Delivering on the Pharmacy Action Plan District Health Boards Consultation 5 March 2018 What we re proposing We re expanding opportunities for community pharmacists to work in an integrated team of health professionals to achieve the best health outcomes for all New Zealanders -- so we can deliver on the goals of the Pharmacy Action Plan 2016-20, and the vision for Integrated Pharmacist Services in the Community developed during our stakeholder hui in 2015-2016. We re strongly committed to strengthening patient safety by enabling pharmacists to work at top of scope as expert medicine managers. We want to support pharmacists to work in new ways and evolve their business model. Equity of health outcomes is critical tailored pharmacist services offer us a unique opportunity to meet the needs of the most vulnerable people in our communities. We want to make it easier for pharmacists, health professionals and the public to work together in the future to create new pharmacist services that our local communities need. We d like to see pharmacists working more closely alongside prescribers and consumers in the future (for example in aged care facilities, marae, Primary Health Organisations). What we re doing We re seeking the views of a wide range of stakeholders on the opportunities you see for integrated pharmacist services in local communities. We re seeking your views on how you would like to be involved in the development, over time, of new pharmacist services. We re seeking your views on how we can support pharmacists to work as expert medicines managers. We re seeking your views on a new contract, proposed to take effect from 1 July 2018, which will provide a framework to enable us, in the future, to deliver on the goals of the Pharmacy Action Plan and the vision of Integrated Pharmacist Services in the Community. We re proposing a one-year extension to the Community Pharmacy Services Agreement (CPSA 12) for those service providers who do not wish to sign the new contract immediately. What we re not doing Under the proposed new contract: DHBs are NOT proposing to reduce overall funding for pharmacist services. There will be NO CHANGES to ongoing services or funding arrangements for community pharmacies, without further consultation with pharmacists or their representatives. There will be NO CHANGES to the way community pharmacies claim and receive payment from District Health Boards, without further consultation with pharmacists or their representatives. Page 1 of 6
Who we think will be interested We think the future of pharmacist services, and how to deliver on the goals of the Pharmacy Action Plan will be of interest to: Pharmacy-owners and their representatives Pharmacists and their professional bodies Pharmaceutical wholesalers PHOs and primary health care providers NGOs in the health sector Communities and consumer groups Government agencies Academic institutions Important links The vision and the goals Integrated Pharmacist Services in the Community A booklet providing more information about the vision for pharmacist services, created after stakeholder hui in 2015-16. Pharmacy Action Plan 2016-20 The five-year Action Plan for pharmacist services, reflecting the New Zealand Health Strategy and the vision for Integrated Pharmacist Services in the Community. Innovative pharmacist services in the community These are examples of innovative services already available. District Health Boards would like to make it easier to provide and fund many more of these types of services. Proposed new Integrated Pharmacist Services in the Community Agreement (IPSCA) Key information (pp3-5 below) Structure of the new contract (Graphic p3) https://tas.health.nz/community-pharmacy/ Services and fees comparison current and proposed agreement Questions & Answers Summary of Integrated Pharmacist Services in the Community new contract Detailed comparison (clause by clause) of current CPSA 12 and new contract Proposed new Integrated Pharmacist Services in the Community Agreement Extension of CPSA 12 for 2018-19 Key information (p4 below) https://tas.health.nz/community-pharmacy/ Questions & Answers Summary of extension CPSA 12 extension (the contract) The proposed Integrated Pharmacist Services in the Community Agreement, and the CPSA 12 contract extension for one year, are scheduled to come into effect from 1 July 2018. Page 2 of 6
Details of the proposal Proposed Integrated Pharmacist Services in the Community Agreement (IPSCA) Offer The new contract will be implemented from 1 July 2018. All new pharmacy owners or pharmacies changing ownership will be offered only the new contract from 1 July 2018. Current contract-holders, who choose to sign a one-year CPSA 12 extension, can move onto the new contract during 2018-19 if they wish. Evergreen The new IPSCA contract is evergreen. It has no end-date so service providers won t have to re-sign it every year. It will be reviewed annually (IPSCA contract pp 23-25) and variations can be considered and agreed as part of the review process. Funding It is proposed that service providers who sign the new IPSCA contract will be eligible for an additional payment for professional advisory services support payment. The clause will be included once the details of the additional payment have been finalised. Those who sign the new IPSCA contract during the year will receive a proportionate amount. (Funding amount to be finalised when District Health Board budgets are finalised). All other funding arrangements remain the same under the new contract. Community pharmacies will claim and be paid in exactly the same way. There will be no changes to overall funding arrangements without engagement with pharmacists and/or their representatives. Page 3 of 6
Services New services developed locally, for local communities, will only be available through the new IPSCA contract. All existing ongoing services remain the same under the new IPSCA contract. You will be offered all ongoing local services you currently provide. There will be no changes to services without engagement with pharmacists and/or their representatives. Signatories to the new IPSCA contract, and signatories to the CPSA 12 extension, will be consulted on the development of new pharmacist services, but they will only be available to signatories of the new IPSCA contract. Service Schedules Services are divided into three schedules. (See Graphic p3) Schedules 1 and 2 Schedule 1 covers pharmaceutical supply. Schedule 2 covers professional advisory services. This change supports the skilled role of pharmacists in medicines management. It will ensure future funding for professional advisory services provided by pharmacists does not directly depend on dispensing a pharmaceutical product. Provision of pharmaceuticals, and provision of professional advisory services, already occurs separately in a range of settings, such as hospitals and aged residential care facilities. Patient safety is paramount. From 1 July 2018, both schedules will be offered to everyone who signs the new contract. Further work by District Health Boards and the pharmacy sector needs to be undertaken on how Schedules 1 and 2 could be offered separately in practice. This work would have to be completed, with full understanding of potential risks and how these will be mitigated, before any District Health Board would consider contracting with a provider for a single schedule only. Any future arrangements will ensure that patients continue to have access to both services product supply AND professional advisory services. In the future, this change will support service providers to evolve their business models in a changing world, and work in new ways. Schedule 3 Schedule 3 covers all other specific services. It is divided into three sections covering: A. Nationally specified services (such as Methadone services for opioid dependency, or Clozapine services). B. Services that may be either nationally specified but can be locally developed (such as longterm conditions or special foods), or wholly local services. C. Individual services (such as the Part P services offered today under CPSA 12, for example rural adjusters). Schedule 3 offers significant flexibility for pharmacists to work with District Health Boards, fellow health professionals and communities to develop services that target specific local health needs. Proposed Community Pharmacy Services Agreement (CPSA 12) extension 2018-19 It is proposed to extend the CPSA 12 by one year to 30 June 2019, for those contract-holders who do not wish to sign the new contract immediately. Contract-holders signing the extension will be offered all ongoing local services they currently provide. Provisions relating to minimum agreed expenditure and new services initiatives (smoking cessation, workforce development) expire on 30 June 2018, and are not proposed to be extended for 2018-19. Page 4 of 6
At a glance IPSCA - NEW CONTRACT Offered to All current CPSA 12 contractholders Owners of new pharmacies New owners of existing pharmacies CPSA 12 extension signatories who want to transfer during 2018-19 Effective 1 July 2018 During 2018-19 year (transferring from CPSA 12 extension 2018-19, new pharmacies, changes of Can contribute to development of new local services Eligible to provide new local services Eligible for professional advisory services support payment Evergreen (no end date reviewed annually by DHBs and sector) Pharmaceutical supply and professional services offered separately Same national and ongoing local services currently provided ownership) Yes Yes Yes No Yes No Yes No Not in 2018-19 Further work will be done to look at how these services might be separated without compromising patient safety CPSA 12 ONE-YEAR EXTENSION 2018-19 All current CSPA 12 contract-holders 1 July 2018 No Yes Yes Workforce Yes No development Subject to individual DHB approach Smoking cessation Yes No Subject to individual DHB approach LTC Mental Health* Yes, for existing service users Yes, for existing service users Same funding Yes, plus additional payments as Yes models described above *Balance of existing fund going to new services initiatives in IPSCA Page 5 of 6
To provide feedback We re seeking your views on the best way to deliver on the Pharmacy Action Plan, and we have a number of questions we are keen to get your feedback on. A summary of feedback will be published on the TAS Community Pharmacy website in April. Your feedback will be considered by the District Health Boards, and final decisions about the steps we are taking to deliver on the Pharmacy Action Plan will be announced in early May. Please provide your feedback at https://tas.health.nz/community-pharmacy/ Consultation closes at 5.00 pm on Tuesday 10 April 2018 Page 6 of 6