Shilpa Shah
As we transition in England through yet another NHS organisational change, I ask myself what does this mean for community pharmacy? I would like to think that this change will bring about opportunity and a chance for community pharmacy to showcase and continue the excellent work that was carried out during the height of the pandemic and is still ongoing today.
I hope that it allows community pharmacy to be regarded as part of the NHS rather than sitting on the side lines. This change has to lead to better funding for community pharmacy, without sufficient funding we will see more pharmacies close.
We are hearing a lot about winter pressures but this year it feels like all year round pressure. What I have seen, whilst the NHS is under such pressure, is North East London (NEL) CCG transitioning to an integrated care board (ICB) almost seamlessly.
I have seen people transitioning into new roles, whilst working hard to ensure that all plates are still spinning, which at the moment is no mean feat. I spent a day out recently visiting pharmacies with the chief medical officer of NHS NEL, Dr Paul Gilluley.
The visits were positive, we felt listened to and understood. The feedback was great, it was recognised that community pharmacy is often the informal front door to the NHS and that we have so much to offer in terms of ill health prevention.
Community pharmacy can offer a total solution as long as we have the tools to do so, which can save so much time and money. An example is the GP CPCS service, which has launched well across NEL.
This service is one that supports increasing GP access as it frees up appointments. If this service was complimented with a national ‘minor ailments’ scheme and with a suite of PGD’s, it would offer all patients a total solution.
It would be great to then see the service evolve into a walk in service and for the service to utilise Independent Pharmacists. We discussed the role of community pharmacy with health inequalities, and this is an area where pharmacy can really excel.
People trust community pharmacy as we have an informal setting (no need to book an appointment) and often people working in the pharmacy are from the same area as their patients.
With impending rising costs, the health inequalities gap is getting bigger. We are now starting to hear of patients having to choose which item to get on their prescription as they can’t afford them all. Now would be the time for England to follow Scotland and Wales and offer everyone free prescriptions.
We shared our vison for community pharmacy and the national plans for all pharmacists to become IPs and what that means for community pharmacy. The Health Education England funding for IP’s is a brilliant initiative for those people who want to become an IP but don’t have the funding to do so.
This is much needed, and it’s been reassuring to hear that David Webb, chief pharmaceutical officer, has announced that pharmacist independent prescribing services will be trialled across England in 2023.
What we are seeing is a lack of designated medical practitioners and designated prescribing practitioners. It’s not that people don’t want to take on this role but in community pharmacy there is a lack of using IP skills, so people don’t feel confident in supervising others, general practice surgery staff have several roles that they are needing to supervise as part of the additional roles reimbursement scheme (ARRS) and don’t have capacity.
It would be great to see the community pharmacy sector come together and support supervision so the more people that are trained can pay it forward to another trainee. This then puts pharmacy in a good place for 2026 when independent prescribing will form part of the foundation training year. At a time when the workforce in all NHS sectors is decreasing this is a positive step towards realigning where patients can get their care.
Ideally in the best place at the best time by the best health care professional. The biggest challenge community pharmacy is facing currently is work force pressures. There are so many different opportunities for pharmacists and pharmacy technicians compared to five years ago, so why would we be surprised that people would explore these different roles?
People want different experiences and no longer stay in a job for years and years. We need to adapt and evolve and ensure that our pharmacies are offering the workforce, pharmacists, technicians and support staff, variety and development. The IP services will help keep people in community pharmacy as they will get to use their qualification and provide their patients with a total solution.
We need to step change the way we work and reconsider any work that we do for free. With the rising costs of fuel, we need to consider whether we should continue free deliveries. So many patients believe that this is an NHS service.
We need to change behaviours and educate the public on what we do (and how much we do for free). Is it time for us to look at opening hours and consider cutting them back to core? The rising costs in utilities may result in a contractor having no choice but to do so.
The issue is that our USP is accessibility and patients not having to make an appointment by being able to walk in whenever. But can we continue the way we currently are? I’m not sure that we can.
I remain optimistic about community pharmacy as we have a huge role to play within local communities and the wider NHS. The new ICS’s will bring the NHS together to improve population health in their local geographies and I am confident that community pharmacy will be an integral component of the ICS going forward.
We may need to think out of the box and do things in a different way but the pandemic has shown what we can do through adversity and as long as we put the patient at the heart of all that we do, we cannot go wrong.
(Shilpa Shah is the chief executive officer at North East London LPC.)
