Section 2: The context for pharmaceutical services - England

A number of key changes in the approach to service provision and in the regulation of services are due to come into effect in 2010; these include the formal introduction of pharmaceutical needs assessments (PNAs) and the introduction of Guidance on Compliance by the Care Quality Commission, replacing the Healthcare Commission core standards. Under these arrangements, for example, a care home will have responsibility for ensuring that a person’s prescription for medicines is up to date.

Another important measure is the increasing emphasis on world-class commissioning. This is about delivering better health and well-being for people, improving health outcomes and reducing health inequalities. The world-class commissioning framework is designed to raise the ambition of PCTs in achieving these outcomes.

The vision and competencies for world class commissioning concentrate on the importance of assessing and prioritising population needs, focusing on strategic outcomes, procuring services, and managing providers to deliver the desired results. Working closely with all local community partners is seen as being central to successful commissioning. It follows that a key element of world class commissioning is the development of robust joint strategic needs assessments (JSNAs) to support planning of high quality, accessible services that are responsive to local needs. The pharmaceutical needs assessment (PNA) is an integral part of a JSNA.

The core of the PNA is a high level snapshot of the PCT’s health profile and needs of the population together with an outline of how providers of pharmaceutical services can meet the current and emerging needs of their local population.

See Figure 1 below, which shows how the PNA fits into the commissioning cycle.

Following the findings of the CHUMS study a recent Department of Health Alert has charged Primary Care Trusts with the responsibility for ensuring that medicines are handled safely in care homes for older people. Specifically, the Alert called for Primary Care Trusts to work with their primary medical care contractors, providers of pharmaceutical services and social care partners to:

  • Determine how medicines errors in care homes for older people can be reduced.
  • Review the safety of local prescribing, dispensing, administration, and monitoring arrangements in the provision of medicines to older people in care homes;
  • Establish a plan for effective joint working in the future, including auditing on-going progress.

caresettings-figure1

The context for pharmaceutical services - Wales

From its inception The Welsh Assembly Government has always recognised the link between Health and Social Care; this synergy has been supported by the Cabinet post of a Minister for Health and Social Services.

The policies of the Welsh Assembly have underpinned this link through developing strategies that address both social care and health needs. Their aim is that both social care and health needs, including chronic health conditions, are managed effectively within the community - avoiding crises and inappropriate hospital or care home admission.
The Welsh Assembly health strategy Designed for Life (May 2005) sets out the vision that “by 2015 Wales will have minimised avoidable death, pain, delays, helplessness and waste.” 

This strategy is supported by Fulfilled Lives, Supportive Communities (Feb. 2008) Improving Social Services in Wales. The Welsh Assembly Government’s vision is to ensure modernised social services are developed in Wales that provide more accessible, personalised care for people, and that people are supported earlier and helped to retain their independence for longer.

This vision will be delivered in a flexible and efficient way, in partnership with other local government services, the health service, private and voluntary organisations, and the service user and carer.

Policy makers in Wales are now recognising that medicines are central in healthcare provision. Effective medicine management provision is paramount to keep patients safe, and living within their communities. Unfortunately, the systems for ensuring that patients know what they are taking and that changes to their medicine are made in a managed way are not reliable. Patients are most at risk when the medicines are potentially toxic and when their care is managed by a number of providers. To address these issues the Welsh Assembly introduced the ‘1000 Lives Campaign’ in April 2008.

The ‘1000 Lives Campaign’ aims to reduce risks to patient safety by implementing life-saving interventions developed by clinicians in Wales.  Interventions include better management of medicines, reducing healthcare-associated infections and surgical complications and improving general medical and surgical care.

The medicine management element of the campaign focuses on two approaches:

  • Ensuring that "high risk" medicines are managed in a rigorous way starting with anticoagulants in secondary and primary care.  Further types of medicines will be incorporated as the campaign progresses.
  • Reconciling discrepancies and omissions at key points in the patient's journey, for example, when they enter and leave hospital

Additionally, the Minister for Health and Social Services established a Task and Finish Group in June 2009 to review the provision of pharmaceutical services in Wales and make recommendations aimed at improving efficiency, effectiveness and value for money of pharmacy services in Wales while maintaining a focus on improving patient outcomes.

The Emerging Themes report published in September 2009 identified how current resources and structures can be used better. The report has been commended by the Minister who has indicated she expects the NHS to support fully the implementation of the recommendations.

The Group has now evolved into a Strategic Delivery Group and is developing its recommendations with key stakeholders and beginning to implement those that can be actioned quickly. The next steps will encompass developing an all-Wales vision for pharmacy services over the next 10 to 15 years. This vision will be used to inform an implementation strategy from which additional key work streams will look at how pharmaceutical service contracts will need to change in Wales to deliver better patient care.

A National Director of Medicines Management has recently been appointed, and one of the areas he will be focusing on will be the adoption of a whole system approach to minimising waste medication, including developing the medicines management skills of Care Home staff and domiciliary carers working in the statutory and voluntary sectors.