The Contractual Framework for Community Pharmacy

The new contract enables community pharmacies to contribute to National Health Service (NHS) service provision for patients, provide a more rewarding and stimulating working environment for the profession and reduce the burden of work currently carried by general practitioners (GPs).

The new contract framework is flexible and better reflects the expanded range of services that Local Health Boards need community pharmacies to provide. It meets local patients’ needs and priorities, and switches the emphasis of reward from volume and quantity of medicines dispensed to the quality and professionalism of the services provided.

An integral component within the NHS family, community pharmacies will:

• support patients who wish to care for themselves;
• respond to the diverse needs of patients and communities;
• be a source of innovation in the delivery of services;
• help deliver the aspirations within Designed for Life;
• help tackle health inequalities.

The contract consists of three different levels of services:

• Essential services
• Advanced services
• Enhanced services

Essential services - these are services offered by all community pharmacies.

Dispensing - Supply of medicines or appliances, advice given to the patient about the medicines being dispensed and advice about possible interactions with other medicines. This includes recording all medicines dispensed and providing advice.

Repeat dispensing - Management of repeat medication for up to one year, in partnership with the patient and GP or prescriber. The patient will return to the pharmacy for repeat supplies, without first having to visit the GP surgery. Before each supply the pharmacy will ascertain the patient’s need for a repeat supply of a particular medicine. The pharmacist will communicate all significant issues to the GP or prescriber with suggestions on medication changes as appropriate.

Disposal of unwanted medicines - Collection of unwanted domestic medicines from households and individuals via pharmacies.

Promotion of healthy lifestyles (public health) - One-to-one advice given on healthy lifestyle topics such as stopping smoking. This may also include campaigns organised by Local Health Boards such as promotion of flu vaccinations or educating the public about the appropriate use of antibiotics.

Signposting patients to other health care providers - Pharmacists and their staff may refer patients to other health care professionals or care providers when appropriate. This service may also include a referral on to other sources of help such as local or national patient groups.

Support for self-care - Advice and support by pharmacy staff to enable people to derive maximum benefit from caring for themselves or their families. This will initially focus on self-limiting illness, but support for people with long-term conditions is also a feature of the service.

Support for people with disabilities - Provision of support for people with disabilities who need assistance in managing and taking their prescribed medicines, in line with the requirements of the Disability Discrimination Act 1995. This support may include provision of reminder charts, labelling medicines in a legible format, through to dispensing medicines in multi-compartment compliance aids.

Advanced services - These services require a competency accreditation of the pharmacist and the pharmacy premises to meet certain criteria.

Medicines Use Review (MUR) and Prescription Intervention Service - The pharmacist will conduct a medication review with the patient to assess any problems with current medication and its administration. The patient’s knowledge of their medication regimen is assessed and a report is fed back to the patient’s GP. This means the patient’s knowledge of their medication and why they are taking it is increased, and any problems with their medication are identified and addressed.

The MUR is conducted on a regular basis, e.g. every 12 months. The Prescription Intervention Service is in essence the same as the MUR service, but conducted on an ad hoc basis, when a significant problem with a patient’s medication is highlighted during the dispensing process. The pharmacist will feed back suggestions and comments to the GP or prescriber using standardised paperwork (this will eventually be done electronically). Reviews have to be conducted in a consultation area which ensures patient confidentiality

Enhanced services - The specification for these services is agreed nationally but commissioned locally by Local Health Boards to meet the needs of the community. Services may include:

• minor ailments management
• diabetes screening
• substance misuse services
• disease specific medicines management services
• palliative care services
• emergency hormonal contraception service
• full clinical medication review
• care home services
• head lice management service
• smoking cessation service
• gluten-free food supply service
• needle exchange scheme
• services to schools.

It is envisaged that the contract framework will develop over time, to keep pace with the changing needs of patients and the NHS. This gradual contract development may for example see some Advanced or Enhanced services becoming part of the Essential category.

Further information on the new contract is available on the following links:

Health of Wales Information Service

Community Pharmacy Wales