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The next steps for community pharmacy?

Screen shot 2016-10-27 at 14.18.45.png

The next steps for community pharmacy?

The Community Pharmacy Forward View clearly articulates the sector's vision for the future. So what are the next steps, and who needs to take them?

Autumn brings, for many, the start of a new academic year or the return to work after the holidays. In some respects, it feels like a fresh start; a chance to knuckle down with renewed vigour and focus.

It was also in that spirit that, in September, PSNC and Pharmacy Voice, with the support of the RPS English Pharmacy Board, published The Community Pharmacy Forward View, their vision for the future of community pharmacy.

This sets out the sector's ambitions to radically enhance and expand the personalized care, support, and wellbeing services that community pharmacies provide, in order to improve quality and access for patients, increase NHS efficiency and produce better health outcomes for all.

At its heart are proposals for three key roles for the community pharmacy of the future: 1. Facilitator of personalized care for people with long-term conditions 2. Trusted, convenient first port of call for episodic healthcare advice and treatment 3. Neighborhood health and wellbeing hub.

In the midst of unprecedented pressure on community pharmacy resources, as well as the wider pressures within the NHS, its authors want the Community Pharmacy Forward View document to help create real consensus about the future role of community pharmacy in the delivery of wider healthcare services.

PSNC says its aim is for "a strategic partnership approach to building the future between the sector, government, and the NHS - one that reflects and respects local autonomy and relationships and is closely aligned to the NHS in its goals, but does not leave implementation and delivery to chance. Pharmacy Voice chief executive Rob Darracott drills down further, urging the pharmacy minister David Mowat to “engage with us on this vision when considering his next steps for our sector."

Frontline views

Mr. Mowat was quick to respond, using his speech at September's annual RPS conference to mention that he thought the principles were "spot on" and that "the quality of that document does testimony to the contribution your profession can make."

Unsurprisingly, the View has also been well received by community pharmacies.

Robbie Turner, chief executive officer at Community Pharmacy West Yorkshire (CPWY), calls it "a really positive development". "We see national organizations representing the community pharmacy sector coming together to describe a clear vision for how community pharmacy should develop over the next few years, expanding its role in delivering more services to help patients, and I certainly welcome it," he says. "It's got great support from CPWY and our whole committee is behind delivering on this at a local level."

Steve Jeffers, chief executive of The Hub Pharmacy group, hopes it will have a wider impact on commissioning. "Many pharmacies are providing bits of all three objectives already, just not yet nationally because of our current fragmented commissioning system," he says. "The NHS needs to save money and, if the full potential of pharmacy were released via these service developments, then lots of savings could be made in the wider primary care budget."

This idea is supported elsewhere, as Julie Wood, chief executive of NHS Clinical Commissioners, says the Forward View provides "helpful insight and ideas" about the future of community pharmacy, and will be "useful for CCGs considering how they can further utilize community pharmacy as part of their overall plans to meet the needs of their local area."

And it seems that general practice representatives are also on board. Dr. Johnny Marshall is a GP and the director of policy at NHS Confederation, which welcomed the publication of the Forward View. He says the three points "encompass a shared agenda for primary care disciplines, and community pharmacy being a vital partner for general practice in achieving those three things is a good way of looking at it."

Turning words into action

Despite this warm reception, Mr. Turner warns that "the challenge remains of how we implement it", stressing that "because the NHS is now delivered on a more local footprint than before, we need strong local engagement to make sure this goes forward".

And as a community pharmacist and NPA board member Mike Hewitson points out, the job of the View is to get beyond just talking to pharmacists. "It's not a report by the pharmacy for pharmacy," he says. "It's by the pharmacy for the wider health system. The intended audience of policymakers, politicians, and key decision-makers in the NHS and healthcare system will recognize a lot of opportunities to ease pressures elsewhere in the system and how to improve there." But he warns: "It's got to be about the best solution that is affordable, not just the lowest-cost solution."

Mike Holden, the principal associate at Pharmacy Complete, agrees. "We must take all those working in community pharmacy with us," he says. But equally, "we must ensure that we do the same for those we need to work with - politicians, DH, NHS England, Public Health England, local commissioners (CCGs and local authorities), other pharmacy sectors, and other healthcare professionals."

To do this, he says the messages for each stakeholder group need to be presented "in their language and address their needs, not just ours" because pharmacy "does not and cannot operate in isolation."

Mr. Hewitson believes there is already a lot of content that is "absolutely deliverable right now, given a consistent will across the system. If you look at sustainability and transformation plans [STPs] that are going on within the NHS, it looks like community pharmacy is missing from a lot of those, but we know there are plenty of opportunities out there that may exist beyond traditional routes and funding envelopes. For example, managing out-of-hours requirements, and GP practices using community pharmacists rather than practice pharmacists as they recognize they are the ones with the existing relationships with patients."

Barriers to success

Of course, obstacles are inevitable. Mr. Turner says, as, in any organization, challenges could be that some implementation might entail a culture change. "Being able to drive this forward is also going to take some resources," he says. "And how we identify them and the people to support our pharmacists and teams on the ground to deliver what is a challenging vision is going to be interesting."

Mr. Holden points out that there will also be those who "don't or won't see a role for community pharmacy in this, both within and outside the profession. We must deal with historical intra- and inter-professional baggage and prejudices, poor delivery, egos, and, critically, be about hearts, minds, evidence, and patients."

Hopefully, barriers will be few. "I think it's really important that we explore how these proposals can be carried out," says Dr. Marshall. "We are already seeing pharmacists being a more integrated part of general practice teams, bringing expertise and learning," and the success of the Forward View can build on that by "working in the community in partnership, above and beyond our sector's interests. It's about aligning activities rather than pitching [sectors] against one another, and working together for the benefit of patients."

Read The Community Pharmacy Forward View at www.psnc.org.uk/wp-content/uploads/2016/08/CPFV-Aug-2016.pdf

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