Review of NHS Pharmaceutical Care of Patients in the Community in Scotland

Contracts and Funding

54. The main legislative arrangements which underpin the provision of pharmacy services in the community have been largely unchanged since the inception of the NHS. This has made the planning and implementation of the services which have been introduced in Scotland over the last ten years more complex than need be. The 2005 Act contains provisions which would allow for a more appropriate and flexible framework for the development and delivery of pharmaceutical care services. We recommend that Scottish Government should also consider how these can be brought into effect in the context of the wider findings of this review and the developing policy landscape. Future contract arrangements also need to be sufficiently flexible to take account of changing ways of providing care and increasingly complex therapies in the community.

55. Part of the framework for the future should relate to the listing arrangements. Currently, only pharmacies appear on the pharmaceutical list, with no identification of the individual pharmacists who provide the service. We believe that the listing of individuals as well as organisations (which would be similar to what happens with other primary care contractor groups) is an important and positive element in underpinning the professional relationship with patients, and the clinical governance systems for which Boards are responsible. It is also likely to be relevant to any future arrangements for revalidation for pharmacists. The practical implementation can draw on the experience gained with the listing of "performers" in other contractor professions.

56. The national funding arrangements which have accompanied the introduction of the new services over recent years have rightly sought to move the system from one which traditionally rewarded volume of dispensing to one which recognises the nature and quality of the professional service provided. But in so doing, the system has become somewhat complex, with a range of different types of payments included in "transition". While not underestimating the challenge, we support the principle of a weighted capitation system based on registration supplemented by some activity measure to recognise acute dispensing. It will be important to ensure that there are no perverse incentives and that the relevant probity measures are included. We also believe that the payments for pharmaceutical care services to care homes (as described above) should be managed locally but within a nationally agreed framework.

57. We recognise the benefits to both the NHS and the pharmacy contractors which have accrued from the jointly negotiated Efficient Purchasing and Prescribing Programme related to the purchasing of generic drugs for use in primary care in Scotland. It is important to ensure that the monitoring arrangements continue to deliver those benefits. Any alternative arrangement that might be considered would have to demonstrate greater savings.

58. We have not sought to establish in detail the impact on the use of resources of the proposals in this review. However, if effective measures are introduced then we would expect savings for the NHS and improved quality of life for patients. We would expect these to arise from reduced hospital admissions, from the consequences of fewer errors of all types, less polypharmacy, from increased appropriate adherence leading to better satisfaction with first line treatment, less escalation to more expensive treatment and less waste. We would also expect a shift in the use of time by pharmacists to allow them to spend more time with patients.