Community pharmacy has remained united in asking the newly appointed health secretary Sajid Javid to allow the sector a level-playing field in the integrated care systems (ICSs) which are being created to join up care across different organisations and settings.
There are genuine concerns within the sector that the changes proposed in the new Health and Care bill may not allow community pharmacy to have a proper voice in the new local systems.
As chancellor in 2019, Sajid Javid pledged to provide the NHS with an additional £33.9bn more per year by 2023-24 compared with 2018-19. He now returns to prime minister Boris Johnson’s cabinet as secretary of state (SoS) at a time when major changes are expected in how health and care services in England are planned, paid for and delivered as the nation recovers from the pandemic.
Pharmacy Business contacted leading pharmacists as well as various pharmacy organisations to find out what they made of Javid’s appointment and what they expected from him.
Some said Javid’s treasury experience might help community pharmacy to “cut through some of the smoke and mirrors” in government, but others dismissed the idea saying it would make no difference because ministers would always follow the advice of their civil servants who have largely remained apathetic when it came to community pharmacy.
Pharmacy needs a level-playing in ICS
Dorset contractor Mike Hewitson is less hopeful of any major changes in favour of community pharmacy.
He said: “Regardless of anything else, Hancock was one of the most pro-pharmacy SoSs we’ve had. It just so happened that he was powerless because of the 2012 NHS reforms. As those reforms are unwound, it is vital that the new SoS creates a level-playing field for community pharmacy in the ICSs as they mature.”
The King’s Fund calls ICSs “partnerships that bring together providers and commissioners of NHS services across a geographical area with local authorities and other local partners to collectively plan health and care services to meet the needs of their population.”
Michael Holden, principal associate of Pharmacy Complete, also called for a better integration of the sector into the new systems.
He said: “As chancellor Javid was cautious with tax payers’ money… If that approach is replicated, I can’t see more money coming the way of the national contract, but maybe controlled investment in local health systems as per the Health and Care White Paper, which community pharmacy must be engaged with and integrated in to access.”
Holden added: “I doubt the political rhetoric will change and inevitably it will slow any potential progress as he gets his feet under the SoS’s desk with many pressing priorities.
The new chair of the Royal Pharmaceutical Society in England, Thorrun Govind, has written to new the health secretary urging him to build on the contribution and leadership shown by the profession during the pandemic and ensure pharmacy continues to be recognised and supported in its important role in the NHS recovery.
She stated that the skills of pharmacists “must be harnessed in strategic and operational approaches to recovery to help reduce pressure on the NHS and manage the backlog of routine clinical care.”
Commenting on the importance of pharmacy’s integration into Integrated Care Systems, Thorrun said: “Patients will benefit hugely from pharmacists having a fundamental role in longer term, post pandemic approaches to health care and we must ensure that the role and contribution of pharmacy is well established in every Integrated Care System.
“This will depend on better integration across care settings, making greater use of pharmacists’ clinical skills, supporting education and training, and boosting public health and prevention to help manage demands on the health service.”
Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, said: “The pandemic has served as a warning, vividly illustrating health inequalities. The NHS must become more ambitious in its commitment to improving the well-being of the population and alleviating yawning gaps in our communities.
“We want to see our government now investing in pharmacies to promote disease prevention, improve health education and healthcare provision for all. We need to become more integrated in the system, we must be used more. We’re ready to help and look forward to working with the new health secretary Sajid Javid to achieve this.”
What’s in new SoS’ in-tray: Williams
For Bristol pharmacist Ade Williams, the appointment of Javid was “a reminder that the work of building bridges that will allow community pharmacy to deliver the best care in an evidence-led, sustainably funded manner is a collective professional responsibility, not just one for designated representatives”.
He said: “Javid’s in-tray and shared knowledge of the multiple challenges facing the NHS must already have community pharmacy as a critical focus to help deliver the solutions needed. The key question, does Javid see and know of us as the untapped clinical resource that delivers value beyond our current funding and, with the right support package, will unleash innovation to address at speed and scale, not only health and wellbeing challenges but also health inequalities?
“With strong links to Bristol, I am confident he already knows some of what is possible. Hopefully, we have made the broader case that there is a broad collective professional ambition and willingness; we are all just waiting to seize. If not, the work begins in harness. He is undoubtedly a man on a mission. They make the best allies if you are in step.”
Ministers rely on civil servants: Soni
Former RPS president Professor Ashok Soni said: “Sorry for the cynicism but ministers are dependent on their civil servants and advisers and until we have people there who believe in community pharmacy and it’s untapped potential nothing changes.
“Has pharmacy ever done well out of a secretary of state?” he asked.
Soni added: “I wonder if he (Hancock) knew he was on his way out when he talked so positively about pharmacy and what it had done over the last year?”
But Amit Patel, CEO at Pharmacy London, thought the next 18 months would be key because there was hardly any clarity on the place of community pharmacy in the proposed Health and Care bill.
“It definitely cant harm that he has treasury experience and may be able to cut through some of the smoke and mirrors between government rhetoric and our NHS colleagues taking equivalent action,” he added.
Resources must be put in place: Lane
Commenting on the announcement that Javid has replaced Hancock as health secretary, Andrew Lane, chair of the National Pharmacy Association, said: “The NPA worked hard to create a shared understanding of independent community pharmacy with Matt Hancock and met him several times for frank discussions about primary care reform and pharmacy funding.
“He adopted the NPA’s description of community pharmacy as the front door to health, and showed genuine enthusiasm when visiting our members. We frequently reminded him, though, that the current level of NHS investment is not enough to unlock our sector’s potential.
“Now we look forward to working with the new health secretary, to put community pharmacy on a more sustainable footing, to get the country through the pandemic and help the NHS catch up its care backlog. He and pharmacy minister Jo Churchill can rely on community pharmacy continuing to give its all, but the resources must be put in place to underpin our vital work at the heart of the NHS.”
Chair of the All-Party Pharmacy Group Jackie Doyle-Price MP is very pleased. “It would be quite wrong for anyone to have been left ‘out of pocket’ after stepping up to the plate and delivering healthcare.
“Our pharmacists are part of the NHS family and need to be treated as such. I look forward to working with DHSC ministers; the NHS and the pharmacy sector on a long term approach to make sure that we fully harness the potential of pharmacy to contribute to future provision of healthcare, recognising that the pandemic has left us with new challenges if we are to deliver the best possible health services.”
Earlier, Simon Dukes, CEO of the Pharmaceutical Services Negotiating Committee, issued a statement: “PSNC would like to congratulate and welcome the new Secretary of State to his role. We look forward to working with him, pharmacy minister Jo Churchill MP, and officials at the Department of Health and Social Care to build on the outstanding performance of the community pharmacy sector over the past 18 months.
“Only by working collaboratively will we be able to continue to develop community pharmacy services for the benefit of patients, the NHS and primary care in England.”