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In the April 2013 edition of CPN a contractor briefing on the
new healthcare landscape was published. Additional content
on the healthcare landscape is available on the PSNC website.
This PSNC PowerPoint presentation accompanies the
contractor briefing and may be used by LPCs to undertake
training for contractors on the new healthcare system.
Additional slides on contracting routes can be found at the
end of the presentation.
Feedback on the presentation can be sent to
alastair.buxton@psnc.org.uk.
9th August 2013
Pharmacy’s new commissioners
A simplified guide to the new healthcare
system
Pharmacy and the new
system
Four levels at which services
can be negotiated
NHS England national - CPCF
NHS England local - Enhanced
Local Authorities (LAs)
Clinical Commissioning Groups
(CCGs)
The Third Pillar –
supporting future NHS
provision
Optimising the use of
medicines
Supporting people
to self-care
Supporting people to
live healthier
lives/public health
Supporting people to
live independently
Community
Pharmacy
GP led
primary care
Hospitals
Community Pharmacy
Contractual Framework (CPCF)
• Three players in negotiations
– PSNC
– NHS England / NHS Employers
– Department of Health (DH)
• NHS England and DH have specific areas of
responsibility
DH’s role
• Leading the nation’s health and care
• Sets legal framework for system, including
regulations for pharmacy
• Secures funding from HM Treasury
• ‘System steward’
• Determines NHS reimbursement price of
medicines & appliances
PSNC Community Pharmacy Conference - 24 April 2013
NHS England
Three distinct, but interconnected roles:
1. A leader and enabler of the overall commissioning
system – supporting CCGs to commission services for
their communities
2. A direct commissioner – securing continuously
improving quality from the services we commission,
including primary care
3. A system wide leader for quality improvement –
collaborating with other parts of the system, including
Public Health England and Health Education England
NHS England’s Mandate
• High quality care for all, now and for future
generations
• Success will be measured through the NHS Outcomes
Framework:
Domain
1
Preventing people from dying prematurely
Domain
2
Enhancing quality of life for people with long-term
conditions
Domain
3
Helping people to recover from episodes of ill health
or following injury
Domain
4
Ensuring people have a positive experience of care
Patient
experience
Domain
5
Treating and caring for people in a safe environment
and protecting them from avoidable harm
Safety
Effectiveness
NHS England
• NHS Community Pharmacy Contractual
Framework
– Commissioning Development Directorate (working
with Operations and Medical Directorates)
negotiates with PSNC on remuneration for
pharmacy contractors and new national service
elements within the contract
– NHS Employers will undertake some negotiations
on behalf of NHS England
NHS England - local
• 27 Area Teams (AT) which are part of the Operations
Directorate
• ‘Local’ office of NHS England
– Direct commissioning of primary care
– Specialist commissioning (e.g. offender health)
– ‘Supervision’ of CCGs
• Single operating model
• Performance management of CPCF
• Commissioning of Enhanced services (including on
behalf of CCGs and LAs)
NHS England - LPNs
• Local Professional Networks (LPNs) for pharmacy,
optometry and dentistry within each AT
• They are intended to provide clinical input into the
operation of the AT and local commissioning decisions
• They:
– support implementation of national strategy and policy at
local level
– work with other key stakeholders on the development and
delivery of local priorities, some of which go beyond the
scope of primary care commissioning
– provide local clinical leadership
NHS England - LPNs
• Pharmacy LPN specific functions include:
– supporting LAs with the development of the
Pharmaceutical Needs Assessment (PNA)
– considering new programmes of work around selfcare and long term conditions management in
community pharmacy to achieve Outcome 2 of the
NHS Outcomes Framework
– working with CCGs and others on medicines
optimisation
– ‘holding the ring’ on services commissioned locally by
LAs and CCGs, highlighting inappropriate gaps or
overlaps
Local authorities
• 152 top tier authorities
• Public Health and Social Care Outcomes
Frameworks influence their commissioning
• Responsible for commissioning the majority of
public health services
– Using a ring-fenced budget
– Can use standard public health service contract
• A Health and Wellbeing Board (HWB) for each LA
– providing strategic oversight and bringing
together all local commissioners
Local authorities
• LAs and CCGs develop the Joint Strategic Needs
Assessment (JSNA), working through the HWB
• The JSNA is used to develop a Joint Health and
Wellbeing Strategy…
• …and informs the development of the
Pharmaceutical Needs Assessment
• Which is used by the NHS England Area Team to
determine some pharmacy market entry
decisions
Clinical Commissioning
Groups
• Responsible for commissioning health services (as
opposed to public health services) using the
standard NHS contract
• All GP practices within the area of the CCG are
‘members’
• Early focus on hospital contracts
• May wish to commission minor ailment services,
palliative care schemes, MUR+ and other
medicines optimisation services from community
pharmacy
NHS Pharmaceutical Services – System Map
Department of Health
Public Health England
Sets legal framework, secures funding
Executive agency of the Department of
Health
NHS Pharmaceutical Services
Product
reimbursement
Services
remuneration
Division of roles
Department of Health
NHS England
Determines NHS reimbursement price
of medicines & appliances
Commissions NHS Pharmaceutical
Services – including Essential,
Advanced & Enhanced services, plus
Local Pharmaceutical Services
Inform market entry
& commissioning
decisions
Local Authorities
Health & Wellbeing Boards
(produce pharmaceutical
needs assessments)
Commission public health
services
Clinical Commissioning
Groups
Commission other
services
Pharmacies
Health Education England
Dispense medicines & appliances &
provide associated & other services
Local Education & Training
Boards
Dispensed prescriptions submitted with
claims for other services
Health & Social Care
Information Centre
Collates & provides
information
NHS Business Services Authority
Calculates and makes payment to
dispensers. Provides management
information
Charged for product
reimbursement
NHS Connecting for Health
functions
Charged for service
remuneration
The role of your LPC
• Add content on the local work the LPC is
undertaking
Questions
&
discussion
Community Pharmacy
Local Service
Commissioning Routes
Who can commission what?
• The services specified or described in the Secretary of
State Directions are additional services (Pharmaceutical
Services)
• Under the terms of the NHS Act 2006, as amended by
the Health and Social Care Act 2012, pharmaceutical
services may only be commissioned by NHS England
• This means that pharmaceutical services (Essential,
Advanced or Enhanced) can only be commissioned by
NHS England
• The Directions list twenty Enhanced services (see penultimate slide)
Who can commission what?
• Responsibility for pharmacy local Enhanced services
previously commissioned by PCTs has transferred to
NHS England (the Area Team)
• NHS England does not have the power to direct CCGs
to manage these services on its behalf
• This does not preclude CCGs from commissioning
services locally from community pharmacies
Who can commission what?
• Pharmacies may also be commissioned to provide any
other services for which they are qualified, by:
– Local Authorities (e.g. public health services); and
– Clinical Commissioning Groups (CCGs)
• Whilst the service specifications of these services may
be identical to those used by NHS England to
commission Enhanced services, for example minor
ailments services commissioned by CCGs, they will not
be commissioned as pharmaceutical services
– LAs may use the standard public health contract
– CCGs must use the standard NHS contract
Who can commission what?
• However, a CCG or LA can ask NHS England to
commission a service listed in the Directions on
their behalf, e.g. a CCG could request that a
minor ailments service is commissioned as an
Enhanced service
• Services commissioned this way are
commissioned under Pharmaceutical Services
and consequently the public health, NHS
standard or local contracts don’t need to be used
Commissioning routes – Local
Authorities
Decision to
commission
service that
could be
provided by
community
pharmacies
Use standard public health
contract
May use a
tender process
or
Any Qualified
Provider
Cost of service is
billed back to the
Local Authority
Once the
providers have
been
identified
Use LA’s own contract
If service is listed in the Enhanced
service Directions, LA can ask NHS
England to commission it as an
Enhanced service
NHS England area team commissions
the service as an Enhanced service
(i.e. under Pharmaceutical Services)
Commissioning routes – CCGs
Use standard NHS contract
Decision to
commission
service that
could be
provided by
community
pharmacies
May use a
tender process
or
Any Qualified
Provider
Cost of service is
billed back to the
CCG
Once the
providers have
been
identified
If service is listed in the Enhanced
service Directions, CCG can ask NHS
England to commission it as an
Enhanced service
NHS England area team commissions
the service as an Enhanced service
(i.e. under Pharmaceutical Services)
Services listed in the
Enhanced Services Directions
• Anticoagulant Monitoring Service
• Care Home Service
• Disease Specific Medicines
Management Service
• Gluten Free Food Supply Service
• Independent Prescribing Service
• Home Delivery Service
• Language Access Service
• Medication Review Service
• Medicines Assessment and
Compliance Support Service
• Minor Ailments Service
• Needle and Syringe Exchange Service
• On Demand Availability of Specialist
Drugs Service
• Out of Hours Service
• Patient Group Direction Service
• Prescriber Support Service
• Schools Service
• Screening Service
• Stop Smoking Service
• Supervised Administration Service
• Supplementary Prescribing Service
Visit www.psnc.org.uk for
information and support on local
pharmacy services commissioning