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NEWS Health check decommissioning in figures

23

PCTs currently commissioning health checks from pharmacy*

£35

Fee earned by some pharmacies for delivering checks***

25%

of trusts considering cutting pharmacy services blame low uptake**

47%

of pharmacists rate their health check service as poor****

Sources: *PSNC local services database (psnc.org.uk); **C+D Decommissioning Investigation 2011; ***Julie Evason, Health Diagnostics; ****readers polled on chemistanddruggist.co.uk, February 2012; C+D PCT Investigation 2011

PCTs drop health check schemes and call for ‘change in mentality’
EXCLUSIVE Trust executive says pharmacy scheme is ‘not at all’ cost-effective
Melanie Hall melanie.hall@ubm.com Pharmacy health check services are being dropped by PCTs because of a lack of interest from contractors and cost concerns, with one senior executive calling on pharmacists to “change their mentality” towards service provision. Pharmacy-delivered NHS health check programmes are in danger of being decommissioned by a number of PCTs, and in some cases have already been cut, according to Julie Evason, managing director of Health Diagnostics, which provides software and support to PCTs commissioning the checks. Ms Evason said around 20 per cent of the 17 PCTs her company works with were either considering withdrawing health check commissioning from pharmacy providers or had already done so. NHS health checks were launched by the government in 2009, when it promised that every patient aged between 40 and 74 in England would be able to access a free check that assessed their risk of developing cardiovascular and other diseases. Commissioning through pharmacy has been patchy, but PSNC’s local services database suggests pharmacists are currently providing the services in more than 20 PCTs. Ms Evason said pharmacy had initially been an “obvious choice” for many PCTs and that some pharmacies had been paid £20 to £35 for every health check they conducted. “It sounded like a licence to print money for pharmacy, particularly when the PCTs didn’t restrict the number of checks that could be conducted,” she told C+D. But results from pharmacy services had been “very disappointing”, she said, with many PCTs now looking for alternative providers. Pharmacy performance has previously been cited as a reason for decommissioning services and a C+D investigation last year found low uptake was a factor in more than a quarter of the 25 PCTs cutting or considering cutting pharmacy services. Trusts contacted by C+D about health checks said pharmacy delivery had been a problem, with one warning pharmacy services had not been cost-effective. Mike Lavender, a consultant in public health medicine for NHS County Durham, said pharmacies in the region were not doing the “kinds of numbers they could be doing” with health checks. And another trust that asked to remain anonymous said it, too, had received a poor response from pharmacies invited to take part in a local pilot, and called for the sector to change its mentality (See Poor performance to blame in health check decision, below). Many pharmacies had cited lack of time as a problem, Ms Evason said. This was backed by a C+D poll, in which 47 per cent of respondents rated the health check service they provided as “poor”, saying they were struggling to deliver it due to lack of time and/or patient interest. Only 6 per cent were happy with how they were delivering health checks. But pharmacies were missing “a great opportunity” by not getting involved in the services, Ms Evason said, warning lack of interest could impact on future decisions for the delivery of other services. “My concern is negative feedback could mean other commissioners decide against pharmacy as a provider.” Alastair Buxton, head of NHS services at PSNC, said he was disappointed to hear about the demise of health check services, adding: “Where it does happen, I hope the LPC and commissioner can examine why the pharmacy activity level was not as desired in order that we can learn lessons for the future.” Mr Buxton warned last month that LPCs “continued to report that locally commissioned services are at risk of being decommissioned”. However, there was good news from C+D’s PCT Investigation 2011, which found that on average PCTs spent more on enhanced services in the last financial year than they had previously. In 2010-11, each trust spent almost £400,000 on pharmacy enhanced services – up 8 per cent on the average of just below £370,000 spent in 2009-10. The average services income for individual pharmacies also rose last year, although less significantly, with almost £5,000 spent per pharmacy, up 1 per cent from 2009-10.

Case study: Poor performance to blame in health check decision
One PCT executive, who asked to remain anonymous, reports a disappointing health check performance from community pharmacists. After six months of commissioning the service, the sector had not delivered a single check, they report. “I spent that six months trying really hard with them, trying to solve all the difficulties and I got nowhere,” they said. Pharmacies were given a second chance when the pilot was extended last year, but the PCT says the results remain disappointing. In 2011-12, £55,000 has been spent on delivering health checks via community pharmacies and only 300 checks have been done. Yet an outreach provider paid £24,000 to carry out checks in the community during the same period has so far carried out 950 checks. Although the PCT concedes many pharmacies don’t have the staff to run such programmes, the executive suggests pharmacists’ mindset is holding them back. “They are used to a way of working and are happy with it. There needs to be a change of mentality.” Go to chemistanddruggist.co.uk for a second case study

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