Fuller ‘blueprint’

NHS England and NHS Improvement published on May 26 the findings of the Fuller ‘stocktake’ — setting out how primary care can work with partners across health and care to best meet the needs of their local communities.

Dr Claire Fuller’s report lays emphasis on the essential role of primary care and the potential of integrated neighbourhood teams in reducing the burden of ill health and tackling health inequities.

It commends community pharmacy for keeping “its doors open to the public throughout” the pandemic whilst being “among the most recognizable of a multitude of dedicated staff delivering care around the clock in every neighbourhood in the country”. The report highlights “recruitment and retention challenges across the wider primary care workforce” including in community pharmacy.

Stressing the importance of community pharmacy teams in urgent care and prevention, including early diagnosis of cancers, the report points out that pharmacists could play “a more active role in signposting eligible people to screening and supporting early diagnosis, building on a number of successful pilots such as those from the Accelerate, Coordinate, Evaluate (ACE) programme”.

‘Blueprint for partnership working’

The report also includes a vote of thanks to leading pharmacist Reena Barai who served on two of the Fuller working groups.

At a launch event for the report on May 26, Barai said: “As a community pharmacist I am part of ‘team primary care’, which is bigger than general practice alone. This report will form the blueprint for partnership working as a ‘must do’ rather than a ‘nice-to-do’. In the last two years I’ve seen a growing desire for collaborative working, driven by the pandemic, but there’s a way to go yet.”

She also pointed to the NHS Community Pharmacist Consultation Service and the Hypertension case finding service as examples of services requiring close collaborative working focused around the needs of patients.

Breaking through silos in primary care

The National Pharmacy Association described the document as a “clear signal” that integrated care systems (ICSs) must break through silos in primary care: “at the heart of the new vision for integrating primary care is bringing together previously siloed teams and professionals to do things differently to improve patient care for whole populations”.

ICSs are encouraged to develop a “single system-wide approach to managing integrated urgent care to guarantee same-day care for patients”. They are also told to develop a primary care forum or network at system level, with a breadth of views including professional representation. According to the NPA, this adds up to a significant opportunity for pharmacies to engage with the NHS at a local level.

NPA chief executive, Mark Lyonette, said: “The NPA is pleased to have worked with the Fuller team to ensure that the voice of community pharmacy was heard within this review. So often in the past community pharmacy has been barely recognised in key reviews.

“This document is a clear signal to ICSs to break through silos in primary care and to engage community pharmacy in a multidisciplinary push on prevention, urgent care and long term conditions. This is an invitation to be active partners in integrated care and that means investing time and energy in building relationships to improve local services.”

RPS England chair Thorrun Govind called the report “a significant step” on the journey towards integrating primary care.

She said: “To maximise the contribution of pharmacy teams, we will need to foster pharmacy leadership at system, place and neighbourhood level to ensure they are involved in decision-making.”

Philosophy of partnership

Stating that a “philosophy of partnership was at the heart of my report”, Dr Fuller outlined the role of the 42 ICSs which “come just at the right time, tasked with achieving four aims: improving outcomes in population health and healthcare; tackling inequalities in outcomes, experience and access; enhancing productivity and value for money; and helping the NHS support broader social and economic development.”

“To get there, we are going to need to look beyond a traditional definition of primary care and understand that NHS urgent care is what patients access first in their community – typically from their home or high street and without needing a GP referral.

“That might be online advice on symptoms and self-care, going to a community pharmacy, a general practice appointment, an urgent treatment centre, or the 111 out-of-hours clinical assessment service.

“As part of accessing urgent care, a patient may then get immediate referral into emergency care or go online or talk to somebody before walking into a hospital emergency department.”

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