 The fact that pharmacy enhanced services are offered to contractors on a postcode lottery basis comes as no real surprise. But while we would expect appalling figures from the underperforming trusts, whittle things down to the average PCT and the figures are still upsetting – they are spending just under £5,000 per year annually on enhanced services at each pharmacy.
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 After last year’s PCT Investigation, C+D hoped readers would be able to use the results to start negotiating new services. But with stories of services being decommissioned already hitting the headlines and more cuts on the way, perhaps this year the focus will turn towards keeping the services we do have in place.
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Senior industry figures talk to C+D about what they thought of our findings
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Exclusive: PCT spending on community pharmacy services varied wildly across England in 2009-10, C+D’s PCT Investigation has found.
Half of PCTs are either offering, or are piloting or planning to pilot, vascular risk assessments through pharmacy in England, C+D’s PCT Investigation has shown.
Inconsistency on fees for smoking cessation  Pharmacists face a postcode lottery for smoking cessation service payments despite most PCTs in England appearing to run a scheme, C+D’s PCT Investigation has shown...
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 Buckinghamshire PCT has been struggling financially, says LPC chief executive Elizabeth Shepherd. And this could go some way to explaining the trust’s position as one of the lowest reported spenders on pharmacy enhanced services – averaging less than £1,000 annually per pharmacy and well below the national average of £4,929.
But Ms Shepherd is supportive of the work being done in the trust, saying the committee has been working with them to help remove barriers to some pharmacy services.
Pharmacy smoking cessation services in the trust “have traditionally been quite successful”, Ms Shepherd says. And not just financially – although a benefit is clearly the fact that the committee has negotiated a possible maximum fee per patient of £82. Pharmacists have also performed well on the service, delivering high quit rates.
And although the trust has recently asked pharmacists to cover their own training costs for the service, to try to incentivise them to get the most out of them, Ms Shepherd says she is confident that proactive relations and developments will continue.
 Chief officer of Camden & Islington LPC David Kent says it’s good to hear Islington PCT has reported one of the highest spends on pharmacy enhanced services.
The trust reported an average spend of more than £11,000 per pharmacy – well above the £4,929 average.
It hasn’t all been plain sailing, and Mr Kent says a pharmacy flu vaccination scheme has been discontinued only this autumn. But he says a pragmatic approach to service provision and to the prices paid for those services has helped. Mr Kent recommends going in with a start price well above your bottom line so the trust can have some “wriggle room”, for example.
And making sure someone at the trust “is pro-pharmacy or at least recognises pharmacy” has been key, he says.
 For London pharmacies struggling to get their MUR numbers up the problem could simply be one of locality, according to Prakash Mahtani, of Warwick Pharmacy in Westminster PCT.
The trust recorded one of the lowest average spends per pharmacy on advanced services, at just £2,968 in the year.
Mr Mahtani explains that for many pharmacies in the trust the customer base is people who work in the area, rather than living there, so pharmacies often have fewer regular customers than might be expected. MURs aren’t suitable for such transient customers, he adds.
“It’s an issue in central London,” he says. “Pharmacy here is unique – this sort of thing doesn’t apply to pharmacies in health centres or suburban areas.”
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 Mike Hewitson of Beaminster Pharmacy in Dorset says he “can’t quite put his finger on” why pharmacists in the area don’t seem to be doing many MURs. According to the PCT, the average spend per pharmacy on advanced services was just £2,955 annually, well below the national average of £4,379.
Mr Hewitson suggests it might be to do with the low population density in the area, which leaves many pharmacies dispensing low volumes meaning they might not have any extra staff, making MURs difficult.
“The LPC has been putting a lot of effort into giving people the skills they need to do MURs, though,” he adds. And he says he has recently increased his own number of MURs to help compensate for the “category M-sized hole” in
his finances.
The trust also has a number of popular pharmacy services such as smoking cessation, which earn contractors up to £80 per quitter and has seen more than 800 people quit in the last year.
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Norfolk reported one of the lowest spends on pharmacy enhanced services, saying it had spent just £150 per pharmacy in the last year. LPC chief officer Tony Dean says he is surprised by this as he believes the situation in the trust has been comparable to those in neighbouring areas.
Mr Dean suggests one reason could be that the trust has a lot of rural pharmacies that aren’t able to participate in the enhanced services and so could be bringing averages down. Another danger with added services is that, once they have been launched, people may forget about them and they can “wither on the vine”, he says.
As well as a range of enhanced services, a particular recent success story has been vascular risk assessments, which Mr Dean says 41 pharmacists are now trained to provide. “It’s not fantastic on remuneration,” he says, “but we’ve sold the case to contractors.” And he says a recent employee taken on by the LPC will be helping offer extra support to contractors providing services.
 While the average pharmacy minor ailments scheme paid contractors a service fee of just £4.16, at the top of the table Doncaster offers a fee of £12.86 per patient, according to the PCT.
LPC secretary Nick Hunter explains that this fee was secured because the Doncaster MAS goes a little bit further than most. The service sees pharmacists sitting down with patients for a consultation and, if appropriate, enables them to prescribe a range of prescription-only medicines under PGDs.
Conditions ranging from acne to earwax and mouth ulcers are covered by the scheme and pharmacies can also input data from the consultations into a live PCT system.
“The fee reflects that input from the pharmacist,” Mr Hunter explains. The service was designed in this way following patient feedback, he adds. “Patients said they wanted the consultations to be reflective of the ones they have with GPs,” he says. Mr Hunter says the service has had significant uptake, but that in the current climate the PCT has had to stop allowing new pharmacies to start offering the service. But he hopes this should help to protect the existing service.
 NHS Tees, which covers Hartlepool, Middlesbrough, Redcar and Cleveland and Stockton-on-Tees PCTs, states in its response to C+D’s questions that: “The four NHS Tees organisations do not commission any pharmacy enhanced services.”
Startling as this may be, it came as even more of a surprise to contractors in the area, who say they have been delivering services such as smoking cessation and NHS health checks for some time.*
One Middlesbrough LPC member tells C+D: “Their response just shows you what we’re up against. They’re doing them but they don’t even know they are doing them.”
Michael Maguire, of Marton Pharmacy in Middlesbrough, says he felt pharmacy services in the area were relatively strong, although he said there had been problems with getting paid on time. “There are a lot of good people doing good work at the PCT but sometimes they haven’t managed to pay us within a reasonable timescale – there seems to be some slack in the system.”
*C+D has tried to find out which services are commissioned by the PCTs, but has not yet had this confirmed.
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 “Service costs must be appropriately factored, taking into account the overheads and capital investment in the business. PCTs have difficulty hitting targets with reduced budgets, but some have engaged with LPCs right from the beginning and delivered successful accounts. I believe that is the right way forward.”
Salim Jetha, chief executive, Avicenna
 “It is especially disappointing that pharmacy has not fully embraced MURs [according to these figures]. The ball is in contractors’ court to deliver and in a world of severely constrained budgets there is a significant risk that investment in this service will become hard to justify.”
Georgina Craig, pharmacy commissioning lead, NHS Alliance
 “C+D’s findings are not surprising, but they are no less troubling for that. In any new contractual settlement, we
would wish to see less scope for nationally agreed funding to be manipulated by the NHS at a
local level.”
Stephen Fishwick, head of external communications, NPA
 “We hear anecdotal evidence all the time but seeing these figures in black and white really shocked me – there is such a massive variation. Could we see a future whereby people need to move to a different postcode to ensure a better healthcare system?”
Mimi Lau, director of professional services, Numark
 “There is such a big variation between PCTs. Where we are in Greenwich the provision is fair, but in Bexley there isn’t much going on. You also have a core of contractors offering many of the services and some doing nothing at all. All pharmacists should be doing the same.”
Sunil Bajaria, Worthcare Pharmacy, Thamesmead
 “On the money provided, we are expected to provide staff and consultation rooms to provide the service, so if we are going to offer enhanced services then we need to get more money for them and have the money guaranteed. It can’t be cut after six months.”
Gordon Couper, Handbridge Pharmacy, Chester
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