Action stations - the Pharmacy Call to Action

NHS England’s Community Pharmacy Call to Action is the profession’s big chance to secure its future and not to be missed. If you haven’t contributed yet, why not?

Community pharmacy was handed its biggest opportunity yet to shape its own future in December when NHS England published ‘Improving health and patient care through Community Pharmacy – a Call to Action’. This consultation provides a rare opportunity for pharmacy staff to make their voices heard at the highest level, and comes at a crucial time in the profession’s development.

This is an essential piece of work for the pharmacy profession, says Claire Ward, chief executive of the Independent Pharmacy Federation. ‘Pharmacy can’t remain at a crossroads forever. This is pharmacy’s moment to consistently add value to patients beyond the supply function. It is also the time to be fully embraced by the NHS and recognised as a core part of health care delivery. We need to get patients and professionals engaged in this debate to create a real understanding of what community pharmacy can deliver.’

Sue Sharpe, PSNC chief executive, describes the Call to Action as ‘an important milestone for the sector in the reformed NHS’. Community pharmacy cannot afford to miss this chance to secure its future, she says. ‘The whole sector must be engaged if we are to ensure that our national commissioner hears the case for the role pharmacies can and must play in the health service and acts upon that.’

The whole sector must be engaged if we are to ensure that our national commissioner hears the case for the role pharmacies can and must play

The main purpose of the document is to ‘stimulate debate in local communities, to shape local strategies for community pharmacy and to inform NHS England’s strategic framework for commissioning community pharmacy.’ NHSE plans to use the results to ‘develop a contractual framework that better supports these aims and secures the most efficient possible use of NHS and taxpayer resources.’ Its aims for community pharmacy are to:

  • Develop the role of the pharmacy team to provide personalised care
  • Play an even stronger role at the heart of more integrated out-of-hospital services
  • Provide a greater role in healthy living advice, improving health and reducing health inequalities
  • Deliver excellent patient experience that helps people to get the most from their medicines.

The four questions

The Pharmacy Call to Action, which forms part of the wider Call to Action that NHS England launched last July, asks four key questions, to be discussed locally, around:

  • Creating a ‘pharmacy first’ culture. Prompts for this discussion might include enhancing pharmacies’ public health role, recognising pharmacy as the first port of call for minor ailments and better use of community pharmacy for the management of long term conditions.
  • Ensuring patients get the best from their medicines, including discussion on national versus local commissioning, number and location of pharmacies, and alignment of the pharmacy and GP contract to, for example, improve repeat prescription management.
  • Integrating community pharmacy into the patient pathway. Prompts for this discussion might include pharmacist access to the Summary Care Record, better management of ‘high risk’ or vulnerable patients, pharmacy skill mix, and ensuring GPs have access to clinical pharmacy advice, eg in their practices.
  • Increasing dispensing safety, which might involve a greater use of robotics, improving the reporting of, and learning from, medication safety incidents, and pharmacy design.

NHS England area teams are currently hosting local discussion events. These are open to everyone who works in community pharmacy, CCGs, commissioning support units (CSUs), health and wellbeing boards, local authorities, patients and carers, local education and training boards (LETBs) and academic health science networks (AHSNs). And pharmacy bodies are now bringing interested parties together to ensure their proposals include contributions from a wide range of pharmacists, patients, healthcare professionals and other stakeholders. PSNC held a series of engagement events for LPCs around the country during January. It also has detailed guidance and resources on its website to help LPCs participate.

Engagement is key

Pharmacists are being urged to engage in this important consultation. Mimi Lau, Numark’s director of pharmacy services, describes it as ‘our biggest opportunity to shape what we want for our profession in the years ahead’. It is therefore ‘imperative’ that every person who works in community pharmacy, including support staff and employers, engage with it, she says.

This consultation is significant because it is the first overarching review of community pharmacy by NHS England and it is part of a series that also takes in GP services and others in primary care, says Mike Holden, chief executive of the National Pharmacy Association. ‘Independent pharmacists have a unique perspective to give – it’s important that their voice is heard,’ he says.

Pharmacists and their staff can download the documents and respond online via the NHSE website. Ms Lau suggests responding to the consultation individually by sharing examples of local success and any barriers to change. Examples could be within the four domains of pharmacy services, namely: Optimising the use of medicines, supporting people to live healthier lives, supporting people to self-care and supporting people to live independently.

Pharmacists should discuss the consultation with staff, pharmacists, other primary care colleagues and stakeholders, and attend meetings being held by LPCs and local area teams. Mr Holden suggests that independents take along a copy of the NPA’s ‘From Survive to Thrive’ document (which is referenced in the Call to Action) to help articulate their needs. Pharmacists should share best practice at these meetings. ‘Tell the NHS what is good about community pharmacy, not just the problems.’ These meetings are also a good chance to make commissioners aware of services needed locally and of ways to improve the local population’s health, he says.

The Royal Pharmaceutical Society’s five priorities for the Call to Action

  1. Creating a ‘pharmacy first’ culture. Pharmacy needs to be considered as part of an integrated NHS out-of-hours and urgent- care service. Pharmacists are ideally placed as highly qualified medicines experts who have a lot of experience in advising and triaging people with common ailments, exacerbations of long term conditions and acute illness.
  2. Ensuring patients get the best from their medicines. There needs to be a big shift in the amount of time and focus pharmacists have on patient care and more clinical services should be provided from community pharmacy. NHS England needs to be much bolder in the commissioning of the services from community pharmacy, as well as ensuring incentives encourage integration with other health and social care providers.
  3. Integrating community pharmacy into the patient pathway. Patients must have consistent support as they move between care settings and community pharmacist access to the electronic health record would help facilitate this. Pharmacists should be part of the multidisciplinary team that looks after patients in primary care, breaking down the barriers between different health and social care providers.
  4. Ensuring services are person-centered. Improving the quality of patient care needs to be at the heart of changes to the provision of services through pharmacy. Ask the public and patients what support they need to stay well and then think through how this can be provided through pharmacy.
  5. A focus on vulnerable older people and those with one or more long term conditions. Community pharmacy could do much more to help. For example, through the provision of medication review services for everyone with a long term condition. This should be geared at supporting these most vulnerable patients who take many medicines often for more than one long term condition.

Now or never

The timing of this Call to Action seems ideal for the profession, which has just conducted its own review of service development via the 'Now or Never’ report of the Commission on future models of care. ‘That report has shaped our thinking about the role of pharmacists and the need for the whole profession to change to focusing to providing better care primarily through improved medicines optimisation across the whole medicines pathway,’ says RPS English Pharmacy Board chair Dave Branford. The Society has outlined five clear priorities as a result (see box).

Pharmacy Voice believes that there is more than one answer to the question of how to improve community pharmacy services. ‘We need to create a variety of solutions and innovations, but we will only be able to do this by acting together, as it is essential that we all hold the same shared values, and have the same desire to improve the lives of the people we serve and the people we employ,’ says Rob Darracott, chief executive, Pharmacy Voice.

Patients want personalised, high-quality, seamless care that is focused on their needs, says Mr Darracott. In order to achieve this, health and social care services must transform to meet rising demand and public expectation. ‘We are part of the “how” that will make change happen. There has been enough thinking, and it is now time for some action. It is essential that we start doing things better in community pharmacy, as well as doing better things.’

Organisations outside of the profession are preparing to express their own views, and some, such as NHS Alliance, are particularly pro- pharmacy. Mark Robinson, pharmacy, medicines and medicines optimisation advisor to the NHS Alliance, believes that there are many excellent examples of innovative community pharmacy-based services around the country. ‘Our issue is both integrating these more effectively within the total community-based primary care service and spreading them across the country to provide a consistency that patients can recognise and rely on. Small improvements in the use of technology, accelerating the access to Summary Care Records, direct access to GP appointments and teleconsultation can make a significant difference.’

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