Subject to a ballot, community pharmacists in England and Wales will be working on a new contract from 1 April 2005.

The new contract has been negotiated by the Department of Health, the Pharmaceutical Services Negotiating Committee (PSNC) and the NHS Confederation. Discussions began in 2002.

If accepted, pharmacists will be rewarded for service range and quality, rather than dispensing volume. This provides an incentive to broaden the range of services offered to the community. Services will be divided into three levels:

• Every community pharmacy must provide essential services (eg, dispensing, repeat dispensing, disposal of medication, promotion of healthy lifestyles, promotion of self-care for patients with minor ailments)
• Advanced services will require accreditation of the pharmacist and specific requirements for premises (eg, medicine use review)
• PCTs will commission enhanced services (eg, supervised administration schemes, supplementary prescribing, emergency hormonal contraception service, needle exchange, smoking cessation, minor ailment schemes)

Introducing the contract, health minister Rosie Winterton said that she wanted to see pharmacists ‘more integrated with the NHS family’.

Sue Sharpe, chief executive of PSNC added:

‘This new contract sets in place a modern, quality-driven framework for community pharmacy to develop its role in the NHS. It will allow pharmacists to deliver real improvements in patient care through a range of new services including the promotion of self-care, the management of long-term conditions, and initiatives to improve public health. It will also ensure that all professionals in primary care work effectively together.’

Lloyds Pharmacy, the largest community pharmacy chain in the UK welcomed the news and revealed preparations had already been made for the new contract. Andy Murdock, pharmacy director said:

‘In anticipation of this move we have already made a substantial investment to provide customers in our 1,368 pharmacies with a wider range of preventative healthcare services. We have just launched a major national campaign to persuade consumers to take a free blood pressure test.’

Ballot papers will be sent to pharmacists in November with the vote’s result to be revealed at the end of November.

A House of Commons committee has questioned PCTs’ handling of the NHS budget when it comes to cancer care.

The all-party parliamentary group on cancer make the following recommendations in Meeting national targets, setting local priorities: the future of cancer services in England:

• remove cancer funding from PCTs
• hand funding to the country’s 34 cancer networks
• send GPs on cancer education courses to help recognise patients that need urgent treatment
• establish a national cancer treatment database on the prescribing on NICE-recommended drugs

The group claims that PCTs are ‘struggling’ now they are allowed to spend over 75 per cent of the NHS budget. They claim that many PCTs lack the experience in commissioning hospital services, and that when it comes to cancer they may be unwilling to spend large amounts on a disease that affects fewer people than heart disease or diabetes.

Cancer networks are suggested as beneficiaries of funding as they currently ‘find themselves negotiating with a dozen or more PCTs, who are often not in agreement with each other’.

Health Secretary John Reid responded to the report by highlighting the 12 per cent drop in cancer deaths since 1997, adding: ‘We will listen, but I am yet to be persuaded that it is better than what we are doing’.

Chair of the all-party parliamentary group, Ian Gibson, said:

‘The inquiry has exposed a serious problem. The government rightly says that cancer is a national priority yet the system that’s expected to deliver it is too fragmented. PCTs are struggling to cope and lack experience in commissioning cancer services. The budget for cancer services must therefore go directly to cancer networks to allow them to plan for sustained improvements in cancer care.’

The report was co-authored by CancerBacup, whose chief executive, Joanne Rule, added:

‘Cancer services need specialist commissioning. If not, access to cancer drugs, equipment and services will continue to vary widely from one part of the country to another. Cancer patients deserve more.’

The all-party parliamentary group on cancer was established in 1998 to keep cancer high on the political agenda. CancerBacup is a charity that provides information to patients and families on all types of cancer.

A&E waiting times have been cut, but the NHS in England needs to employ three times more emergency consultants than it does at present, according to the director of emergency care in England.

The comments were made in relation to an A&E progress report by Sir George Alberti, dubbed the trolley tsar because of his mission to keep patients from waiting on trolleys in hospital corridors.

At present, there are just 505 emergency physicians in England. A May 2004 report from the Royal College of Physicians recommends that the NHS should aim to have three in every acute trust, a total of between 1,200 and 1,400.

However, the report, Transforming emergency care in England is also effusive in its praise for A&E policy and contains encouraging quotes from impressed international pundits and horrifying statistics about 24-hour waits in otherwise civilised countries like Canada.

It also pats frontline staff on the back for initiatives leading to improvements in individual hospitals.

The report helpfully outlines some of the documents and strategies that have led to the changes.

Commenting on the document, Health Secretary John Reid was pleased but not resting on his laurels: 'This report shows that 19 out of 20 people are seen, diagnosed and treated within four hours in A&E. They can now get the right treatment wherever and whenever they need — be it at a walk-in-centre, minor injury unit or A&E department.

'We are not complacent about these sustained improvements in emergency care and recognise that more work is needed to provide even better and quicker services for patients.'

Paul Burstow MP, Liberal Democrat shadow health secretary, was less impressed, remarking: 'This government report is utterly complacent. Overworked staff and frustrated patients will not recognise this perfect picture of a shiny happy A&E.

'Of course the new investment and the hard work of dedicated emergency staff has led to improvements in waiting times. But there is still a huge amount to be done to tackle staff shortages and ensure that increases in services like NHS Direct do not mean that A&E departments lose vital staff.'

Waiting times are going down in Wales because patients are being offered treatment at different hospitals.

In the last quarter, there has been an 8.4 per cent drop in patients waiting over 18 months for an inpatient or day appointment. Health Minister Jane Hutt attributes this to a new Assembly scheme that started in April 2004 under which patients are offered faster treatment at a different hospital or an alternative procedure at the same hospital.

Of the 4,850 patients made second offers since April, 878 declined. The most popular reasons given by these decliners were:

• Did not wish to travel: 30 per cent
• Wanted to stay with their consultant: 10 per cent
• Social reasons (eg, not being visited by relatives): 34 per cent

Men and women will be screened for bowel cancer from April 2006 to prevent 2,000 of the 16,000 deaths a year caused by this condition.

Bowel cancer is the second most common cancer killer in the UK — after lung cancer, with 35,000 cases diagnosed each year.

The programme, which was promised in the NHS Plan, will cost £37.5m over two years.

Studies have show that the death toll can be cut by 15 per cent using a screening method involving looking for blood in stools. In pilot schemes in the west Midlands and on Tayside, men and women aged between 50 and 69 were sent a testing kit and invited to participate. Uptake was 60 per cent. Men, people from ethnic minorities and those living in deprived areas were less likely to participate.

The British Society of Gastroenterology has warned that colonoscopy in the NHS is in a poor state. A survey of 68 hospitals and 9,000 procedures found that most of the staff were poorly trained. The DH has promised to remedy this with training and has said that 345 more endoscopists will be ready to start work by April 2005, supported by 88 more trainers.

Patients will be getting quizzy from Monday 1 November as 'Ask about medicines week' begins.

This year, the theme is choice and there are three messages:

• Everyone is entitled to be involved in deciding whether a medicine is right for them
• Everyone should be able to get good information to make decisions about medicines, from the source they choose
• Healthcare professionals need to help people make choices

The week also sees the launch of a new booklet The health and medicines guide and directory which advises on getting health information.

The week backs up the NHS move towards concordance and self-care.

The National Institute for Clinical Excellence (NICE) has recently published two sets of advice:

• a guideline on the diagnosis and management of the epilepsies in adults and children in primary and secondary care
• and guidance on Imatinib for the treatment of unresectable and/or metastatic gastrointestinal stromal tumours

The guideline on epilepsy aims to ensure that people with the condition in England and Wales can access treatments and interventions that are based on the best available evidence.

Advice includes tailored drug therapy to match seizure type, epilepsy syndrome and individual lifestyle factors.

Epilepsy affects an estimated 400,000 people in England and Wales.

Imatinib is used to treat gastro-intestinal stromal tumours that cannot be removed by surgery, or have spread to other parts of the body. It blocks the process that allows the tumour cells to grow and multiply, slowing down or stopping the growth and spread of the tumour.

NICE chief executive, Andrew Dillon, said:

‘Gastro-intestinal stromal tumours are difficult to diagnose but it has been estimated that there are between 200 and 2,000 new cases per year in England and Wales. Of these half are likely to be metastatic and/or unresectable, making this a very serious but rare cancer. This medicine is an important advance in the treatment of this condition.’

Almost 60,000 people have responded to the Scottish smoking consultation, making it the biggest ever response to a Scottish Executive exercise.

Health Minister Andy Kerr was delighted with the response:

‘This is a truly unprecedented response to any government consultation ever held in Scotland, almost 40 times bigger than any other Executive consultation. It is clear that the subject has sparked an incredible level of public debate and I would expect that a number of strong views will emerge from the responses.

‘We have made it clear that we are committed to introducing more smoke-free public places in Scotland. The cabinet will discuss how this could be achieved on November 10 with an announcement to follow shortly after.’

The consultation ran from June to September and people were able to submit their views by post and on the internet.

Around 13,000 Scottish people die every year because of smoking. Scotland has the highest rates of lung cancer in Europe for both men and women.