As a former health secretary warns the NHS white paper is simply the outer edge of a jigsaw puzzle, Hannah Flynn hears how pharmacy could help fill the middle

Far from being a complete plan for the future NHS, Andrew Lansley’s health white paper simply provides the outer border of the jigsaw puzzle, according to former secretary of state Alan Milburn. Speaking at the C+D Conference at the Pharmacy Show in Birmingham on Monday, Mr Milburn called the paper a “sketch”, and he urged pharmacy to help complete the picture.

“Pharmacy is the most cost-effective provider of primary care services, and the government will ask,

‘How do we get more outcome for lower cost?’. That is what Andrew Lansley’s white paper is all about,” Mr Milburn said. But he warned pharmacy against waiting for the current health minister to hand the sector its future on a plate.

Other speakers at the C+D Conference agreed the white paper offered pharmacy many opportunities, but warned the sector needed to grasp these. Many called for a more united voice from leadership bodies to outline to politicians where pharmacy should fit into the NHS, for example.

Chief executive of the Royal Pharmaceutical Society (RPS) Helen Gordon agreed the NHS reforms could offer many prospects for pharmacy as a low-cost healthcare provider. However, she expressed concerns that an outcome-based framework as outlined in the paper might prove to be unworkable for the sector.

Ms Gordon said: “The new reward systems focus on outcomes for patients and quality, and it is a welcome change. But this is hard to measure in healthcare as all of us work in systems where many people can have an influence on outcomes. We don’t have the metrics to measure this.”

Ms Gordon said a meaningful outcomes base was needed, and her view was echoed by director of pharmacy at Lloydspharmacy Andy Murdock (pictured). Mr Murdock invited anyone to let him know about pharmacy interventions that had meaningful outcome measures, warning: “The outcome-based framework will be very hard to measure. We only have measurements for asthma and COPD.”

Mr Murdock also expressed concerns about pharmacy’s ability to influence crucial factors in the NHS framework, saying they had already been decided. “We are not in consultation, the train has already gone. The PCTs have been disbanded and we are unsure about what services they will still be offering by Christmas,” he said.

Clearly, pharmacy will need a strong lobby in order to have an influence in the coming times of severe financial restraint. But Mr Murdock said he felt the sector could survive the changes, although it would need to change significantly over the next couple of years.

Commissioning will be high on the agenda, as GP consortia gear up to take over the role from health trusts, and pharmacy will need to ensure it has some influence.

As a multiple, Lloydspharmacy had the wherewithal to approach commissioners directly, Mr Murdock said, but other groups, including wholesalers and LPCs, could also help.

Concerns regarding commissioning were raised repeatedly at the C+D Conference, and it is clear there is no guarantee that pharmacy will see any of the money given to GP consortia. Director for clinical commissioning at NHS Alliance Julie Wood said she was aware of the concerns pharmacists had over the future of NHS commissioning. And she agreed that currently the future of commissioning was a blank slate.

Some influence could come from the national NHS Commissioning Board, as Ms Wood pointed out: “If consortia have to do all commissioning they will be weighed down with a millstone.”

But there will still need to be local flexibility. For example, considering how a new pharmacy contract might work, Ms Wood said: “It will be a disaster if consortia up and down the country draw up their own contracts. But the new contract needs to be able to be tweaked. My concern would be that it won’t be able to be tweaked and will be centrally driven.”

One of the biggest uncertainties, she pointed out, is that the future structure of the NHS Commissioning Board is not yet decided. Whether this will exist purely on a national level or have local offices is not yet known. This will, of course, have a significant effect on how LPCs and pharmacists will operate going forward.

If local offices do exist, LPCs might be able to coalesce around them, for example.

As Mr Murdock told conference attendees: “LPCs could help, but not LPCs as we know them.”

And while the future for LPCs is unclear, the same is true for everyone in pharmacy – from the representative bodies, to individual pharmacists at the coal face. There may be many informed guesses, but exactly how all of these changes will develop is clearly still up for debate.