The RPS is pleased to see the Government take account of its listening exercise and translate the Future Forum report into new Government policy. The policy document published by the Government on 20th June 2011 recognises what healthcare stakeholders have said about the original version of the Health and Social Care Bill. 

A Future Forum Listening Event took place at the RPS London offices, hosted by Cath McLean and Ash Soni, of the Future Forum. A report was made from this meeting and, in addition to further conversations with key individuals and organisations within the profession, a series of issues were compiled to form a document. Grouped under five separate headings, the issues contained all the key aspects of the Bill that the profession believed should be amended. This document was presented to the Future Forum for inclusion in its Report.

These headings were entitled:

1. Composition of Clinically-led Consortia and Health and Wellbeing Boards
2. Delivering better care within primary care and across care boundaries
3. National, regional and local frameworks
4. Governance, clarity and responsibility in the new structure
5. Competition

1. Composition of Clinically-led Consortia and Health and Wellbeing Boards
The profession suggested that GPs must consult with clinicians from all stakeholder professions in addition to being open in relation to the outcomes of those discussions.

Board members of the clinically-led commissioning groups were also expected to meet relevant standards and to have the necessary skills to undertake the new role. Clinical commissioning groups would benefit from the input from a pharmacist and, further, the commissioning groups should have an appointed pharmacist medicines guardian with responsibility to ensure the right medicines are prescribed in a cost-effective manner.

The Government has accepted the Future Forum’s recommendation to create senates to assist clinicians in making decisions that are either complex in nature or involve the work of other healthcare professionals.

It hasn’t stipulated that an individual in every clinical commissioning group should have overall responsibility for pharmacy and prescribing. The roles of individuals on the Senate, and the body itself, are still unclear

The RPS will continue to press Parliamentarians for clarification of these roles and responsibilities We will also press for the role of a pharmacist medicines guardian either on the board of clinical commissioning groups, or as an integral part of the pharmacist presence on every senate.

2. Delivering better care within primary care and across care boundaries
The profession is clear on its need to be included in the process of service and tender design, integrated service delivery, monitoring of performances and measurement of outcomes.

The Government has indicated in its policy document that the identified processes will remain the responsibility of clinical commissioning groups but input from the senate will be invited, with a requirement by commissioning groups to demonstrate that the information and advice given has been taken into account before a decision is made.

3 National, regional and local frameworks
The profession is clear that the accreditation of pharmacists would be much more efficient if a national form of accreditation existed, requiring pharmacists to undertake accreditation just once. We believe that a national framework for services can also be created to help shape the views of commissioners but also allow for regional and local variation.

Some specialist services would be better commissioned at regional or national levels. Oncology or the provision of medicines information are two examples of where national commissioning may be more effective.

The profession is keen to see a national system of deaneries, similar to that utilised by doctors.

We will work to promote the concept of national commissioning frameworks in addition to maintaining regional commissioning for specialist services. It is essential for the Government to understand that, even though the number of patients served by specialist services is small, the services provided have a major impact upon those who receive them.

4. Governance, clarity and responsibility in the new structure
The profession was clear that clinical commissioning groups must commission services that respond to the needs identified in the Joint Strategic Needs Assessment, created by local authorities.

We also wanted responsibilities and reporting lines within the new healthcare landscape to be more transparent, with a clear role for health and wellbeing boards to oversee the work of commissioning groups and compare outcomes to those identified in the Joint Strategic Needs Assessment.

The profession also asked that the essential skills and experience of primary care pharmacists are kept within the new healthcare environment. It is felt that their expertise in emergency planning and delivering public health initiatives will require these key skills to ensure successful outcomes.

The RPS will continue to press the Government to ensure that essential specialist skills are not lost during the remodelling of health services.

5. Competition
Pharmacy said that enhanced competition between providers must be balanced with increased co-operation between those same service providers to deliver an integrated service at a time and place that best suits patients.

We believe that the multidisciplinary team of service providers:

• must have access to all relevant information
• drive up the quality of care using peer competition
• is open about all costs of service provision
• sets quality as the key criterion for whether a provider can provide a service

The Government will advise Monitor on which services should be bundled to promote high quality care and competition. The profession believes this advice should take the form of a framework, allowing for local variation to fit the needs of individual communities.

Pharmacy believes that HealthWatch England’s role of examining choice and competition within each clinical commissioning group’s area will be critical to ensuring effective delivery of local services. Competition must be based upon the quality of services provided in addition to key indicators important to patients: health outcomes, location and availability.

The Government expressed a wish in the Health and Social Care Bill, to introduce Performers’ Lists. There is no information on their role, or how these are expected to work.  

We will press the Government to explain how it anticipates the performers’ list to be used, who will maintain it, and how much duplication will take place with the register held by the GPhC.

The profession will also be keen to measure the performance of Monitor in settling disputes where providers consider fair competition

The RPS believes the new measures incorporated within the Health and Social Care Bill are a substantial improvement on the original Bill. The new legislation is likely to provide better choice and a better standard of care at a time and place that suits the patients, We will maintain a watching brief over the Government’s proposed amendments, seek clarification on those issues that haven’t been fully explained, and continue to lobby for those issues we must be included in this Bill.    

For further information please contact Charles Willis: charles.willis@rpharms.com or tel: 0207 572 2670.

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