Analysis: Does the global sum add up?
With details of the £645m services funding clearer, is now the time to put all your eggs into the services basket? By Saša Janković
The end of November saw Community Pharmacy England (CPE) reach agreement with Government and the NHS on the launch of a new national Pharmacy First service as well as other changes to pharmacy funding and services, unanimously accepting a deal that sets out how the £645 million investment pledged within the delivery plan for recovering access to primary care will be used to support community pharmacy services.
Under the agreement, a new Pharmacy First advanced service will launch at the end of this month (subject to the required IT systems being in place), alongside an expanded Pharmacy Contraception Service and an updated Hypertension Case-Finding Service, with additional funding to support these latter two.
On the announcement of the agreement, CPE said it believes community pharmacies “should now support these services if they can and look to offer them at scale”, acknowledging: “This will be incredibly challenging in the current climate”.
While any additional funding – and the long-awaited launch of Pharmacy First – is good news, are some community pharmacy businesses still relying too much on their share of the global sum at the expense of other opportunities? Ash Soni, community pharmacist and president of the National Association of Primary Care, says: “In terms of the pure global sum yes, but it’s still hard to assess, as what this amounts to remains a moveable feast.
“The Pharmacy First service announcement and extended roles for community pharmacy are a good area for people to think about, but in general terms, many contractors are still focusing too much on getting their income from dispensing.
“The national contract as it exists right now will at best allow you to wash your face, but if you want to be profitable and successful, you need to look outside the core dispensing function.”
Michael Holden, associate director of Pharmacy Complete, agrees, warning: “Chasing prescription numbers and spending time on procurement of medicines where there is minimal or no profit margin is a downward spiral to a dead end.”
With the Government and the NHS making it clear that the future is service-led around medicines optimisation (New Medicine Service and Discharge Medicines Service); common ailments (Pharmacy First); protection (vaccination and contraception), and prevention (blood pressure checks), Holden stresses: “There are also many opportunities, and more margin potentially, in private services – although these must be focused on market opportunities within their local capture area, not just immediate community, and be well set up and promoted.”
Indeed, private services like travel vaccinations, ear microsuction and aesthetic consultations have become an important income stream for many, but what’s the best way to balance the responsibility of these alongside the launch of Pharmacy First?
“It will depend on capacity, as well as the actual demand for the new Pharmacy First services, not to mention the growing volume of dispensing activities exacerbated by pharmacy closures and patients being dispersed between remaining pharmacies,” says Mark Burdon, pharmacist at Burdon Pharmacy Group in Newcastle-upon-Tyne.
“In a perfect world where pharmacies are suitably resourced, we would all keep pace with all demand. However, during these straightened times, some tough decisions are needed to decide where to focus efforts.
“Getting the balance is important, but I don’t think there’s a magic formula. Each pharmacy owner will have to take time to think about their own circumstances, but finding that time is a problem in itself.”
The Government’s recent announcement of the new living wage will also put a strain on the resources of many pharmacy businesses, which could have a knock-on effect on service provision. Holden calls it “a real challenge to balance”, especially since “capacity and capability in their teams will require investment when they have limited funds to do so”.
On the other hand, although Pharmacy First will take additional time, there are now more opportunities to delegate elements of most services to the wider pharmacy team in order to release pharmacists’ time – although this, too, needs balancing.
“With the launch of Pharmacy First, there is a potential for pharmacies to carefully evaluate their staffing arrangements and scheduling practices to ensure that they can effectively meet the needs of all patients,” says Funmi Balogun, community pharmacy integration lead at Bedfordshire, Luton and Milton Keynes integrated care board (ICB).
Balogun says another key challenge is ensuring that the new NHS services provided under Pharmacy First are “seamlessly integrated” with existing patient care pathways. She notes that “pharmacies are working closely with their local healthcare system to develop clear referral processes and communication channels to avoid confusion and delays in patient care with the support of integrated technology”.
Despite these challenges, Balogun calls Pharmacy First “a welcome development supported by the local pharmacy leaders and community pharmacies” and says: “By working collaboratively with primary care networks (PCNs), ICBs, and Community Pharmacy England, we are confident that they can overcome these challenges and deliver high quality care to all patients.”
Collaboration is key
It is the issue of collaboration that many within community pharmacy recognise could make or break the sector’s future.
At the Avicenna conference in September 2023, Soni recommended that pharmacies forge strong relationships with PCNs and ICBs to develop and pitch NHS-funded opportunities outside the global sum. But is this easier said than done?
“At national and ICB level, there is much wider recognition of what pharmacies can be used for, and what else pharmacists and their teams can do in our communities, but the challenge here is engagement”, admits Soni.
The solution, he says, is to understand the new architecture of the NHS. “You have to know what an integrated care system (ICS) and an ICB is, what an integrated neighbourhood team means, and what your relationship is within primary care.
“Get to know who does what within the system and then work out where the gaps are and how you can get involved.
“Find your PCN pharmacy lead and get to know them, talk to your LPC [local pharmaceutical committee] to find out what it is doing to support people to engage with the PCN, and go talk to the PCN clinical director. It’s not always easy and I know not everyone can do it or has the time, but it’s about finding the person who is prepared to step up and there’s always someone who can.”
Soni is not alone in pushing this relationship-building approach. “I think Ash is correct, and that we should try,” says Sanjay Patel, director of Innovate Pharma Services Ltd. “However, I think that most PCNs and ICBs are overspent, overstretched and don’t have enough funding themselves, let alone to share parts with other parts of the NHS such as community pharmacists. That said, I still think it’s important for everybody to build strong relationships with local healthcare providers. This is going to be critical if you want to be successful in the pharmacy, and I think this is why some of the multiples and smaller groups have struggled.”
Of course, it pays if the system is receptive. Strengthening local relationships with PCNs and ICBs and other community pharmacies is a crucial strategy to identify and develop NHS-funded opportunities both within and outside the global sum, says Balogun. She says her ICS is “committed to supporting community pharmacies in their efforts to expand their role within the healthcare system”.
This is, in part, a culture change. “We need to grasp what the local purse is that’s held with the ICB,” stresses Ade Williams, director and superintendent pharmacist of the M J Williams Pharmacy Group. “Other sectors know this and go to them for funding, but pharmacy still looks to the NHS for its future and that needs to shift.
“We are also not yet at the place where everybody has visibility of our offer, which means we are not having conversations where we are showing we are the solution to their needs.”
The pathway to the solution, says Williams, is “to make sure we have good working relationships with the commissioner [at the ICB] because if we don’t, someone else will, and we will end up finding ourselves out in the cold because they will continue to go back to the people they have already been working with.
“If there’s nothing coming out of your relationship with your ICB at the moment, that’s a warning sign – we sit back at our own peril.”