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Essex LPC Enhanced Service Kitemarks

Some time ago we devised a checklist for evaluating a service, as we felt there was little benefit in working up a service unless it satisfied some basic criteria:

Is it worth doing and will it enhance the reputation of pharmacy?

  • is it relevant now?
  • is there a demand?
  • does it have an evidence base?
  • does it have stakeholder engagement (especially GP approval and support)? and
  • will the service grow or become redundant?

Is there a good reason for service delivery via pharmacy?

  • Access;
  • Demonstrable need for service; and
  • Premises, competency, training, skill mix
Why do we kitemark?

Each individual pharmacy contractor must decide whether a particular enhanced service is suitable for their business and whether or not they wish to enter into a contract with the commissioner. The LPC has a responsibility: Local Pharmaceutical Committees (LPCs) are bodies recognised under NHS legislation (Section 167 of the National Health Service Act 2006) and as such PCTs are required to consult with the committee on matters relating to pharmaceutical services. The LPC has a duty to represent the NHS pharmacy contractors in the LPC area. The LPC wants it to work: The government has made it clear that community pharmacy must take on new roles and become more integrated with the NHS. Enhanced services have been introduced with our new contract and it seems likely that in the future the income generated by these services will be more and more important to a viable pharmacy business. Besides which, pharmacists have always been keen to make better use of their clinical skills and at last the government is listening. Getting the contract right is a key part of making the service work and we have found a few pitfalls: ‘The devil is in the detail’ – The LPC check the detail of each SLA to try to ensure the wording is meaningful and relevant, and that audits are only included where they have relevance to improving the quality of the service or form part of the performance management toolkit or provide evidence for evaluation of the service. Extra requirements can be time consuming and must be given consideration as part of the whole package - it is vital that they are proportionate to the overall service and considered as part of the remuneration package. For example: There is a move towards use of standard template Service Level Agreements (SLA) which are suitable for use as a contract between the PCT and any provider not just for pharmacy. These templates often contain standard phrases which appear meaningless or impractical in the pharmacy environment. One of the aims of the LPC is to work with the originator of the SLA to reword these sections to ensure that they can be applied to community pharmacy in a practical way. PCTs are also very keen on adding references to compliance with their own policies and procedures without always making sure that these are available for community pharmacies. The commissioner is able to include whatever conditions they see fit for a local contract. For instance, using incident reporting as an example, there is often a requirement to report any adverse events through the PCT reporting system included in the SLA for patients treated via an enhanced service, whereas the national pharmacy contract covering essential services allows each pharmacy to report adverse incidents and near misses via their own reporting mechanism. Many SLAs also reference that the provider must work within guidelines produced nationally such as NICE guidelines, Standards for Better Health and any disease specific guidelines. These can be huge documents that contractors must source, read and ensure that all staff involved in a service are familiar with. Why should the PCTs want to participate in the kitemark process? We want the same thing – quality services provided to our population We can help – the LPC members and their pharmacy contacts are a good sounding board for what will work in community pharmacy. We can provide reassurance to pharmacy contractors that we believe a kitemarked service to be commercially viable, clinically sound and that pharmacy is able to deliver the outcomes required by the PCT. (As long as it is sufficiently publicised to the public, agreed and supported by other clinicians such as GPs). We can suggest ways to implement the service.

What are the Kitemark criteria?

  • The LPC have been involved in consultation
  • The LPC have been consulted in sufficient time have the opportunity to comment, seek the views of contractors and work with the commissioning organisation to make improvements.
  • Fair remuneration for the service specified in the SLA. If the payment is not sufficient then not only is this inconsistent with current NHS policy of reward for achieving desired clinical outcomes but it also discourages pharmacists from engaging with the service. If payment is insufficient then even the keenest pharmacist will, over time, re-prioritise their time. We have seen this with a gradual drop off in numbers coming through the stop smoking schemes. Quitters are harder to get, the government guidelines have specified an increased level of time input and follow up yet in some areas the fee has not increased.
  • The LPC believes the service to be: sustainable for the duration of the SLA considered clinically sound by current evidence has suitable performance monitoring arrangements Will enhance patient care Will enhance our relationship with other healthcare professionals
  • The Service is deliverable in practical terms
  • Performance criteria included in the SLA must support a quality service with audits that will produce meaningful information (which will be collated and put to good use providing evidence for future services) rather than gather data for no reason.
  • Performance measures must be achievable and reasonable.
  • The administration required to run the service must be proportional to the service size and income generated.
  • We believe that most pharmacies would consider it worthwhile

Often unnecessary barriers to engagement are written into SLAs without due consideration being given as to whether they really add value – for instance – mandatory audits, excessive accreditation requirements or compulsory attendance at annual updates. Locums also need to be considered; whether locums need to be fully accredited to provide the service if they are only filling in for one day or whether general competency and SOP will enable them to continue service provision. Compare needle exchange with PGDs Implementation Services need to be introduced properly at a suitable time of year and with support from the commissioner. Support may take the form of posters, direct face to face contact with the administrator or anyone who helps run the service, clinical or administrative training for pharmacists or pharmacy staff, advertising the service to the public, promoting the service with other health professionals etc. There may be additional criteria considered depending on the service