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Guardian angel or thorn in the flesh?On the one hand there is evidence

that intervention by pharmacists canreduce GP prescribing errors – by a lot.1

On the other it can seem that pharma-cists are always phoning up about some-thing – one 2011 survey showed theyquery around 2 million prescriptions peryear.2

GPs’ views about community pharma-cists doubtless cover the spectrum fromrespect to resentment and it seems it isthe same for pharmacists: the represen-

tatives of both professions and theiremployer believe each needs to under-stand the other a bit better.

The BMA’s General PractitionersCommittee, the Pharmaceutical ServicesNegotiating Committee (PSNC) and NHSEmployers have updated their guide tocommunity pharmacy for GPs and theirstaff,3 and its equivalent for pharmacistsabout general practice.4 The CommunityPharmacy. A Guide for General Prac ti -tioners and Practice Staff aims to ‘sup-port the two professional groups, as wellas provide an insight for commissionersas new ways of integrated working in pri-mary care start to take shape’.

So, for those GPs busy answering thephone, here are 10 things they need toknow about community pharmacy.

1. Pharmacists learn a lotBecoming a pharmacist means, at a min-imum, taking a four-year degree, complet-ing a year’s postgraduate training andpassing an exam to join the register.Then, under the watchful eye of theGeneral Pharmaceutical Council, pharma-cists must maintain their competence byundertaking CPD.

For many, education and improve-ment do not end there: there is furthertraining to become a supplementary orindependent prescriber, or to become aPharmacist with Special Interests.5

2. There are three high-profilerepresentative bodies for phar-macyThe General Pharmaceutical Council(GPhC, www.pharmacyregulation.org) promotes good governance and enforces professional standards. The RoyalPharmaceutical Society (www.rpharms.com) used to have a regulatory functionbut now offers professional leadership.The PSNC (www.psnc.org.uk) negotiatesterms and conditions for NHS contractors.

Community pharmacists now do a lot more than just dispensing

Ten things GPs need to knowabout pharmacistsSteve Chaplin BPharm, MSc

Steve Chaplin describes a new guide for GPs that aims tofoster a better understanding of the role of communitypharmacists.

SPL

3. Pharmacists can provide threetypes of services to the NHSThese are defined in the NHS CommunityPharmacy Contractual Framework,agreed between the PSNC and NHSEmployers.6 All contractors must provideessential services, eg dispensing, medi-cines disposal, support for self-care.

Pharmacists who undergo trainingand are accredited can provide advancedservices, of which there are four (medi-cines use review/prescription interven-tion, stoma appliance customisation,appliance use review and the NewMedicines Service).

Locally commissioned services (for-merly known as advanced or enhancedservices) include anticoagulation moni-toring and palliative care. They are com-missioned by NHS England (before that,PCTs) to meet demand identified in thelocal Pharmaceutical Needs Assessment.

Local authorities and their publichealth services, and also clinical commis-sioning groups, can also commissionservices such as smoking cessation,supervised administration and emer-gency contraception.

4. The average pharmacy earns90–95 per cent of its incomefrom NHS services.This estimate excludes large high-streetpharmacies and supermarkets, for whichretail earnings vary and can be substan-tial. The remaining income comes fromprivate services and over-the-countersales. (In 2012, 39 per cent of pharma-cies were independent, defined as con-tractors who owned five or fewerpharmacies.7)

5. Funding for pharmacists isnegotiated nationally betweenthe DH, NHS England and thePSNCContractors are paid a fee for each pre-scription dispensed, fees for additionalservices such as extemporaneous dis-pensing and fitting hosiery, and an estab-lishment payment if they exceed athreshold number of prescriptions dis-pensed.

They also receive practice paymentsfor providing support under the EqualityAct (eg to help patients with disabilities,

such as a multicompartment complianceaid), an annual payment for a repeat dis-pensing service and a monthly paymentif they have a validated electronic pre-scription service. Advanced and locallycommissioned services are funded sep-arately.

6. Reimbursement for medicinesis complicatedThe amount paid to pharmacists to reim-burse the cost of medicines is deter-mined nationally by the DH based on theprices of generic drugs (listed in the DrugTariff) and the list price of branded drugs.

This total is reduced to allow for theaverage level of discounts pharmacistsreceive from wholesalers – a deductionthat averages up to 9 per cent. This incen-tivises pharmacists to buy cheaper med-icines and they win if they negotiate ahigher discount and lose if there is no dis-count (as may be the case for brandedproducts).

7. Cost-saving initiatives canreduce pharmacy incomeSwitching programmes can lead to ashortage of medicines (increasing pro-curement costs and creating problems forpatients) or may not be communicatedeffectively to patients (increasing phar-macy workload).

Branded generics seem cheap buttheir low price may be unsustainable andpharmacists cannot buy them at a dis-counted price. They then lose moneybecause they are reimbursed at belowcost when the national discount isapplied.

8. A pharmacy must operateunder the supervision of a single responsible pharmacistThe responsible pharmacist must be satis-fied that ‘the operation of the pharmacy willbe safe, taking into account the standardoperating procedures, staffing levels on theday and any other relevant circumstances’.

Their day-to-day clinical scrutiny andservices for patients are supported bymedicines counter assistants and dis-pensers, who must train to standards setby the GPhC; by pharmacy technicians,who must be registered with the GPhC;and accredited checking technicians who

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undergo further training to carry out anaccuracy check of dispensed medicines(though not a check for appropriateness,which remains the pharmacist’s job).

9. Community pharmacy incomewill depend more on clinicalservices than dispensingIn 2005, the Community PharmacyContractual Framework introduced nationalarrangements to allow pharmacists to bepaid for providing clinical services.

This development has continued and,as improvements in technology and staffcompetence reduce the burden of dis-pensing on pharmacists, many haveexpanded their professional role to includeprivate and NHS services to patients suchas screening and public health initiatives.Governance requirements and specifica-tions for suitable premises have increasedaccordingly.

10. Patient records are coveredby the same rules in pharmaciesand GP practicesAll pharmacy staff comply with the DataProtection Act, NHS information governance

requirements and the NHS ConfidentialityCode of Practice, and access to patientrecords is restricted to staff who are provid-ing pharmaceutical care.

ConclusionThese days there is more to being a phar-macist than dispensing prescriptions,important as that is, but GPs will onlywork well with their local pharmacists ifthey have confidence in what they do.This document should help to encouragerespect between the two professions tobring that reality nearer.

References1. Avery AJ, et al. Lancet 2012;379:1310–9.2. Pharmacy Voice. Local pharmacies inter-vene on two million prescriptions every year.September 2012 (www.pharmacyvoice.com/press/local-pharmacies-intervene-on-two-mil-lion-prescriptions-every-year).3. BMA General Practitioners Committee,Pharmaceutical Services NegotiatingCommittee, NHS Employers. The communitypharmacy. A guide for general practitionersand practice staff. July 2013 (www.nhsemploy-ers.org/Aboutus/Publications/Documents/Community -pharmacy -guide-GPs-practice-

staff.pdf).4. BMA General Practitioners Committee,Pharmaceutical Services NegotiatingCommittee, NHS Employers. The GP practice.A guide for community pharmacists and phar-macy staff. August 2013 (www.nhs employ-ers.org/Aboutus/Publications/Documents/GP-practice-guide-pharmacists-staff.pdf).5. Primary Care Commissioning. GPs and phar-macists with special interests (GPwSI andPhwSI). December 2007 (www.pcc-cic.org.uk/article/gps-and-pharmacists-spe-cial-interests-gpwsi-and-phwsi).6. Pharmaceutical Services NegotiatingCommittee. Community pharmacy contractualframework (http://psnc.org.uk/contract-it/the-pharmacy-contract).7. Health and Social Care Information Centre.General pharmaceutical services in England: 2002–03 to 2011–12. November 2012(https://catalogue.ic.nhs.uk/publications/pri-mary-care/pharmacy/gen-pharm-eng-2002-03-2011-12/gen-pharm-eng-2002-03-2011-12-rep.pdf).

Declaration of interestsNone to declare.

Steve Chaplin is a pharmacist who specialises in writing on therapeutics

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