Background 
A major government review in 2000 was the catalyst for fundamental changes in the provision of out of hours (OOH) primary care in England.¹ Through the new General Medical Services contract, general practitioners (GPs) have been given the ability to ‘opt out’ of 24 hour responsibility for their patients; since December 2004 Primary Care Trusts (PCTs) have taken over this role where necessary. It was anticipated that through these arrangements new kinds of OOH providers would emerge.² Government guidance suggests ways in which the pharmacy profession can contribute to OOH provision by integrated working with other OOH providers and by providing access to medicines in the OOH period.³ Jolley⁴ suggested how pharmacists may contribute to OOH care, although he noted that there were some contractual and funding issues to overcome. As of 2005, OOH pharmacy services may be commissioned using either the new national contract for community pharmacy (CP), or the alternative local pharmaceutical services (LPS) contract.

Aims 
To consider how the LPS contract is currently being used, and could be used in the future, to deliver OOH pharmacy services.

Methods 
Data was drawn from a number of sources as part of the national evaluation of LPS pilots: a literature review was conducted on OOH services; LPS applications and contracts were reviewed; telephone interviews were conducted with PCT LPS leads and an in-depth case study was undertaken at one first wave LPS pilot site providing OOH services.

Results 
LPS pharmacists are contributing to OOH care in a variety of settings including a GP co-op, a walk in centre (WIC), a community health centre and a hospital pharmacy. LPS OOH pharmacy services are staffed by pharmacists from different backgrounds: primary care, community and hospital. The pharmacists dispense from restricted OOH formularies, maintain GP medicines bags and provide medicines advice to other health care professionals (HCPs). Current pilots involve pharmacists in conducting minor ailments consultations with patients and others plan to extend the role of the pharmacist to include this in the future. A variety of referral pathways are operating: sites see walk-in patients, use their own call-handling system or are integrated with NHS direct. The case study site provides an example of the successful integration of pharmacists with GPs and nurses, with the pharmacist undertaking patient consultations both via the telephone and in person as well as dispensing prescriptions and maintaining medicines stocks.

Discussion 
Under LPS, pharmacists are successfully contributing to OOH services within a variety of innovative service configurations, as part of multi-disciplinary teams. Recent changes in community pharmacy contracting, such as the requirement for pharmacies to be open at least 40 hours a week, mean that the LPS contract will continue to be a useful contractual option for those looking to use pharmacists to provide OOH services in the future.

References

1. Department of Health. Raising standards for patients: New Partnerships in Out-of Hours Care. 2000. London, Department of Health

2. Department of Health. Building on the best. Choice, Responsiveness and Equity in the NHS. 2003. London, Department of Health

3. Department of Health. A vision for pharmacy in the new NHS. 2003. London, Department of Health

4. Jolley, J. Integrating pharmaceutical services into out-of-hours primary care. Pharmaceutical Journal 2004; 272:122