Alison I need to ask you about the contracts that you have set up for practice support.
We have set up a contract with the Commissioning Support Unit to provide medicines QIPP advice. We have done this with a number of CCGs to provide a whole time equivalent with analytical support.
So what do they do?
Well they take the medicines management QIPP targets and develops a range of prescribing efficiency metrics. We discuss these and weed out the ones that we do not believe represent good quality advice and accept the rest. We ask the CSU to monitor these and send through to the practices.
But how do you implement these.
We have set up a contract at practice level for prescribing support, dependent on achieving these efficiency metrics and other process metrics that I have set for medicines reconciliation and medication review. It is up to the practices to decide how to spend it. They can either employ a pharmacist directly or sub-contract with the CSU.
Do the practices often employ directly?
More than half do and usually for more hours than the contract amount – they top it up themselves.
And why do they do that?
We have built on the existing skills of the pharmacist and have a development program in place to support them using a pharmacist who has been in this role for several years. The pharmacists are usually computer literate, clinically aware and well organised. They help the practice to risk stratify their patients and ensure that services focus on medium to high risk patients. They help the practice work with local community pharmacists and the end goal is that they help the practice to achieve maximum QoF. It is getting harder to achieve maximum QoF and the practices see the value in the pharmacists. Half of these pharmacists are already independent prescribers and run both disease management and medication review clinics.
And where do you see this going in the future?
My aim would be to encourage every practice to have at least a part time practice pharmacist and I would like to see some specialist pharmacists syndicated across practices.
What is a syndicated specialist pharmacist?
We have always had specialist pharmacists in substance misuse and smoking cessation, but we have worked with our local hospital to develop further specialist pharmacists. There is a COPD specialist and a diabetes specialist, but the program is set to create other specialists like pain management and heart failure.
And what do you intend to do with them?
The aim is to support higher level primary care based services. Practices are able to bid for additional resources to develop services where there is a clear need. There are limitations as to what they can use the money on and one of the options is to contract a specialist pharmacist or nurse for specific duties, either organisational, educational or service delivery.
Thank you for this insight – I want to come back and ask you about the pharmaceutical industry and your education plans