Rather than reframing well documented challenges, improving primary care will mean less focus on process and a transition to a qualitative and improved, patient-centric model. So says project chair and GP James Kingsland in his introduction to a new report from think tank Public Policy Projects and consultancy Healthworks. 

Stronger Together: collaborative primary care at scale calls for a better understanding of what each service does, over and above its contractual obligations, suggesting ‘thinking the unthinkable’ and braver collaborations would benefit all parties. Rather than ‘building back better’, primary care needs a more meaningful mantra, such as ‘achieving fair and sustainable health improvements’. 

Covid has forced radical changes to the way care is accessed, and it has highlighted inequalities in UK health outcomes. The contributors to this rare collaboration across the contractor professions conclude that there is a pressing need to reset care delivery by applying fresh thinking to the concept of ‘primary care at scale’ (PCaS), which is not only possible, but a necessary progression. “To be successful, a cultural shift is required by both clinicians and patients which changes the dependency on the GP being invariably the first point of contact and creates new models of care management.” 

Community pharmacy must be open to a radical change of structures and mindsets. A ‘grid of ideas’, matched by a will and ambition to commission and to be contracted, is needed next. “It’s important for the sector to have a unified vision for the future. That vision or roadmap should be based on a clear definition of the role of pharmacy, and should reflect an understanding of (but not be constricted by) what is acceptable to patients and providers.” The sector should create it or risk having change imposed on it. 

Noting that some pharmacies moved into services such as ear wax removal, normally provided by GPs, during the pandemic, the report recognises that the whole system can benefit from satisfying a need in a consumer-driven market. Citing the national flu vaccination programme, the report says commercial drive often promotes innovation. “Reducing the option for people to pay for services would lead to unintended consequences and both pharmacy and the population must learn to live comfortably with this duality.”

The report reflects concerns that local commissioning could fragment services, arguing that “having an optimum national service specification set on which the pharmacy sector is unified, would end complex local negotiation… and offer more consistent services to the benefit of the population and health economy.” The Covid-19 vaccination programme was nationally agreed but commissioned locally, but “an over-reliance on national frameworks can threaten to stifle innovation”.

Specifications would need to be reviewed regularly. The ideal environment is one in which local innovations are shared and quickly adopted to a national level, perhaps through an innovation hub to prevent unnecessary duplication. 

Addressing what it calls “longstanding areas of misunderstanding and mistrust within - and of - the pharmacy sector” requires different kinds of conversations between the professions, especially between GPs and pharmacists. “Changing contracts is not the ideal starting point for initiating change,” it says. “The more powerful drivers are around job satisfaction, work-life balance and self-esteem.” 

Speaking at the report’s online launch, contributing author and Somerset LPC CEO Michael Lennox said the GP Directed Enhanced Service around CVD and hypertension was the beginning of a blending together of the GP and community pharmacy contracts. Running in parallel, the community pharmacy hypertension case finding service is an opportunity to deliver at scale blood pressure cohort management. 

Citing the Community Pharmacist Consultation Service, the Discharge Medicine Service and the New Medicines Service as the building blocks of wraparound services for patients, he said he was “too old to be a kid with a crazy dream. These services are here, will be successful and will grow. That is PCaS in an integrated manner. Of course many things get in the way. Do we trust each other? Do we like each other? Do we want to work together? Stronger Together says ‘let’s work together to build the right culture’.” 

Stronger Together was created by focus groups of leaders from the four contractor professions. Participants included Cornwall LPC chair Nick Kaye, Lucy Dean, MD at Dean & Smedley, CCA head of policy Nick Thayer and Stancliffe Pharmacy’s David Broome. Download here