A former health secretary tells community pharmacy that the sector must ensure its voice is heard on the newly created integrated care systems (ICS) boards.
Jeremy Hunt, who chairs the parliamentary health and care select committee, also said the sector needs to brace itself for “a proper technical integration” as the NHS in England is being reorganised once again.
He said: “Make sure your voice is heard on the new ICS boards that are being set up around the country in 42 places. Because otherwise, the risk is that people will fall back on old ways of work, and they won’t embrace the innovation that is offered by the pharmacy sector.”
Hunt’s statement came amid concerns that the new bill could allow commissioning decisions to be made solely by one part of primary care, i.e. general practice and in the absence of representation from the majority of the primary care workforce.
He was speaking at a webinar organised by Sigma Pharmaceuticals on the new health and social care bill which is currently being scrutinised in parliament by cross-party politicians.
Hunt, who is the longest serving health secretary in history, had to oversee the reorganisation of the NHS in 2012 after the health and care bill spearheaded by his predecessor, Andrew Lansley, got royal assent to become law. As part of the then Health and Social Care Act 2012, primary care trusts were abolished and their work was taken over by clinical commissioning groups.
The former health secretary said he broadly supports the current bill’s focus on improving the health and wellbeing of the population. He noted that a vast majority of changes proposed by the government are indeed those that “the NHS has actually asked for”, meaning it will enact policies set out in the NHS’s recommendations for legislative reform.
He believes the changes will also provide “enormous opportunities for pharmacies to play a much more central role in the provision of core NHS services”.
“They basically reflect something that pharmacies have known for a very long time, which is that the pattern of care that we’re delivering is fundamentally changing so that the majority of care is no longer to people who have one illness that is essentially treated, cured and then someone goes back home and leads their normal life.
“The majority of care is now delivered for people who have multiple long-term conditions who are regular visitors to different parts of the NHS, regular visitors to pharmacies. They are often people with very complex needs, taking medicine bundles, with a high potential risk of conflict.”
Hunt also favours the “move to a model based on collaboration” which is different from the previous one which was “essentially based on competition”.
However, in reply to a question on how pharmacy to make the most of the opportunity, Hunt said although the NHS had more money than did in the past the demand for its services had also risen significantly.
Therefore, he said: “The way to get paid for additional contributions you make to local NHS services is to demonstrate that what you’re doing is actually saving money in other parts of the system, particularly by reducing pressure on primary care.”
He said he would personally like to see pharmacy represented in the integrated care boards but in the event it wasn’t, “you need to make sure that you have someone who is representing the voice of pharmacy on those boards, who can make the points you need to make”.
What are ICSs?
The stated aim of the 2021 Health and Care Bill is to remove barriers to integrating services “to improve health outcomes” and “reduce health inequalities”. The new legislation will give local health and care systems the flexibility to make their own arrangements for joined up and integrated services. It’s purpose is to facilitate greater collaboration within and between the NHS, local government and other partners, and to support the recovery from the pandemic.
Integrated care systems (ICSs) are being created as a means to forge partnerships between providers and commissioners of NHS services with relevant local authorities in order to deliver improved outcomes for health and wellbeing of their populations. They will comprise an integrated care board (ICB) and an integrated care partnership (ICP).
Established as statutory bodies, the ICB will be responsible for the day to day running of the NHS, while the ICP will develop an integrated care plan to address the system’s health, public health and social care needs. The ICB and relevant local authorities will be required to establish an ICP, bringing together wider partners across the NHS, social care, public health and wider stakeholders.
Balance tilted towards ICBs
Shadow health minister Alex Norris concurred with Hunt and said that community pharmacy would do well to have a representation on these ICBs where the power will ultimately lie.
“The balance is tilted too much in favour of the integrated care boards,” he said, adding that he would “really make a case for pharmacy being around the table there”.
Norris, who sits on the bill committee in his capacity as shadow health minister, however, added that structurally there was “a great strive towards collaboration” in the bill and that “pharmacy should be considered a really key driver of that”.
He also liked that the bill, in its broad canvas, emphasised on early interventions, people’s well-being and healthy life expectancy — all of which are well within pharmacy’s grasp and remit.
“I certainly am committed as an opposition frontbench on that bill to be pushing amendments relating to pharmacy.
“We look forward to use this bill as a vehicle to improve primary care… I think there’s a lot of scope for that”, he said, adding that the bill presented “a really solid foundation to build on”.
Norris said from his talks with pharmacy minister Jo Churchill he has found out that the government wants to put more things in primary care and have pharmacy do more things but he would like to see this reflected in the national contract “so that our wonderful pharmacies can gear up for that” and are well resourced to be used as the first port of call for people.
Hub and spoke dispensing
On the ‘hub and spoke’ model of dispensing, Norris said this legislation would enable community pharmacists to be free and use their high level of clinical skills to do more for their patients but he would like a healthy debate on the subject because he has heard mixed from from across the broad spectrum of pharmacy.
Stating that “the future of pharmacy is really exciting”, he said that “the bill now presents a really good opportunity to build on that… pharmacy is a real backbone part of all of our community.”
Glorified retailers
Speaking at the webinar, Jackie Doyle Price, the chair of the All Party Pharmacy Group, regretted that there were “too many in our (current) commissioning system who still see pharmacies as glorified retailers” which was “something that needs to be challenged”.
She said pharmacists “who have well and truly stepped up to the plate” were “an intrinsic part of the NHS family – they should be treated as such and properly recompensed”.
Speaking about the bill she said it’s whole purpose was to make sure that “our health service works better and more efficiently”.
“As we develop integrated care systems through this bill, one of the things that are going to be very focused on is that we really make sure that primary care delivers as we intended it to be.”
However, she added: “We still got an issue where we’re not making the most of that partnership that can exist between GPs and pharmacists.”
This was the fourth in a series of webinars hosted by Sigma this year titled ‘Taking Pharmacy Forward’. The webinars are free for all community pharmacists and healthcare professionals, provided they register online at the company’s website.
Sigma Pharmaceuticals is one of the UK’s largest independent short-line pharmacy wholesalers and has been in operation since 1982.
