The Pharmacist: NHS Structure and its influence on Pharmacy

- Rising expectations of health services and increase in patient demand. What are the current factors increasing - Ageing population. pressure on NHS? - Cost containment. - Evidence based practice. - The publicly funded health care system in the UK. - It is free for all at the point of use. - It is a complex system made up of multiple organisations. What is the NHS? NHS England, Scotland, Wales, and What are the four parts that make up the Health and Social Care in Northern IreNHS? land. When was the NHS established and who by? The NHS was established in 1948 by Health Minister Aneurin Bevan. 1. For everyone. 2. Access based on clinical need not ability to pay. 3. Aspires to the highest standards of care and professionalism. What are the 7 key principles of the NHS 4. Patient at the centre of care. Constitution? 5. NHS will spend taxpayers' money carefully. 6. NHS will work with other organisations to give better care. 7. Accountable to the public for decisions. What does it mean by the statement "Healthcare in the UK is devolved"? The UK parliament allocates central funding, but spending is decided by the devolved government. Historically, there was a lot more independent working in the NHS, such as What was the historical structure of the the hospital services working separately to the community services and primary NHS? care. There was no collaboration or connections. 1/7 What is the current NHS structure? - The 2022 Health and Care Act introduced new legislative measures that aim to make it easier for health and care organisations to deliver joined-up care for people who rely on multiple different services. - Local health needs are considered. - There are integrated care systems. How does funding flow in the NHS? Treasury --> Department of Health and Social Care --> NHS England --> Integrated Care Board --> Providers of services - NHS long term plan 2019 (sets out commitments to address and prevent healthcare inequalities, systematic approach to reducing unwarranted variation in care). - Health and Care Act 2022 (more collabWhat are the strategic drivers of the NHS orative care, integrated system) that guide and support? - NHS System - Oversight Framework 2022/2023 (Outlines NHS England's approach to NHS oversight for that year. It is aligned with the ambitions set out in the long-term plan). Nationally, there is the NHS England and How are providers regulated and comNHS improvement team, there is also the missioned at the National level? Care Quality Commission (CQC). At the regional level, there are NHS How are providers regulated and comEngland and NHS Improvement regional missioned at the regional level? teams. Locally, there are the Integrated care boards in charge of commissioning. The different providers they commission to How are providers regulated and com- include acute, community, and mental health NHS trusts. Other providers of missioned at the local level? NHS-funded care include GPs, voluntary sector, social enterprises, and private healthcare. 2/7 What are NHS England and NHS improvement and what do they do? - Responsible for providing national direction on service improvement and transformation, governance and accountability, standards of best practice, and quality of data and information. - Both came together in 2019 to act as a single organisation (whilst maintaining separate boards). The aim of this merger is to work more effectively with commissioners and providers, making more efficient use of resources, and removing duplication. What is the Care Quality Commission (CQC) and what do they do? - Independent monitoring agency. - Regulate quality of health and social care. - Inspect quality of care in hospitals, general practices, care homes, ambulance services, and walk-in centres. - Protects interests of people detained under the Mental Health Act. Formulated in 2022, manage and support the NHS. There are 42 ICSs across England. Comprises of the integrated care boards and integrated care partnerships. - Improves outcomes in population What is the Integrated Care System and health and health care. what do they do? - Tackles inequalities in outcomes, experience and access. - Enhances productivity and value for money. - Helps the NHS to support broader social and economic development. What is the Integrated Care Board? Independent chair and statutory bodies (with expertise and knowledge of mental illness) who allocate NHS budget and commissions services. They produce a five-year system plan for health services. 3/7 They are responsible for planning and funding most NHS services in the area. Formally known as the CCG. What is the Integrated Care Partnership? Statutory committees that bring together a broad set of system partners (local authorities, voluntary, community and social enterprise sector. They plan to meet wider health, public health, and social care needs, developing and leading integrated health and care strategies for the area. What are Primary Care Networks and what do they do? Consist of GP practices that deliver primary care services, there are currently 1250 PCNs. GP practices work together and with other local health and care providers including hospital, mental health, community pharmacy etc. - They provide care to match different people's needs including joined up care for those with complex conditions. - They focus on prevention of illness and personalised care. - They use data and technology to assess population health needs and inequalities, deliver care, support clinical decision making, and monitor performance and variations. - They make the best use of collective resources to allow greater resilience and access to a larger range of professional groups. What is the NHS Long Term Plan (2019-2029)? - Sets out priorities for healthcare over the next ten years and how the NHS funding settlement will be used. - It ensures that the NHS will be more joined up and coordinated in its care, more proactive in the service it provides, 4/7 and more differentiated in its support offered to individuals. Community pharmacies are contracted and commissioned under the National Community Pharmacy Contractual Framework (CPCF) set out by NHS England and NHS Improvement. This sets out the services that need to be provided, how quality is assured and othHow does pharmacy fit within the NHS, er expectations like safety. They are the in terms of community pharmacy? first point of contact for patients, support with urgent and self-care and focus on healthy living and prevention. Local NHS England Pharmacy contract teams monitor contracts with local community pharmacy teams with the help of a central national pharmacy commissioning team to ensure consistency. Hospital pharmacies receive direct NHS How does pharmacy fit within the NHS in funding and commissioning. terms of hospital and PCNs? Primary care networks receive direct NHS funding. - A 5-year deal setting out how community pharmacy will support delivery of the NHS long term plan. What is the Community Pharmacy Con- - It is negotiated nationally multi-annualtractual Framework (CPCF)? ly between NHS England and NHS improvement, Department of Health and Social Care, and the Pharmaceutical Service Negotiating Committee (PSNC). Some arrangements for CPCF recently include the launch of the pharmacy contraception service, extension to CPCS What are some recent arrangeand NMS services, and blood pressure ments/agreements made by the CPCF? checks and smoking cessation services can be delivered by pharmacy technicians. 5/7 What is the Pharmacy First Service? - Launched 31 January 2024. - It adds to the existing consultation service and enables community pharmacists to complete episodes of care for 7 common conditions, following defined clinical pathways. - Essential (mandatory) services - dispensing medicines and medicinal appliances, disposal of unwanted/spare medicines, advising patients on self-care, providing advice on healthy living and providing medicines support following a hospital discharge. - Advanced (optional) services - flu vacWhat are the three types of services cinations, New Medicine Service, Comprovided by community pharmacies as munity Pharmacist Consultation Service outlined by the CPCF? (CPCS). - Enhanced and locally commissioned (optional) services - anticoagulation services, locally commissioned services such as minor ailments, public health services (weight management, stop smoking, health checks, sexual health clinics). - Launched in 2019 as part of the CPCF. - Same day appointments with community pharmacists for minor illness and/or What is the NHS Community Pharmacist urgent supply of regular medicine. Consultation Service (CPCS)? - It aims to improve access to services and providing more convenient treatment closer to patients' homes. 6/7 - Funded for contract work under the CPSF (outlined in the drug tariff) - Fees - they get paid on a per activity basis for delivering certain core services under their NHS contract. - Payment for advanced and enhanced services they perform under the NHS. - Payment for other commissioned services as a part of locally commissioned services. These are usually paid for by the body that commissioned the service, such as a local authority or ICB. - Retained margin - reimbursement rates from the NHS for prescription medicines that are bought from wholesalers and How are community pharmacies fundmanufacturers for the best price they ed? can. For some medicines, any difference between that price and the drug tariff can be retained as profit (retained margin). - Pharmacy quality scheme (PQS) - an additional NHS payment for a national performance scheme that is intended to financially reward pharmacies for delivering quality in the areas of clinical effectiveness, patient safety, and patient experience. - Private healthcare still exists in the UK and pharmacies can receive payments for private services (dispensing, male pattern baldness, travel vaccinations etc.) 7/7