PSNC has presented an alternative path for community pharmacy development – Alastair Buxton explains more about the proposals, and the thinking behind them, to P3

The government has extended its consultation on community pharmacy’s future following the letter of last December in which it set out plans for a funding reduction and other changes. Here Alastair Buxton, director of NHS services at PSNC, fills us in on the service developments that PSNC has suggested in response to the government’s plans.

We’ve heard about funding cuts and now we’re talking about service developments. What’s going on?

The government published an open letter to PSNC on 17 December 2015, in which it outlined some changes for the community pharmacy network, including a 6 per cent reduction in funding for 2016/17. In both the letter, and a subsequent consultation slide deck, the government was clear that it wanted to develop a clinically focused pharmacy service, but the details of this service and how we will get there are still not yet clear.

PSNC therefore worked on a service development proposal that is designed to answer this question for the government and NHS. Our proposals describe how community pharmacy services could progress over the next few years, in several phases, within the context of government drives for efficiency.

The proposals offer a possible way for community pharmacy to develop while meeting the NHS and government’s stated aims for patient care and efficiency. They are intended to show the government an alternative path in which community pharmacists and their teams could support patients to manage their own conditions through better understanding of their treatment, thereby helping reduce pressure elsewhere in the overburdened NHS.

What have you proposed?

The service proposals include the introduction of a care package that would see electronic repeat dispensing becoming a default option where medicines are needed on a long-term basis, patient registration at pharmacies, and pharmacies offering enhanced medicines optimisation services, building on MUR and NMS. They set out how community pharmacy teams could offer inhaler technique checks and coaching sessions, post-discharge MURs and minor ailments advice and emergency supply services. We also suggest that pharmacies could take part in six national public health campaigns every year, and that teams could record prescription interventions using a standard classification system.

The proposals have been set out in three phases, in recognition of the need to allow the wider NHS and community pharmacy to adopt them in a controlled manner that also allows time for other enablers, such as IT, to be put in place. These are set out in the boxes below.

Proposals: phase 1

  • Transfer from repeat prescribing to e-repeat dispensing (eRD) and develop a community pharmacy care package for patients
  • Offer of an inhaler technique check and coaching session to patients prescribed inhalers
  • Prescription interventions to be clearly recorded using a standard classification system and the data to be centrally collated
  • Post-discharge Medicines Use Reviews (MURs) to continue
  • To effectively implement a Minor Ailments Advice Service and an Emergency Supply Service
  • Public Health England (PHE) and NHS England should agree up to six national campaign topics each year, running within pharmacies for up to two months.

Proposals: phase 2

  • Additional elements would be provided as part of the care package in phase 1, with the aim of optimising the patient’s use of medicines, treatment of their condition and improvement of their patient activation score
  • Pharmacies will work towards achieving a Healthy Living Pharmacy equivalent accreditation, with support staff training to become health champions to effectively support behaviour change by patients and the public.

Proposals: phase 3

  • Pharmacies would additionally provide support to specific groups of patients to manage long term conditions
  • More advanced support would be available for frail and older people living with multiple conditions
  • This phase would require the majority of community pharmacists to be qualified as independent prescribers.

 

Where did you get these ideas from?

The service development proposals build on PSNC’s vision, first published in 2012, which has formed the basis of its work plan over the past four years. A contractor survey carried out after publication of the vision found that 98 per cent of respondents supported PSNC’s aspiration for the community pharmacy service to offer support to our communities, helping people to optimise use of medicines to support their health and care for acute and long-term conditions, and providing individualised information, advice and assistance to support the public’s health and healthy living.

In updating the vision into new proposals, we took into account factors such as the latest evidence that we have for services, the government’s plans and priorities, and our most recent negotiations with the NHS.

What evidence is there for this?

Over the years we have built up a range of evidence for the benefits of community pharmacy services, and this has been growing, even in very recent months. For example, an evaluation of an NHS-funded community pharmacy emergency repeat medication supply service (PERMSS) discovered that, in the absence of this service, 50 per cent of patients would have missed their medication until they saw their GP, while a further 46 per cent of patients would have accessed another out of hours service. The evaluation, published by BMJ Open, concluded that emergency supplies should be provided by community pharmacies in order to reduce the burden on the wider NHS.

And it isn’t just supply services that have received attention. Another recent BMJ Open publication was the result of a systematic review exploring the effectiveness of pharmacy-delivered interventions for weight management, smoking cessation and the misuse of alcohol. The review concluded that community pharmacy is an appropriate and feasible setting to deliver a range of public health interventions and that given the potential reach, effectiveness and associated costs of these interventions, community pharmacy should be considered by commissioners to help deliver public health services.

DH has already identified the need for additional clinical pharmacy support for care homes. PSNC believes community pharmacy can provide some of the necessary support, but the approach to team working with general practice would need to be explored in order to maximise the value provided to patients and the NHS. This is work that could initially be explored using funding from the Pharmacy Integration Fund.

Have you had a chance to talk to the Department of Health about these sorts of services yet?

PSNC has long been discussing these sorts of services with key NHS stakeholders. For example, in 2014 we hosted an event focused on community pharmacy’s role in helping people with asthma, and a Minor Ailments Advice Service (MAAS) was discussed at length with the NHS as part of the 2015/16 funding settlement.

We had hoped that we would be able to reach agreement on our detailed proposal for the MAAS, but NHS England subsequently decided not to pursue this. PSNC received no feedback as to why NHS England decided not to take this service forward at the last minute, but given the significant number of local commissioners continuing to fund or express an interest in minor ailments services, and the benefits and value that we know a national service could bring for patients and the NHS, we believe that we must continue to make the case for this.

What happens now?

We believe that rather than focusing on pharmacy numbers, the NHS should be making use of the accessibility and regular patient contact that the community pharmacy network offers to build services to help it meet its ongoing financial and demand challenges. Clinical services that are provided alongside the medicines supply function of these pharmacies can offer more convenient care for patients and better value for the NHS. We will continue to make this case to the NHS and government in our ongoing discussions with them over the next two months.

Alongside these detailed discussions, we have been working with the other pharmacy organisations on a campaign, both to warn about the risks of the government plans and to promote community pharmacy and the services that we offer.

In a meeting of the All-Party Pharmacy Group (APPG) on 16 March, pharmacy minister Alistair Burt stated that the government saw real potential for greater use of community pharmacy and that the community pharmacy consultation would be extended by two months to give government more time to develop its proposals working with PSNC and informed by other stakeholders.

Community pharmacy teams can be assured that PSNC will be continuing its discussions with DH and NHS England, seeking to understand more about their plans and to ensure that community pharmacy’s role is recognised and developed. Overall, the proposals set out by PSNC represent a starting point for discussions with DH and NHS England, describing how community pharmacy teams could make a more significant contribution to patient care. At this time of financial strain and increasing demand, we believe they present a way forward that DH and NHS England cannot afford to ignore.

How can pharmacy contractors help?

Contractors and their teams can all get involved in the campaign for community pharmacy’s future, which involves petitions, lobbying, press coverage and the Support Your Local Pharmacy website. You can help in a number of ways, whether it is tweeting examples of the brilliant care you are giving, persuading patients to sign the Downing Street petition, or taking part in a local media interview. For useful tips, guidance and resources, visit our community pharmacy campaign hub page.

We have built up a range of evidence for the benefits of community pharmacy services, and this has been growing, even in very recent months

We Recommend

Inhaler recycling scheme is set to expand

GSK’s Complete the Cycle inhaler recycling scheme is gathering pace, says the company

Leading for the NHS

Today’s leaders in healthcare have to be able to inspire their teams to give their best – it’s all about hearts an...

Popular Features

Our time has come- or has it?

Mike Smith puts the world to rights… We have read much in the press lately that the time for pharmacy has come – but...

Selling in the pharmacy

How to balance commercial enterprise with proper and correct care.

Epic debate in Parliament highlights support from MPs

A motion in Parliament against community pharmacy cuts received strong support for the sector from MPs in hours of debat...