The White Paper on pharmacy in England introduced a requirement for PCTs in England to undertake a Pharmaceutical Needs Assessment (PNA). The provision of services to meet local need, such as that identified by a PNA is increasingly important for pharmaceutical services and will have a massive impact on how pharmacy services develop locally.

In England, the PNA is used to justify the awarding of new pharmacy contracts, direct the increased provision of services currently provided to a wider population and for the commissioning of new services. Commissioners of healthcare services in other countries will produce similar documents.

Put simply, commissioners, through the PNA, will regularly review the provision of pharmaceutical services within its area and commission new services or new providers to fill gaps.

This might be through the existing network of pharmacies or through new contracts, Local Pharmaceutical Services (LPS) contracts or from providers other than pharmacies.

Healthcare needs are examined across a region, but also in distinct local areas. For example, in an area that has few problems with drug misuse, commissioners may choose to limit the provision of drug misuse services to a small number of contractors, allowing them to focus their efforts and resources on areas with greater drug misuse problems. Pharmacies in the latter areas would do well to recognise that opportunity and ensure that staff are trained, to be able to demonstrate that the team are ready to offer the service.

If local contractors are unwilling to provide the services required to meet local needs, commissioners will of course encourage new providers to apply for new contracts or invite providers to tender for contracts.

In England, the PNA is informed and influenced by the Strategic Commissioning Plan (SCP) and the Joint Strategic Needs Assessment (JSNA). The JSNA is an assessment of the health and social care needs of the local population and is produced through public health and the local authority social services and children's services departments.

The SCP outlines the strategic aims of commissioners in terms of improving health locally. These aims will be broken down into priorities and then the goals by which the organisation will measure its success. Commissioning decisions are based upon such documents. It is important to recognise that it is unlikely that commissioners will fund anything that is not linked explicitly to their stated goals.

It is vital for pharmacy contractors to engage with the local planning process to allow them to understand the direction of the development of pharmaceutical services in line with local strategic objectives. It is also an opportunity to influence the development of services to meet local needs that they have identified and link these to healthcare objectives.

A degree of lateral thinking may be needed to link local practical needs to goals. Services that contribute to more than one of the local strategic goals will probably stand a higher likelihood of being commissioned. For example, an MUR service for elderly patients on three or more medications could be linked to local goals to reduce A&E attendance (through falls prevention), increase the provision of support for elderly people to stay in their own homes and reduce the occurrence of hip fracture. Similarly, an alcohol-awareness campaign run through pharmacies might support the goals of decreasing accident and emergency attendance, reducing health inequalities and encouraging healthy lifestyle choices.

To compete for local funding for services it is vitally important that pharmacies engage fully with commissioners.