In this new series we ask the national clinical directors for their views on clinical commissioning – the so-called tsars. This month, we speak to Jonathan Mason, national clinical director for pharmacy
Why should pharmacy be a priority for practice-based commissioners?
Across England we spend about £8bn a year on primary care prescribing. At least £100m of this is on medicines that are not used, while around a third of medicines are not taken as prescribed. So there’s a real incentive for commissioners to invest in pharmacy to encourage better medicines management, which would help reduce waste and improve health outcomes.
One of the strengths of pharmacy is its accessibility and convenience. Pharmacists see a wide range of people who are well but who may be at risk of conditions such as diabetes, so they are well placed to deliver screening and health promotion services.
What has PBC done well in terms of pharmacy?
In a number of PCTs, practice-based commissioners are working with practice support pharmacists to undertake medication reviews and make prescribing savings. GPs also employ pharmacists to manage repeat prescribing, helping them to get the best outcomes from medicines, reduce waste and improve the management of prescribing expenditure.
And what could it do better?
Commissioners need to build relationships with pharmacy. Whenever I talk to pharmacists, one of the main issues they raise is that commissioners don’t seem to be engaging with them. I don’t think this is a wilful attempt to not pay attention to pharmacy; it’s just that so much effort is being put into reducing referrals to hospitals.
What’s held PBC back in the area of pharmacy and what will change this?
There is a lack of awareness of how pharmacy fits in with PBC, so it may not be on the radar of all commissioners. More commissioners need to recognise what pharmacy can do to improve outcomes, such as reducing medicine wastage.
What’s impressed you about PBC?
How commissioners are redesigning care pathways to improve long-term conditions such as diabetes, heart failure and COPD.
Is there anything that worries you about primary care clinicians being involved in commissioning?
There is a danger that individual practices will commission pet projects, like acupuncture, rather than those that are evidence based. A big worry is the tendency to focus on services GPs can provide, so community services like pharmacy often get left out, or feel left out, of the commissioning process.
In your ideal world, how would GPs commission pharmacy services?
GPs would recognise the major part pharmacy has to play in health promotion, disease prevention and screening as well as support for patients with long-term conditions. The GP commissioners would also be mindful that medicines are the most frequent patient intervention in a pathway.
From a pharmacy perspective, what are the three single things commissioners could do that would most improve health outcomes?
We need to improve the commissioning of services to support people to get the best from their medicines. Targeted medicines use reviews (MURs) will help pharmacists ensure patients get better outcomes.
Pharmacy has a big role to play in health promotion. Its accessibility and convenience means it’s in an ideal position to support people to change to a healthier lifestyle. Pharmacists should also be commissioned to help patients use medicines more safely, which will also reduce hospital admissions.
Is there anything on the way in terms of new guidance for pharmacy that practice-based commissioners should look out for?
Since the contractual framework for pharmacy was introduced in 2005, Pharmaceutical Needs Assessments (PNAs), which can be used by PCTs to support and extend existing pharmaceutical services to deliver benefits to local patients, have focused on existing pharmacies within the trust. Now PNAs are to become a tool when commissioning new pharmacies.
So when, say, a new housing development is being built, PNAs will enable commissioners to identify if there is a gap to open a pharmacy and what services are required to meet that new community’s needs.
Jonathan Mason is national clinical director for pharmacy
Interview Kathy Oxtoby