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One of the completely justified criticisms of the current pharmacy contractual framework in England and its equivalent for GPs is that each operates in splendid isolation of the other. This lack of joined-up thinking has always been lamentable €“ but things may be about to change.

NICE is consulting on new QOF indicators for therapeutic areas such as diabetes care and hypertension case finding, as well as polypharmacy and medication review. It looks like an open goal, doesn't it? Surely this is an ideal opportunity to begin the process of dovetailing the GP and pharmacy contracts more closely, something that is long overdue.

This is a great chance to underpin a role for pharmacists in long-term condition management, where they can take some of the pressure off GPs, and integrate pharmacy services more cohesively into primary care. With one body, NHS England, now in charge of both national contracts, this would be a powerful lever to streamline patient pathways, increase efficiencies and improve care.

However let's be clear on one thing. While patients would undoubtedly benefit from a closer alignment of incentives for pharmacists and GPs, it would come at a cost. Community pharmacists are not surrogate doctors to be commissioned on the cheap. If pharmacists are to take on these new services, they must be funded properly, if necessary by redistributing monies from the GPs' pot. This would take some very strong leadership. To put it bluntly €“ does NHSE have the kahunas?

Richard Thomas, Editor