Department of Health guidance on PBC [1] recommends that community pharmacy should be involved in the local population needs assessments that underpin service redesign.  It also includes community pharmacies in an illustrative list of providers from whom services might be commissioned.  Eight Strategic Commissioning Tests[2] have been published by NHS Primary Care Contracting to help PCTs and SHAs assess whether the PCT is maximising the value of community pharmacy.  Within the Commissioning Tests framework, PCTs are asked to assess: How is community pharmacy involved in practice based commissioning planning and service specification, and how is community pharmacy involved in the provision of services via PBC?

There are a number of steps that PCTs can take towards engaging pharmacy, thereby fulfilling obligations set out in guidance, for example:

PBC Planning processes

1. Utilise the knowledge and insight of all relevant clinical professionals, including community pharmacists, when establishing the needs of the local population[3]. Community pharmacies already record information that is not available in other settings and also have a footfall unparalleled in other healthcare settings, which makes them well placed to identify local health needs.



2. Ensure there are opportunities for community pharmacy input at all planning stages, from needs assessment through to service specification, service procurement and service evaluation.

PBC Governance and transparency

1. Ensure that needs assessment and commissioning documents of the PCT and PBC groups are easily accessible as required by the Commissioning Framework for Health and Wellbeing[4]



2. Put in place mechanisms to ensure the LPC is provided with relevant information in a timely manner



3. Ensure processes are in place for potential providers wanting to bid for services and that these processes are well publicised.

Skills to deliver services under PBC

1. Include local pharmacists with enhanced skills and competencies, such as non-medical prescribing, in your skills directory[5]



2. Include Pharmacists with Special Interests (PhwSI) in your considerations. A framework for PhwSI[6] exists and highlights opportunities in diabetes management, substance misuse and pain management, among others. Agree processes for accrediting these roles and ensure these are well publicised.



3. Minimise barriers for accreditation by exploring the possibility of harmonising the accreditation of enhanced services[7] such as the work going on in the North West Pharmacy Workforce Development Group



4. Ensure that funds and opportunities for skills development are distributed equitably and that community pharmacy is included as a recipient.

PBC Communication

1. Include the LPC in strategic, planning and other appropriate discussions.



2. Be an enabler for dialogue between GPs, pharmacists and other primary care providers and also between primary and secondary care providers. Some PCTs have arranged for community pharmacy to be represented on each PBC locality group, and others have organised stakeholder workshops.



3. Ensure that pharmacists are made aware of redesigned pathways, so that they may effectively fulfil their contractual obligation to signpost patients to local services.



4. Publish contact details of the PBC groups in your locality

Service redesign

1. Embed the community pharmacy contractual framework into your patient care pathways to best utilise what is already happening and funded.



2. Consider a range of options when considering service redesign to ensure that the skills of pharmacists and their teams and the benefits of pharmacies, such as access (opening hours and location) can be used for maximum benefit to patients.



3. Scope and understand what community pharmacy already offers in your locality - including services (within their core contract and also locally commissioned), skills and premises. Draw on your Pharmaceutical Needs Assessment for this purpose, if you have one up to date.



4. Think radically about the potential roll of community pharmacy in providing services to reshape patient care. Examples already exist where services in the contractual framework or locally commissioned services have been used to shift and reduce hospital outpatient activity, release capacity of other health care professionals or reduce unscheduled care demand.

By taking up these suggestions, your PCT will facilitate the engagement of community pharmacy in practice based commissioning, marshalling their skills and expertise in pursuit of improved patient care.

Pharmacy PBC Week, 24-28 September

[1] Practice based commissioning; practical implementation. DH Nov 2006 www.dh.gov.uk

[2] Community Pharmacy Strategic Commissioning Tests -  Benefits Realisation Assessment

www.primarycarecontracting.nhs.uk/uploads/Pharmacy/april_07/cpaf_april_07/cpaf_strategic_tests_v4.pdf 

[3]  Practice based commissioning; practical implementation. DH Nov 2006 www.dh.gov.uk

[4] Commissioning framework for health and well-being. DH March 2007 www.dh.gov.uk/en/publicationsandstatistics  

[5]Practice based commissioning: early wins and top tips. DH 2006 www.dh.gov.uk

[6] Implementing care closer to home – providing convenient quality care for patients. A national framework for Pharmacists with Special Interests

www.primarycarecontracting.nhs.uk/uploads/Pharmacy/PhwSI/launch_sept_06/phwsi_framework.pdf 

[7] NHS North West Community Pharmacy Enhanced Services Harmonisation of Accreditation.

www.primarycarecontracting.nhs.uk/200.php