An increasingly beleaguered community network in England has suffered setback after setback over the past year: the pharmacy cuts, judicial reviews, category M reductions and the possible Amazon invasion – and all this while the relationship with mandarins at NHS England has become more fractious and distant.
One could be forgiven for thinking the future looks completely grim. However, despite the serious threats and challenges, opportunity still exists for those with the fight left in them. “The next few years are paved with uncertainty in the pharmacy sector, particularly with the impact from funding cuts and income from prescriptions potentially declining,” says Laura Reed, director of professional development at Numark. “It’s essential that pharmacies look at how they can future-proof their business,” she says.
The recently launched Public Health England document Pharmacy: A Way Forward For Public Health outlined key areas where community pharmacy could have an impact in reducing health inequalities, disease burden and premature mortality. The Scottish strategy Achieving Excellence In Pharmaceutical Care outlines key roles for the community pharmacy team and development of the contract to meet the healthcare needs of the people of Scotland. In addition, it details a commitment to increase the clinical skills of community pharmacists. “Both documents recognise the important role pharmacy can play going forward,” says Ms Reed.
“They also both recognise the role of the wider team. When looking at how to drive additional income, pharmacies can often forget the importance of training. If pharmacies are to maximise all opportunities, they will need this skilled workforce to support them and drive recruitment into services.”
She believes the key to enhancing the clinical role of pharmacy is an independent prescribing qualification. “This may take time to fully implement, but becoming an independent prescriber is an option many pharmacists should begin to explore,” she says. “Not only can this qualification be utilised to support the NHS, it can also open up new opportunities in private services, such as Botox and other non-surgical cosmetic procedures, as well as linking to services such as smoking cessation.”
In addition to the nationally identified priorities, Ms Reed says it’s crucial to identify which pharmacy services are being commissioned locally and liaise with the LPC and commissioners to understand how you can make the most of the opportunities. “But it’s important that you deliver on any agreed outcomes within the contracts,” she says. “It’s no longer sufficient to just offer every service available. Commissioners are increasingly demanding outcomes and value for money.”
If you haven’t yet participated in the Community Pharmacy Quality Payment Scheme, you are missing out on your share of the £75 million budget. At least £6,400 is available for each pharmacy once it has fulfilled the four gateway criteria and achieved 100 points over two review periods.
The aim of the scheme is to reward pharmacies for clinical effectiveness, patient safety and patient experience. If you didn’t submit a claim for the first review period on 28 April, there’s still time for the next one on 24 November. It’s an opportunity to recoup some of the money from the cuts. “It’s worth remembering this is the minimum amount you will receive,” says Ms Reed. “The funding is based on 100 per cent of pharmacies achieving the full 100 points. It’s unlikely all pharmacies will achieve all the points across the two review dates. Any remaining funding will be divided between qualifying pharmacies based on the number of points they have achieved. To support our members to meet the quality points criteria, Numark has produced a variety of resources and tips.”
With healthy living pharmacies in England now part of the Quality Payment Scheme criteria, getting behind this quality mark is important. “HLP can help you to deliver additional services and encourage loyalty among customers,” says Ms Reed. “This can lead to increased service revenue as well as improved OTC sales. “For commissioned services, this kite mark could serve as evidence for tenders or may even dictate which pharmacies can sign up to future services.
“While there is a lot of support to get HLPs accredited, the key now is to maintain this going forward and be able to demonstrate through evidence the positive impact HLPs are having.”
Understand your local demographics — what are the key health priorities locally? Tailor your service offering accordingly. What is happening nationally? What is high on the agenda of Public Health England? Consider how you can explore these as opportunities.
Healthy living pharmacy — with the inclusion in the Quality Payment criteria, now is the time to consider becoming an HLP.
Deliver on outcomes — it’s no longer sufficient to just offer every service available. Commissioners are increasingly demanding outcomes, so if you sign up make sure that you deliver.
Make the most of your skills — are you using your skills to maximise the opportunities? For example, if you have received vaccination training, have you looked at other vaccination services you could offer, such as meningitis, shingles and travel?
Maximise all current income streams — as well as looking to expand the range of private services, make sure you are delivering all commissioned/national services fully.
Explore becoming an independent prescriber — while this isn’t for everyone, the opportunities for linking to private services can make this a worthwhile investment. Source: Numark
It’s been estimated by the Royal Pharmaceutical Society that having a pharmacist in every care home could save the NHS £135 million a year and reduce problems such as falls and inappropriate use of psychotropic medicines.
“This presents a fantastic opportunity to reach out to and build a case to support them,” says Ms Reed. “Before deciding to get involved, however, you need to do your homework. Working with care homes isn’t suitable for every pharmacy, but those prepared to commit the time and resources can find it to be a lucrative and rewarding business.
“Even once you’ve secured the business, this isn’t the end. You will need to retain and protect your investment. Think about the added value you can add. For example, could you offer to deliver MURs or NHS flu vaccination at the home, subject to local area team approval?”
Also consider any training requirements,” she suggests. “Care homes have a duty to ensure all staff are properly trained to order, administer and record medication activities. Numark offers members a training package that enables them to deliver comprehensive medicines management training to care homes.”
Private services are one of the areas of opportunity for community pharmacists to use their skills and experience. For pharmacies already providing flu vaccines, it’s not a great leap to provide a comprehensive travel clinic service or other private services that could attract much needed revenue.
“A potential opportunity for pharmacies is the travel market,” says Ms Reed. “With NHS England conducting a review of travel vaccines available on the NHS, now is the ideal opportunity for pharmacies to expand into this service, which can increase profitability and footfall. Many pharmacies now routinely offer flu vaccinations either via an NHS or private service, but why not explore other vaccination services as well, such as meningitis and pneumonia?
Ms Reed also believes there are many other opportunities, but it’s important to carefully consider the services you want to offer. “Don’t limit yourself to the standard services such as blood pressure monitoring and diabetes screening,” she says. “With many areas decommissioning services, such as smoking cessation, why not fill this gap with a privately run smoking cessation service?” You could also link with a PGD where appropriate. “And don’t be afraid to think outside the box,” she advises. “If you have a passion for a particular clinical area or condition, why not explore if it could be developed into a viable service?”
Despite the doom and gloom, there are still opportunities to start to bring community pharmacy out of the doldrums. Maximise what you already do and the skills you have, build new services based on these and patient need, engage with commissioners and develop new skills to invest in the future. It’s not an easy time, but there is still scope to thrive.