Is Wales the Future for England?

Is Wales the Future for England?

Discussing the similarities between the contractual frameworks in England and Wales and the lessons learned from our Welsh counterparts

By PSNC Committee Member Stephen Thomas

The title of this blog may seem very strange. However, when we are talking about the Community Pharmacy Contractual Frameworks in Wales and England it may not be as odd as it sounds:

  • Both frameworks have a five-year flat funding agreement (although the Welsh version did not have the cuts applied to it);
  • Both frameworks seek to move the emphasis from supply to service;
  • Both frameworks want pharmacy to relieve pressure on GPs and the NHS by becoming a key point for the delivery of urgent care services;
  • Both frameworks have a considerable emphasis on quality measures (i.e. Pharmacy Quality Scheme in England);
  • Both frameworks want to see pharmacy more integrated into the country’s relevant NHS structures;
  • Both frameworks use the same reimbursement structure in the tariff so contractors on both sides of the border are affected equally by price changes, etc.

So, given that, arguably, Wales started down this road two and a half years ago what lessons can we learn in England from their experience?

Firstly, and it probably doesn’t have to be said, flat funding is hard. Even in Wales, as time has moved on, the pressure that contractors are under to assure the viability of their business has ramped-up considerably. Clearly, taking money out of the supply function to fund services means that the pharmacy is busier than ever to just stand still. The use of skill mix becomes crucial here. Are pharmacists undertaking activities that a pharmacy technician could do, for example? If a larger proportion of your income is coming from services that only the pharmacist can deliver then the pharmacist should take a long, hard look at the activities they (and their team) are undertaking to make sure they are working optimally. Efficiency is key.

One note of caution here, though. Because of our traditional role, there can be a temptation to put more effort into purchasing than services. While both are crucial to the ongoing viability of a pharmacy, spending time securing 1p off a packet of atenolol when you could have completed an NMS is probably not economically wise; what support is available for you from software and membership groups so that you can have more of a service focus?

It’s obvious, but services take longer to deliver than supply does. Therefore workload has an almost exponential increase so, secondly, the workforce needs to be well-trained and motivated and working at the ‘top of their licence’ (NB. This does not have to include massive expense as there are many free resources out there as well as training from membership organisations). Linked to this point, do you need to consider giving a member of staff extra management duties such as managing people’s holidays or making sure basic paperwork is completed? Anything that takes the time of the pharmacist when someone else could do it is wasting effort and efficiency and removing the opportunity to generate income. It’s probably also adding unnecessary stress.

It may seem obvious but, thirdly, do all staff in the pharmacy understand the direction of travel for pharmacy? One thing we are seeing in Wales is that where the whole team understands that the contract is changing and that some of their duties are changing with it then the team itself is stronger, more cohesive and performs at a higher level. Do you fully understand what is happening? Have you read the CPCF agreement document? Are you signed up for PSNC newsletters? Do you regularly access the resources on the PSNC and LPC websites? Can you explain all of this to your team? If the answer is no to any of these, you have some work to do if you want you and your team to succeed.

Building on this, how good are your relationships with other local healthcare professionals? In Wales, there is a large reliance on referrals from other professionals into the Common Ailments Service. From April, pharmacies in England will be similarly reliant on referrals from local GP practices under the Community Pharmacist Consultation Service (CPCS). In addition, though, do your local GPs fully understand the other services on offer? For example, if there’s an Emergency Contraception service they may want to refer all their patients straight to local pharmacies to free-up appointments. Do you (and your neighbouring pharmacies) spend any time cultivating your relationships locally? If not, you could start to lose out. Of course, this is where Primary Care Networks (PCNs) really come into their own. From April 2020, when these really ramp-up activity, how engaged with them will you be?

Finally, the big one, consistency. If you are moving from a mainly supply function towards service delivery, you have to be able to provide those services to patients on a consistent basis. If patients come to expect that services will be available and, suddenly, they are not they will very quickly go elsewhere. The same is true for GP referrals. This is particularly critical if an increasing proportion of your income is coming from service delivery. So, are all the locums that work in your pharmacy accredited to provide all the services that your pharmacy provides? If not, if you’re on holiday or off sick those services will stop and it can take quite some time to get them back up to speed leading to a loss of income in the interim. What have you done to engage locums to support your service delivery? Equally, if you are going to expect locums to be more involved in services and less involved in supply (leaving the technical function to the rest of the team) have you told them of this expectation?

There are many other lessons to be learned but these are the big ones. Being almost ruthlessly efficient, ensuring maximum use of the workforce and building relationships and doing all this consistently will help. It won’t be easy but it could make all the difference.

Stephen Thomas is also a member of Community Pharmacy Cheshire and Wirral (CPCW)
A version of this blog first appeared on the CPCW website in December 2019

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