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Will the impetus for developing pharmacy services come from national or local commissioning? This was one of the debates at last month's Sigma conference in Cancun, Mexico. Richard Thomas reports

The message from PSNC chief executive, Sue Sharpe, unsurprisingly, was that national contracting for pharmacy services is the way forward. And if pharmacies are not providing MURs and the NMS, they can be considered €high risk€, she warned delegates.

However a significant number of pharmacies are still not offering these national clinical services. Reasons given include inadequate funding, lack of space, wrong skill mix or even awkward patients.

Over half (56 per cent) carry out fewer than 200 MURs a year. Some 8 per cent don't offer MURs at all, while 17 per cent have failed to sign up a single patient to the NMS. This has to change, Ms Sharpe said.

The trend is clearly for funding to be linked more closely to services, not prescription volume. In other words, pharmacies not providing services could not expect the same levels of profitability as in the past.

€Adding more burden onto pharmacists within their traditional operations is simply not sustainable,€ she argued. €The past is well and truly gone.€

Pharmacists have the clinical skills and enjoy more supportive relationships with patients than other healthcare professionals, Ms Sharpe said. This ability to shape patients' changes in behaviour is an important attribute.

Politicians could help by mentioning €pharmacists€ every time they talk about €doctors and nurses€ and by building electronic information exchange systems for GP surgeries, pharmacies and hospitals.

Think local

Independent Pharmacy Federation chairman and pharmacy owner, Fin McCaul, took a different view. While agreeing that the focus should be on outcomes, not cost and supply, he felt that local rather than national services is the way ahead. €I don't think there will be new national services in the contract in the next two or three years. It has to be done locally.€

Pharmacy has a track record of delivery and patients trust pharmacists, Mr McCaul continued. The biggest danger facing independents is inertia. €We've got to work collab- oratively and get off our backsides and do it,€ he urged.

Building relationships

Rick Stern, chief executive of NHS Alliance, also talked about the importance of building local relationships with other health providers, especially GPs €“ but pharmacists had to take the initiative.

€Don't wait to be told what to do,€ he said.

Things won't happen just because organisations like NHS England say they will. Pharmacists had to sit down with their local GPs, discuss the pressures they are both under, and decide how to work differently together to deliver better patient care.

Make your case

The need for a consistent message and one voice from the sector was also emphasised repeatedly. Sir Kevin Barron MP, chair of the All-Party Pharmacy Group, said pharmacy had to make its case effectively, both nationally and locally. This was not something the profession had always done in the past. €The world does not owe pharmacy a living,€ he said.