engage and settle your team – developed and motivated workforce will be more productive

3.  Now is the time to invest in your people – develop them as Health Champions so that you have the right people doing the right things at the right time

4.  Hold up a mirror to yourself and your business; build on your strengths and minimise your weaknesses

5.  Maximise all current opportunities – focus first on delivering quality MURs, NMS, flu vaccination service (prepare and plan now), the Quality Payment criteria and any locally commissioned services

6.  Look at your OTC business and set short, small growth targets and engage your team in achieving these, rewarding with team incentives

7.  Take a critical look at your community (your market) and consider the health and wellbeing opportunities to grow further

8.  Make a plan and engage your team in the development and implementation of that plan

9.  Fully embrace and implement Healthy Living Pharmacy – this is more than a quality criteria, its a business development model that will differentiate your pharmacy

10. Create an ethos that delivers a high quality customer experience that will build loyalty, footfall, service delivery and transaction value