Pharmacy's place in the new healthcare system

The new system for commissioning is complex but pharmacy can still play its role, says Mike Smith

I’ve been reading the NHS Confederation report ‘Health on the High Street – rethinking the role of community pharmacy’ about where pharmacy fits into the new healthcare architecture.

The system of commissioning is complex and I have heard comments from some areas that it is not working very effectively. I have discussed this before, but I think it is time for a refresh.

Essential services (which include public health services, public health campaigns, prescription-linked healthy lifestyle advice and support for self-care), and advanced services (including supporting patients’ adherence to medicines and associated lifestyle interventions that may improve health outcomes) are commissioned by NHS England. Local services (such as EHC, smoking cessation, methadone and needle exchange programmes) are now commissioned by local authorities and health and wellbeing boards are responsible for developing and updating pharmaceutical needs assessments (where accuracy is vital for assessing contract applications) and promoting integrated care.

In the report it is acknowledged: ‘This is a more complex system with more bodies responsible for commissioning different services from community pharmacies’. Are you with me so far? I quote: ‘Community pharmacies sit right at the heart of our communities and are trusted, professional and competent partners in supporting individual, family and community health.’ We all know this and it is widely acknowledged. So why then have things become so complicated? The NHS Confederation describes an intention for: ‘A coherent approach to commissioning community pharmacy services that aligns across localities and between local and the national contracting process.’ But who is going to make this happen? And the report adds: ‘Sustained efforts will be needed to drive understanding of the value of services provided by community pharmacy.’ What is it that we have been doing for all these years?

These words are lost on me. Almost 12 months after the introduction of new commissioning structures, the issues seem more complicated than ever: talk about rearranging the deckchairs on the Titanic! Despite the publication of this never-ending pile of reports, we poor pharmacists are battling under increased workloads, falling profits and the day-to-day challenge of operating our pharmacies for the benefit of our patients.

The ‘Health on the High Street’ paper was produced by the Pharmacy and Public Health Forum with input from the RPS, CCA, NPA, PSNC, GPhC, NHS England, Faculty of Public Health, Association of Directors of Public Health and Public Health England – no wonder things are so complicated. Please give pharmacy something it can work with – and it will deliver!

We all know what to do – we just need to do it and be paid for it. No more empty rhetoric

Here are just a few more recent consultations:

  • ‘Review of NHS pharmaceutical care of patients in the community’ and ‘Prescription for Excellence’ (Scottish Government, Scotland)
  • ‘Making it better through pharmacy in the community’ (DHSSPS, Northern Ireland)
  • ‘Vision for community pharmacies’ (PSNC, England)
  • ‘Now or never: shaping pharmacy for the future’ (RPS, England)
  • ‘Putting the care into pharmaceutical care’ (Welsh Government, Wales)

I am sure everyone involved are well meaning, but we know what to do –we just need to do it and be paid for it. No more empty rhetoric.

There’s little chance of a minor ailments scheme across England in the next two years, according to Sue Sharpe of PSNC. This is a pity because it works well in Scotland and would meet many of the aspirations of the document I discuss above. We work hard for the communities we serve – and we can make a real difference to the public’s health. This is vital, for it is only through improved public health that the NHS can survive if it is to remain free of charge.

On an upbeat note, I am delighted to see the first list of RPS Faculty members. They should be very proud and it will do much to increase the Society’s professional credibility.

I hope you have all had a successful trading period.

Mike Smith is chairman of Alliance Healthcare.

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