By Claire Anderson
The Royal Pharmaceutical Society has long called for the NHS to make greater use of pharmacist’s clinical skills and with the ‘Now Or Never’ report in 2013, it made the case for shifting the balance from dispensing towards more patient-facing roles. With people living longer, often with multiple conditions, it was clear that something had to change to make the most of the third-largest health profession.
The report argued that freeing up time would enable pharmacists to deliver more services, such as caring for people with long-term conditions, helping people who are taking multiple medicines, providing advice for minor ailments, and supporting public health. While the ambitious vision of Now or Never hasn’t yet been entirely realised, the new community pharmacy contract is a really positive step in the right direction.
There is much to welcome in the new contract, which focuses on areas such as urgent care, prevention, medicines optimisation and safety. With an NHS workforce crisis, the Community Pharmacy Consultation Service could be game-changing for primary care. Referring patients with minor illnesses to a pharmacy, instead of GP appointment, can take some of the strain from other parts of the health service and help patients get the help they need more quickly. It will support the delivery of the NHS Long-Term Plan, have a positive impact on relationships within the primary care multidisciplinary team, and help educate patients about the support and expertise that pharmacists provide.
The NHS Long-Term plan saw an emphasis on primary care and helping people stay healthy and out of hospital. The role of community pharmacists around public health and prevention will be fundamental to this, so it was great to see the contract recognise the success of the Healthy Living Pharmacies in supporting people’s health and wellbeing.
The contract also provides an opportunity to explore new and innovative services to showcase the enhanced roles that community pharmacy can play. This includes detecting undiagnosed cardiovascular disease in community pharmacy and referral to treatment within Primary Care Networks (PCNs); point of care testing around minor illness to reducing inappropriate antibiotics prescribing; and routine monitoring of patients being supplied under electronic repeat dispensing. The contract proposes to use the Pharmacy Integration Fund and the PCN Testbed programme to pilot services and see whether they can be rolled out across community pharmacy. It is understandable that the Government will be looking to build the evidence-base for what works, particularly when it comes to deciding what services to fund in future.
At the same time, with no guarantee of year-on-year funding for additional prevention and detection, how pilots are evaluated will be crucial to their long-term success. I also look forward to more detail on potential activity to complement the PCN service specifications, with the contract highlighting examples of early cancer diagnosis and tackling health inequalities.
Pharmacists will underpin government and NHS efforts to improve patient safety and as Medicines Use Reviews are phased out, it will be vital that pharmacists in all settings, including within PCNs, are enabled to help people get the most from their medicines.
With PCNs potentially needing support from as many as 6,000 pharmacists, delivering the NHS Long-Term Plan will now require an adequately-funded strategy to support recruitment, training and education. This needs to account for capacity and capability, whilst maintaining patient access and the quality of current provision.
We can’t simply pull future pharmacists from one bit of the system to another. What will be the impact on educators in hospitals, wondering whether they will train new pharmacists only to see them disappear? This will need an integrated approach to pharmacy, across the whole system, supported by a national strategy and better workforce data.
The interim NHS People Plan has given some encouragement in this regard and my only hope is that national issues aren’t passed down to local NHS organisations to solve because they are too difficult. Pharmacists will also need to be supported to deliver any new services to a consistently high standard, including through appropriate training, guidance and access to quality-assured professional development wherever they may work.
The five-year settlement will offer some certainty for contractors, although with funding remaining flat and contractors facing rising costs, they will be keenly watching how further details and payments are negotiated each year. This new contract is a welcome step forward and we look forward to working with the Government, NHS and partners on how the profession can further support patient care. Claire Anderson is RPS English pharmacy board chair.
Claire Anderson is RPS English pharmacy board chair.
This article also appears in the September issue of Pharmacy Business.