From 1st July 2019, every community pharmacy in England will find themselves located within the geographical footprint of a Primary Care Network (PCN). PCNs are being introduced by NHS England to bring together multi-professional healthcare teams who will together deliver joined-up health and social care services to the patients they serve – that could be anything from 30,000 to 50,000 patients.
The PCNs have groups of GPs at their core, and these GPs will receive, under their new contract, network funding to deliver the services that NHS England wants from PCNs (based on the NHS Long Term Plan priorities). The network agreement enables the GPs to recruit more healthcare professionals to their teams and to collaborate with other service providers, including community pharmacies. It is expected that community pharmacies will play an active role in delivering services that meet the PCN’s priorities.
There will be a clear opportunity for community pharmacies to get involved in PCNs, which fundamentally will be the building blocks of primary care in the future. But to do that, with around 1,000 PCNs expected to be in place across the country, we will need to be organised and work together as a sector. So, what steps do pharmacy teams need to be thinking about now?
PCNs are a key part of the NHS Long Term Plan, and, ultimately, they will provide the structure and funding to develop many local services of the future. Before trying to tackle collaboration with the networks head on, it is important to understand a little bit about what a PCN actually is and what they will be doing.
The Quick Questions (see below) answer some key questions about PCNs and you can find lots more information on the Pharmaceutical Services Negotiating Committee (PSNC) website (psnc.org.uk/pcn). In particular look out for the summary briefing: PSNC Briefing 013/19: An introduction to Primary Care Networks.
You will also be able to find out information about PCNs from your Local Pharmaceutical Committee (LPC) who should be a key local contact for you; NHS England has a range of resources available including FAQs and a video animation explaining PCNs.
Spending just a little time browsing these sorts of materials will leave you with a good understanding of what it is that you are going to be trying to get involved with.
It is expected that there will be as many as 10-11 community pharmacies within a typical PCN footprint, and these pharmacies will need to engage with their PCN in a coherent way.
This means working together, most likely with the support of the LPC, to come to some agreements so that you will be ready to present a united voice and offer to the PCN. NHS England is keen that pharmacies do not compete within local areas to work with PCNs; instead, the aim should be to find ways for you all to collectively contribute to improving patient care within the PCN.
LPCs will be well positioned to help pharmacy owners to start these conversations between themselves. We expect that LPCs will be seeking to work locally with the
Local Medical Committees (LMCs) which could, when the time is right (most likely from July 2019 when the PCNs have been established), help to facilitate joint discussions between community pharmacies and their PCNs. So, the advice in the first instance is to approach your local pharmacies, but also your LPC who help coordinate these conversations for you all.
In order to make the most contribution to PCNs, and to make the business case for pharmacies to deliver PCN services, community pharmacies will need to think about local priorities and how they can support those. An important first step will be to describe to the PCN the benefits to patients that collaborative working with community pharmacy will bring. Our portal aimed at local commissioners may provide some inspiration: psnc.org.uk/ commissioners. Focusing on positive outcomes for local health populations will help, particularly in light of the current challenges in workforce and capacity for GPs – the message is that community pharmacy can help!
Conversations can be based on how community pharmacy can support PCNs to:
- Reduce pressure on urgent care services (through services such as DMIRS and NUMSAS, if available in your area, which are currently being piloted by NHS England)
- Deliver prevention and public health services (such as by collaborating on flu vaccinations and public health campaigns)
- Deliver on the seven national services that PCNs are going to be asked to deliver (see Quick Questions below)
With the help of your LPC, you may also like to think about local priorities using resources such as the local Joint Strategic Needs Assessments (JSNA), local Pharmaceutical Needs Assessments (PNA) and local Sustainability and Transformation Partnerships (STPs) or Integrated Care Systems (ICS) delivery plans to find out what local healthcare services are looking for.
Local GP practices could also help this and as part of their PCN engagement after July 1st pharmacies could talk to practices collaboratively about what challenges they have which you might be able to help with. This might be through the provision of vaccinations, or GPs might be able to refer patients to services such as the New Medicine Service to support medicines adherence for their patients.
Focus on challenges
Part of the challenge ahead for community pharmacies will be to find new ways of working that free up capacity to enable pharmacy teams to offer more services to patients in line with the objectives of their PCN. That will not be easy, but it is possible to see that things like making best use of the full pharmacy team and some forms of technology might be able to help.
To help you to start thinking about the future, it is worth watching PSNC’s future of pharmacy animation which sets out the challenges ahead and highlights how things such as making better use of technology and team members’ skills, interacting with patients digitally, and updating skills are key areas for pharmacists to explore. Contractors can also focus on maximising delivery of existing commissioned services and ensuring that their pharmacists and teams keep up to date with accreditation and take any opportunities for ongoing development and training. Organisations such as the Centre for Pharmacy Postgraduate Education (CPPE) offer useful courses and remember to ask your LPC about any local training events.
Building strong day-to-day working relationships with local GP practice teams and pharmacists working in GP practices will also be an excellent foundation on which to build future engagement. Building trust and rapport between you now will help to ensure that any future challenges can be addressed. You can achieve this by helping practice teams to understand what services you provide and how that can support them and their patients; and by offering to work together to improve processes e.g. setting up a weekly call with a designated representative to iron out issues relating to prescriptions, orders and missing items can work really well.
Engage with PCNs
Once you have talked to other local pharmacies and come up with some collective ideas and offers for your local PCN, you will need to agree how you will represent yourselves collectively to the local PCN. Your LPC is likely to be talking to the local LMC and may be able to help you to tailor your messages and to advise on the best time to start making contact with your PCN.
You may wish to consider appointing one local accountable individual or individuals who can engage with the PCN on behalf of local community pharmacies. Again, LPCs may be able to help you to set up this PCN leads arrangements.
All community pharmacists in each PCN may have different specific skills, and it is worth taking that into account as you work to engage with PCNs to ensure that everyone is playing to their strengths.
Sources of help
LPCs are likely to be the first port of call for pharmacy teams seeking advice on engaging with the local PCN. But don’t forget that there will also be other sources of help – NHS England already has a range of resources about PCNs including a series of webinars, with more expected to follow. Plus, PSNC will be continuing to work with the other national pharmacy organisations to provide resources and guidance for contractors and LPCs to help them on this important journey.
Quick questions on primary care networks
Where is my local PCN?
By July 2019 GPs have been asked to form their Primary Care Networks (PCNs). The shape and boundary of your local PCN will depend on the constituent GP practices, other local services, and the local community.
What will PCNs do?
PCNs will be responsible for the delivery of joined up care services to the communities they serve. They will need to deliver extended hours services as well as NHS Long Term Plan commitments. NHS England has named seven services that they will want them to deliver and which are being negotiated as part of the new GP contract. The GPs at the core of the PCNs will need to collaborate with other local healthcare providers in order to deliver these services; they are also receiving funding to recruit additional staff such as clinical pharmacists.
What services will PCNs focus on?
The seven new national service specifications which are being negotiated for PCNs include: structured medication review and optimisation; enhanced health in care homes; anticipatory care; personalised care; supporting early cancer diagnosis; CVD prevention and diagnosis and tackling neighbourhood inequality.
How can pharmacy help deliver these?
Collaboration with non-GP providers, such as community pharmacies, will be a requirement for PCNs from April 2020. NHS England expects that community pharmacies will help with the delivery of some of the seven services, for instance helping to detect people with CVD who might not regularly come into contact with their GP practice. In addition to this, community pharmacies may be able to support PCNs to manage demand on urgent care; to provide proactive care, prevent ill-health and support early diagnosis and identification of people at risk; and to improve medicines safety and adherence.
What will clinical pharmacists in PCNs do?
In 2019/20, all PCNs will be able to claim reimbursement for one whole-time-equivalent (WTE) clinical pharmacist (2 WTE if the PCN covers a population of 100,000 or more). It is expected that there might be up to 6 WTE clinical pharmacists in post in each PCN’s community multidisciplinary teams by 2024. Clinical pharmacists in PCNs will provide a focal point for collaborative working across the different pharmacy sectors including with community pharmacy. They will undertake an 18-month training programme, carry out structured medication reviews for PCN patients, and they will be supported to become independent prescribers.
You can find out all the latest news on PCN development and other topics by signing up to receive PSNC’s news emails at psnc.org.uk/email and following the #futureofpharmacy hashtag on Twitter.
This article was supplied exclusively to Pharmacy Business by the Communications Team at PSNC. All PSNC PCN resources mentioned in this article can be found via the website (psnc.org.uk/pcnresources).