It’s long. 136 pages. But don’t let that put you off. It’s overly optimistic. Don’t let that put you off either. It was launched by a Prime Minister whose track record on the NHS to date has been all warm words and little action. ‘Spending more than ever on the NHS’- in cash terms, course you are, it’s called keeping up with inflation - covering up for an eight year funding squeeze, with the 3.4% a year for the next four years (barely keeping pace with ‘NHS inflation’ of 4% a year).
Read it. But when you do, focus on the right bit.
Not unreasonably, I guess, the response from community pharmacy has focused on the direct reference, like the last sentence of paragraph 4.21: “In community pharmacy, we will work with government to make greater use of community pharmacists’ skills and opportunities to engage patients, while also exploring further efficiencies through reform of reimbursement and wider supply arrangements.” It’s more threats, a return to the NHS’s ‘preferred solution’ of hub and spoke, more cuts. It’s easy to read what we want to read into those words. Or to have our views reinforced by the echo chamber.
Instead, I’d read “consistent”. Look at the wider economy. Distribution/logistics has undergone a seismic shift. And, underneath the surface, away from the headlines, the shift has started in pharmacy too. Greater use of technology. Robots. Hub and spoke solutions in the largest and increasingly the middle-sized and smaller groups too.
And, if you want to read it that way, the Plan reinforces a distinction between “clinical pharmacists” doing lots of whizzy things, for which read roles more hands on/face to face with patients, sorting out medicines, improving medicines taking behaviour, reducing polypharmacy, from “community pharmacists” who can and do do all those things, although they have lots of other responsibilities too, including acting as a first point of contact for members of the public on the high street. We can keep pointing out the semantics, or we can do something about something we can do something about.
So, if you do find the time to read the NHS Long Term Plan – and I hope you do – ask yourself a different question. Instead of “why don’t they want community pharmacists to do this?”, ask “why not?”
Start with Chapter One.
Paragraph 1.9 talks about “£4.5 billion of new investment into expanded community multidisciplinary teams aligned with new primary care networks based on neighbouring GP practices that work together typically covering 30-50,000 people.” So instead of “why aren’t community pharmacists going to be part of these networks” ask yourself “How can we ensure the community pharmacy network is part of this?” Or ask people like Somerset LPC’s Michael Lennox or North East London's Janaka Perera, both working on ensuring the pharmacies they represent are. And note, ‘primary care networks’ is NHS England’s description of choice. The National Association of Primary Care’s ‘primary care home’ programme is virtually the same thing.
Paragraph 1.10 says: “From 2019, NHS 111 will start direct booking into GP practices across the country, as well as refer on to community pharmacies who support urgent care and promote patient self-care and self-management. CCGs will also develop pharmacy connection schemes for patients who don’t need primary medical services.” Don’t sit back and wait for somebody in the NHS or the Department of Health to work out what this might look like. Ask yourself: “How would I make this work if this was down to me. What do I need to make this fly?” “Who do I need to speak to, to find out what’s happening locally on this, and to put in my idea (even better, plan) for how this can work here?”.
Paragraph 1.12 says: “We will also offer primary care networks a new ‘shared savings’ scheme so that they can benefit from actions to reduce avoidable A&E attendances, admissions and delayed discharge, streamlining patient pathways to reduce avoidable outpatient visits and overmedication through pharmacist review.” It doesn’t specifically mention community pharmacies, but why not? What would need to happen so that it did? Who can make that happen where you are?
And paragraph 1.26 says: “We will fully implement the Urgent Treatment Centre model by autumn 2020 so that all localities have a consistent offer for out-of-hospital urgent care, with the option of appointments booked through a call to NHS 111. UTCs will work alongside other parts of the urgent care network including primary care, community pharmacists, ambulance and other community-based services to provide a locally accessible and convenient alternative to A&E for patients who do not need to attend hospital. Your response should be the same as for Paragraph 1.10. So, don’t sit back and wait for some would-be genius etc etc. You know what you do (and can do) better than anyone else.
There’s plenty more in the Plan to unpick – the absence of real detail about finance in lots of areas, whether the further move to integrated care systems (ICSs) is the final total abandonment of the Lansley reforms, how the ambitions for public health and prevention sit alongside continuing cuts to the public health budgets transferred five years ago to local authorities, and whether the plan really provides the basis for a serious debate about how we sort out social care in England, given the reluctance of politicians of all parties to bite the bullet on long term planning/funding. You need to speak the language, and recognise it's changed.
Further insights on all this coming soon.
Until then, happy reading.