Read and delete this slide

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

Local Authorities (LAs)

Clinical Commissioning Groups (CCGs)

NHS England local - Enhanced

The Third Pillar – supporting future NHS provision

Community Pharmacy

GP led primary care

Hospitals

Optimising the use of medicines

Supporting peopleto self-care

Supporting people to live healthier lives/public health

Supporting people to live independently

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

PSNC Community Pharmacy Conference - 24 April 2013

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

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:

Preventing people from dying prematurely

Enhancing quality of life for people with long-termconditions

Helping people to recover from episodes of ill health or following injury

Ensuring people have a positive experience of care

Treating and caring for people in a safe environment and protecting them from avoidable harm

Effectiveness

Domain 1

Domain 2

Domain 3

Domain 4

Domain 5

Patient experience

Safety

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 self-care 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 HealthSets legal framework, secures funding

NHS Pharmaceutical ServicesProduct

reimbursementServices

remuneration

PharmaciesDispense medicines & appliances & provide associated & other services

Division of roles

Department of Health

Determines NHS reimbursement price

of medicines & appliances

NHS England

Commissions NHS Pharmaceutical Services – including Essential,

Advanced & Enhanced services, plus Local Pharmaceutical Services

Charged for service remuneration

Charged for product reimbursement

Clinical Commissioning Groups

Commission other services

Local Authorities

Health & Wellbeing Boards (produce pharmaceutical

needs assessments)

Commission public health services

Inform market entry & commissioning

decisions

Health & Social Care Information Centre

Collates & provides information

NHS Connecting for Health functions

NHS Business Services Authority

Calculates and makes payment to dispensers. Provides management

information

Dispensed prescriptions submitted with claims for other services

Health Education England

Local Education & Training Boards

Public Health England

Executive agency of the Department of Health

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

May use a tender process

orAny Qualified

Provider

Use standard public health contract

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)

Once the providers have

been identified

Cost of service is billed back to the Local Authority

Commissioning routes – CCGs

Decision to commission service that

could be provided by community pharmacies

May use a tender process

orAny Qualified

Provider

Use standard NHS contract

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)

Once the providers have

been identified

Cost of service is billed back to the

CCG

Anywhere CCG

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