Rosie Winterton – 2004 Speech to the PSNC Conference

Below is the text of the speech made by Rosie Winterton, the then Minister of State for Health, on 3 November 2004.

My sincere thanks to Barry for his warm welcome.

We have reached a critical – an historic – moment. This is probably the most significant turning point for the NHS and for community pharmacy in the history of NHS pharmacy services.

That is why today’s conference is key to achieving the progress we all want to see in the weeks ahead.

There are dynamic opportunities ahead to forge new partnerships, new working relationships for the benefit of patients.

I hope that Local Pharmaceutical Committee representatives and NHS delegates will use today as a springboard to develop these relationships. I have consistently said how important it is to talk.

The future holds exciting prospects – but we all recognise there are challenges too. That will mean fresh approaches. Fresh commitments. Fresh ideas if we are to turn this to our mutual benefit and advantage.

Thank you Barry for recognising my commitment and enthusiasm for making sure this does happen.

Since taking up this post some 15 months ago, I have wanted to see community pharmacy fully involved, fully integrated and playing its full part in our modernisation of NHS services.

In the four years since we published the NHS Plan and the subsequent Pharmacy in the Future, I believe the patient experience has transformed. To take just three examples, access has much improved across all sectors, more than half a million people have successfully quit smoking through NHS smoking cessation services and more than half of all PCTs now have collaborative medicines management programmes. Quite frankly, these sort of achievements just would not have happened without community pharmacists playing their part.

But there is a long way to go. Our NHS Improvement Plan promises even more radical developments, backed up by significant new investment in NHS services. With £90bn plus being spent on the NHS by 2007-08 we must make sure that investment is backed up by modernisation and reform. People will want to see 21st century services meeting their needs.

I want to see services, which put patients in the driving seat. Where they have more choice and control over what is available to them. A NHS which fits the services to the patient – and is held accountable to them – and not the other way round. Improving access is essential to achieving this

And I want to see an NHS which offers full support for people with long-term health conditions. Those services must be responsive. They must enable people to get the best out of their lives, understanding their needs, testing what works and learning from the experience.

We also want a NHS which helps promote the best health for all. A much greater focus on improving health, to reducing the health inequalities that quite frankly still persist and to preventing ill health generally. Not an NHS which caters for ill health, but an NHS that caters for promoting health.

That’s where community pharmacy has shown already how much it does offer here – and holds out the opportunity to offer so much more. Provision of emergency hormonal contraception, smoking cessation schemes and substance misuse services. These are just three examples where pharmacy makes a direct, relevant contribution to the health of local communities and helps reduce the health inequalities I have just referred to.

And it can do so much more. So our forthcoming white paper on public health, and our pharmaceutical public health strategy, to be published next year will reflect that contribution and the potential pharmacy offers to open up new ways of delivering services.

Tackling antibiotic resistance is important to public health. Later today, as part of Ask About Medicines Week, I will be launching an information leaflet for the public on antibiotics. I’ll be doing that from a nearby pharmacy, to highlight this issue. Produced jointly with the Royal Pharmaceutical Society, this recognises one of community pharmacy’s key attributes – its ability to communicate health messages to people who are well as well as sick. We will build on this strength in the new contract.

Developments in last 12 months

As Barry and Sue have already mentioned, the last 12 months have been momentous. The pace of change probably more rapid than at any other time in living memory. I know some people fear change and transition. But change and transition are inevitable and must be faced up to if we are to achieve the transformations the new framework promises.

I also know from many visits to pharmacies in the last year how enthusiastic and committed to the framework you are.

And not a little impatient too! Pharmacists have said to me “We’re ready. We’re committed. Give us the tools the framework promises which will really enable us to deliver”. I’ve appreciated that sense of frustration.

But I also appreciate your professionalism and dedication. It is that sure basis I am determined to build on – maintaining that confidence and trust but also invigorating the drive to liberate pharmacy’s potential.

There have after all been a number of achievements on the pharmacy front this last year.

We have reaffirmed our plans to improve pharmacy’s role in the Vision I launched in Summer 2003. That identified and aligned our ambitions for pharmacy clearly and rightfully alongside our ambitions for the NHS as a whole.

We made clear in Building on the Best pharmacy’s vital role in improving access to medicines and patients’ use of their medicines;

We extended coverage of medicines management collaboratives and repeat dispensing, underpinning closer working between pharmacists and GPs to improve medicine taking;

We have seen 250 (two hundred and fifty) pharmacists qualified as supplementary prescribers;

And we launched guidelines for pharmacies to use the NHS logo – an important step for better integration and a clear signal to all that community pharmacy is truly a part of the NHS. Something that has been very dear to my heart.

And community pharmacy’s potential has featured more prominently in discussions about how to improve services – how it can be more widely utilised by the NHS and other health professionals – and its ability to respond innovatively and creatively more openly acknowledged. Not just in primary care but across other sectors too – in accident and emergency and in the field of mental health. That is all positive news.

Because patient expectations are rising and will continue to do so. NHS services in the future must fit those expectations. We can achieve that where we maximise the potential and skills of NHS staff. We cannot achieve that if we perpetuate old-fashioned notions that professionals only do what they’ve always done. We have to revolutionise the way services are offered. In doing so, we can revolutionise the patient experience of the NHS.

Pharmacy is not stuck in a time warp. It has faced up to and indeed embraced considerable change in this new millennium. Some of that was catch up because community pharmacy lagged behind other areas of primary care. It is still not as prominent as it should be

But views and perceptions have shifted – pharmacy is increasingly recognised as an indispensable element in primary care delivery. Pharmacy of course already has a proud history of breaking new ground which I’ve already outlined.

I know that imagination and innovation are not in short supply. I want to see that groundbreaking talent utilised in other areas:

– In helping patients with long-term conditions such as diabetes

– In helping patients with asthma or mental health problems

– By building on the best we’ve already seen in medicines management schemes

– In treating patients with minor ailments

– In supporting better use of medicines

These illustrate what is key – community pharmacists better integrated in the NHS, working closely with other primary care professionals, using their skills to deliver quality healthcare services to patients.

This would not work if patients did not trust their local pharmacist. I know they do. I know that from the Big Conversations earlier this year. People see pharmacies as an essential part of the local fabric of health services. Easily accessible, reliable and often the first port of call for patients needing advice and help.

Now I do know that some remain anxious about the reforms to the control of entry rules. Let me say I do believe these will benefit patients, with greater choice, and improved and more convenient access.

But it is a balanced package of measures. I know there were worries. But we have made changes. The right competitive edge will still be there for existing contractors to enhance service delivery and new entrants to fulfil unmet needs. But there will be checks and balances to ensure community pharmacies’ vital role is maintained, safeguarding in particular ready access to pharmacies in poorer and rural areas.

“Control of entry” remains – and must at all times do so – a tool to securing our aims – not an end in itself.

Which brings me to the heart of today’s event. Reaching agreement on the contractual framework.

Sue has already set out the details of that. I will not go over them again. But I would highlight some points which I think are critical

First the categorisation of services which mirrors so closely that for GPs is as sure an indication you can have of pharmacy’s integration within the NHS

Second, the breadth and depth of services which will be open to you to provide sends the clearest possible message that community pharmacy is first and foremost a clinical health care profession – not another retail identikit.

That does not mean I wish to ignore your entrepreneurial skills. I want to capitalise on them – using the resourcefulness and imagination you have to invest in new ways of service provision.

Third, the funding structure – more transparent, more secure than the current system ever has been, which I believe will enable you to invest with confidence for the future

Fourth there are real opportunities for pharmacy to be a fully paid up member of the NHS as I’ve said. Pharmacy’s role in attaining local performance targets & national PSA targets, addressed within local delivery plans will be pivotal. Pharmacists, utilising their undoubted skills to best effect, can really impact on other pressure points within the NHS. This is a message I hope NHS delegates will be taking back today.

Now to achieve that there must be support for PCTs and pharmacies to implement the new framework. Sue and Barry have already mentioned the support pharmacy is getting

I want implementation to be a wholehearted success for the NHS too. That is why I am pleased to announce today a programme of continuing support for that process for PCTs

The Department has worked closely with a number of organisations including the National Primary and Care Trust Development Programme (NatPaCT), the National Primary Care Development Team, the Medicines Management Service of the National Prescribing Centre and the Centre for Pharmacy Postgraduate Education as well as NHS colleagues from SHAs and PCTs and others.

I am pleased to announce publication of a prospectus today to publicise this substantial package of support. These include:

– guidance on the new framework and control of entry reforms

– a series of 5 roadshows for PCTs in December

– further in-depth training events by early 2005 for those with day to day responsibilities for the control of entry reforms

– a help-line to deal with questions and queries

– support and information through web-sites, including the answers to frequently asked questions and service improvement guides
tool-kits to support PCTs in undertaking pharmaceutical needs assessments to inform commissioning and their role in supporting and monitoring

– the development of strategic tests to guide the monitoring of the implementation of the new framework

– training for pharmacists and their staff on repeat dispensing, risk management etc

The Medicines Management Service at the National Prescribing Centre will also be refocusing its efforts to establish a collaborative programme specifically to support the new contractual framework. Local teams that participate will be supported in making their own improvements, as well as quickly sharing their learning with neighbouring organisations. Further information will be available in the coming months.

The prospectus is the first version. Other versions will be published as further elements of support are identified and added to the package.

My agenda is ambitious. I make no apology for that. I believe the new framework will come to be recognised as a watershed. It promises significant benefits for patients, a secure and stable basis for pharmacists and their staff to invest in delivery and make best use of their skills. It will help the NHS deliver the modern services and promote better health for all.

I would like to add my thanks to everyone involved in the new framework – PSNC, the NHS Confederation and officials at the Department. I believe the new framework is what contractors have wanted for so long. That is why I very much hope for the same outcome and unanimity as last year when you vote on the framework. I believe it to be a very good deal indeed – good for contractors, for patients and the NHS and for taxpayers. I think it will fulfil the potential for community pharmacy services in the 21st century, which I hope you want and which patients and the public want.

I wish you a very successful and rewarding day.