By Mark Robinson
Since the NHS Alliance and the Royal Pharmaceutical Society published Pharmacists and General Practice in 2014 enthusiasm and money has gone into putting pharmacists into general practice, with increased clinical skills to ensure they can take on face-to-face consultations. By contrast, the future of community pharmacy is less clear.
Let’s not forget the positives:
• A pharmacy is an integral part of its community; people can walk in and speak with a pharmacist on demand
• Community pharmacy will become a first line disposition for people seeking help through NHS111 and urgent treatment centres, and for emergency medicine supply
• Increasing demand on the NHS, and GP and practice nurses recruitment difficulties, will provide additional opportunities for pharmacists
• The pharmacy has always been a window to public health
On the other hand:
• The increasingly fragile supply chain, and difficulties around medicines reimbursement, is creating greater financial uncertainty
• The use of digital technology to manage repeat prescriptions and direct-to-patient delivery will continue to grow
• Automation will enable hub pharmacies to manage increasing volumes of prescriptions efficiently
• Point of care diagnostics are inadequately used in primary care
• There are few independent prescriber pharmacists in community pharmacies, and even fewer with NHS contracts
• The outdated community pharmacy contract needs to change to support integration within primary care networks (PCNs)
Over the next few months, every GP practice will have to join a PCN, each one covering around 50,000 people. Practices will hold a practice contract, with enhanced services and additional contracts placed through the PCN. It would be sensible for community pharmacies to align with their local PCN, as this will better place them as part of the implementation of the NHS Long Term Plan.
Digital Front Door: As the NHS encourages self-care and access to healthcare through digital platforms such as the NHS App, community pharmacy will have an important role guiding patients to the most appropriate element of the NHS, or another sector, for their needs. Community pharmacy teams should gain access to social prescribing and be able to cement connections between local community assets. Healthy Living Pharmacy will continue to expand.
Access: Community pharmacy will be an important disposition for NHS111, GP triage and urgent treatment centres. The network may contract elements of a minor ailments and injury service, and create local referral systems in which pharmacists can videocall GPs or make direct appointments.
Continuity and co-ordination of care: The relationship between hospital, practice and community pharmacists will be enhanced to support safer and quicker transit of patients through the system while reducing medicines errors. Community pharmacists dispensing hospital pharmacists’ prescriptions and delivering them to patients as they arrive home will become more common. The shared patient record will expand to community pharmacies.
Prevention: Community pharmacy will take a greater role in prevention. Smoking, alcohol and obesity are still major issues. Pharmacies will work closely with vaccine coordinators to improve uptake and have a greater role in ABC (atrial fibrillation, blood pressure, cholesterol) health checks.
Contracted activity: Networks will contract community pharmacies, sharing local protocols within treatment pathways. Patients will be able to choose to have elements of their care provided within the community pharmacy if that represents the most convenient place for them. Accredited pharmacists will initiate or discontinue medicines within agreed protocols, taking responsibility for monitoring and review. Community pharmacists could work closely with practices to undertake medication reviews and asthma checks to improve outcomes.
Skill mix/staff rotation: Pharmacists and other staff will move more freely within the primary care network, softening boundaries between sectors. Training to upskill the workforce for new and advanced roles will be given a greater importance.
There are some big challenges ahead:
• The financial stability and sustainability of the existing model
• The shape and form of new contracts between community pharmacies and PCNs, which will need to cover clinical responsibility and indemnity, and allow for integration of healthcare staff within PCNs
• Maintaining accredited independent prescriber pharmacists when contracted pharmacies are open and providing services
• Redesign to create high quality clinical consultation areas
• Training (and accreditation) of pharmacists, accelerating the process to becoming competent clinicians
• The procurement and maintenance of appropriate diagnostic equipment
Not all pharmacies will want to, or be able to, integrate and contract with them, but PCNs will change the face of community pharmacy.