The management of long-term conditions is a major burden for healthcare. You don’t need any clever statistics to know this – you can see it from your own prescription data. Eighty per cent of prescriptions that are dispensed in pharmacy are repeats, so by definition, these are for long-term conditions.

As the landscape of the NHS changes, community pharmacy services must also change. Our supply function has been de-skilled. The need for medicines production is far behind us. The role of the community pharmacy has moved from ‘production and supply’ to ‘supply and safe use’ and needs to move forward to ‘supply and medicines optimisation’.

Research has shown that unfortunately, non-adherence rates are as high as 50 per cent. However, many patients with long-term conditions can improve their situation through changing lifestyle factors. Taking on the challenge of supporting these patients is the logical next step for community pharmacy.

Expected outcomes

If pharmacy is to make an increased contribution to the NHS, we all need to understand what outcomes we should be aiming for. These can be broken down into:

• Patient outcomes
• Organisational outcomes.

Patient outcomes are improvements in symptom management or quality of life.

Organisational outcomes are reduced costs to the NHS, reduced workload and improved management processes. In the NHS, this might mean reduced drug costs or reduced hospital admissions. It might also include reduced workload in GP services that lead to improvements in efficiency.

By helping patients to use their medicines more effectively, pharmacy will help reduce prescribing costs and contribute to a reduction in hospital admissions.

Identifying needs

In the past, it could be argued that the way in which pharmacy most often approached local commissioners of services was to think about what it could do, then try to convince the local NHS to commission a service based around this. The success of this approach was variable and somewhat liable to change.

This is a model of selling that does not work effectively. It could be described as starting with a solution and then finding a need for it. If an approach from a financial advisor was ‘I have this great policy, let’s look to see how it could benefit you,’ you would, understandably, be difficult to convince.

A more effective approach is to identify needs and then devise the best solutions. This allows for the creation of the right solutions for your locality. There are a number of opportunities for you to understand the needs in your local area, at a range of different levels.

A primary care organisation (CCG or Health Board level) will have published strategic plans. These will often include three-year plans, an annual plan for the current year and joint health and wellbeing plans, produced in conjunction with other authorities, such as the Health and Wellbeing Board or the Local Authority.

These strategy documents will give high level plans for the key strategic goals for the area. These should link to national priorities and meet local needs. Local priorities will identify areas of health need, as well as the need for structural changes locally and plans for meeting these needs.

At a more local level, you can identify needs for an individual or group of medical practices. The Association of Public Health Observatories, which is part of Public Health England, provides detailed information on medical practices. This includes demographic data and key performance indicators based on different therapeutic areas.

The data provide information about prevalence of a disease and how well it is being managed. For example, it describes the prevalence of diabetes relative to the CCG and national statistics and the proportion of people who have blood pressure and lipid readings within national guidelines. This information will help you to identify opportunities for supporting patients within the framework of NHS priorities and areas where input from pharmacists can reduce NHS spending through prescribing or hospital admissions (as a reminder, this can be accessed online here).