NHS Long Term Plan paves way for local role rethink

By Michael Lennox, chief officer, Somerset LPC and council member, National Association of Primary Care

Last month’s NHS Long Term Plan puts pharmacy at the heart of transformational change in our healthcare system… and it presents us with an ideal opportunity to radically rethink the traditional role of the community pharmacist.

The importance of broadening the work of community pharmacists – shifting the focus from dispensing to patient care – is emphasised in the plan. The development of primary care networks, with pharmacists working in partnership with other health professionals, is central to it.

It’s a timely document because most of us recognise that the days when we could make 90 per cent of our profits from dispensing are gone. The way in which we provide healthcare in this country is changing, and community pharmacists must keep pace if they want to survive and thrive. It’s long been recognised that pharmacists are one of the most under-used professional resources in the NHS, but how do we move from a profit-based contract to one based on patient-centred care?

The 2008 White Paper Pharmacy in England: building on strengths – delivering the future heralded a new vision for pharmacy, encouraging the sector to expand and improve the range of clinical services it offers, particularly for those with long-term conditions, including routine monitoring, screening and supporting better use of medicines. It encouraged pharmacies to be centres promoting and supporting healthy living, offering lifestyle advice and self-care support,as well as treating minor ailments.

Progress has been relatively slow, but over the last couple of years we’ve witnessed a transformation taking place in primary care and, in some parts of the country, community pharmacy has played a key role in this changing landscape. I’ve found this willingness to move to localised integration and innovation very heartening to see.

In 2015, the National Association of Primary Care (NAPC) spearheaded the drive towards health and social care professionals working together in primary care networks with the launch of its primary care home (PCH) programme. The PCH model now has a well-established reputation as an innovative approach to strengthening and redesigning primary care, with the focus on integrated working designed to provide enhanced, personalised and preventative care for local communities. 

Primary care transformation

Staff working across the health and care system come together as a complete care community – drawn from GP surgeries, community, mental health and acute trusts, social care and the voluntary sector – to focus on local population needs and provide care closer to patients’ homes. That focus on a defined, registered population enables primary care transformation to happen at a fast pace, either on its own or in collaboration with others as a foundation for larger models. 

Through its PCH model, NAPC aims to extend the integration of services and the work of multi-disciplinary teams so that community pharmacies play a key role in supporting the health and care needs of their local population. This new model of care has led to many exciting developments in terms of an expansion in the role of local community pharmacists. 

There are now 220 PCHs across the country, including Beacon Medical Group PCH in Plymouth where local pharmacists work as part of a multi-disciplinary team. Instead of competing for patients, surgeries and pharmacies work together to improve flu vaccination rates, taking advantage of all opportunities to promote the vaccine and recommend the easiest, most appropriate setting for each individual patient. 

This joint working has led to an increase in the number of people taking up the vaccine, including those with respiratory conditions. Pharmacists form part of Beacon’s urgent care team, working alongside GPs, a paramedic and nurse practitioners to screen all patients seeking same-day appointments. The PCH holds monthly multidisciplinary team meetings, which include pharmacists, to discuss patients of particular concern and create treatment plans. 

Somerset LPC is NAPC membership pioneer

The new Long Term Plan makes it clear that NHS England is committed to making far greater use of pharmacists’ skills, as we’re now seeing in Plymouth and in other parts of the country. As part of that commitment, an extra £4.5 billion will be invested in expanding community-based multi-disciplinary teams with a substantial increase in the number of pharmacists involved. These teams will be aligned with new primary care networks, including NAPC’s PCH model.

The plan outlines how pharmacists may become more involved in helping to identify and treat people with high-risk conditions and undertaking a range of medicine reviews, including educating patients on the correct use of inhalers and visiting care homes. The increased funding will enable more pharmacists to work in general practice, helping to relieve pressure on GPs and hospitals.

Change tends to be met hesitantly in community pharmacy, but the changes I now see taking place are exciting and something to be embraced rather than feared. In Somerset we’ve just become the first LPC in the country to become a member of NAPC – an organisation which is at the centre of shaping the future of healthcare, spreading innovation, influencing policy and supporting and connecting professionals. By joining NAPC, we’re sowing the seeds for community pharmacy to become integral to the new models of care now taking shape in Somerset. 

Last year I worked closely with NAPC and others across the sector to produce a guide to strengthening relationships between community pharmacy and general practice. Primary care home: community pharmacy integration and innovation  demonstrates some of the opportunities that exist for greater integration and improved health outcomes.

Within three years of the PCH programme launch, it’s already covering nine million patients – that’s 16% of the population. Many more PCHs are currently under development across three integrated care systems (ICSs) and more than a dozen sustainability and transformation partnerships (STPs). 

A new ways of doing things

I’ve been inspired by some of the early successes of PCHs elsewhere, particularly those which have put community pharmacists at the heart of their workforce and service redesign. They are testament to the fact that self-determining, mindset change is possible, and so is tangible change – in many cases by optimising and altering the use of existing resources. What the most forward-thinking PCHs have in common is an appetite for a new way of doing things among different health professionals who are willing to abandon the old ways of silo working and collaborate in the best interests of their patients.

As an example, in Fleetwood, Lancashire, pharmacists are working with their colleagues in the local primary care home and the town’s residents to help people take control of their health. Pharmacist Chris Roberts, the medicines management lead for Fleetwood PCH, which looks after around 30,000 patients, ran a local community pharmacy until he joined the practice in 2016. The surgery was short of two GPs and Chris, one of the first pharmacists in the country to be based in a practice, became part of their multidisciplinary team helping with medication management and reviews, long-term conditions and patients being discharged from hospital.

He set up a minor ailments service and put EMIS software, that allows access to the GP patient record, into community pharmacies so they could access patient information. Chris and his PCH team are aiming for the “demedicalisation” of healthcare in Fleetwood, replacing traditional treatment with social prescribing. Their mission is to give patients a better service in the local community, to improve their quality of life and reduce the cost to the NHS of secondary care. 

The PCH has been instrumental in the development of a huge range of resident-led activities such as dance and exercise classes, walking football, a table tennis club, fishing group and a “health and harmony” singing group which now has more than 150 members including residents of local care homes. Fleetwood PCH’s approach to multi-disciplinary working and transforming patient care earned it the title of Primary Care Home of the Year in last year’s NAPC awards. You can read more about this here.

In Somerset we intend to use the Beacon and Fleetwood experience and many others examples of best practice around the country as the basis for our own primary care transformation journey. We’re in the early stages now, and we’re currently laying the groundwork for what I believe will be a rich harvest of innovative, joint-working projects over the coming months. This involves building strong relationships and agreeing the way forward with key partners, including the local clinical commissioning group (CCG), STP, general practices, hospital trusts and voluntary sector. 

Last year our LPC worked with the CCG and Local Medical Committee (LMC) to host a series of ‘Walk in my Shoes’ exchanges, which involved GPs visiting some of our local community pharmacies and pharmacists spending time in GP surgeries. This built trust and the will to work together and that in turn has led to some small, initial changes and allowed us to start scoping projects to develop later this year. These include piloting access to EMIS in local community pharmacies to give them more opportunities to undertake medicine reviews.

If you’re interested in setting up some similar exchanges between GPs and pharmacists in your area, the Pharmaceutical Services Negotiating Committee (PSNC) web site has a useful ‘Walk in my Shoes’ toolkit  to guide you through the process.

Local strategic forum points way

We have also just enrolled our first wave of community pharmacy independent prescribers with the support of the CCG, LMC and Health Education England. This investment in broadening the skills of community pharmacists reflects the local appetite for change, underpinned by a belief that it will result in a good return on investment – both for the pharmacy and the neighbouring GP surgery providing the designated medical practitioner to supervise the independent prescribing course.

But we’ve gone bolder. Last month Somerset LPC hosted a community pharmacy strategic forum, bringing together 36 local and national key players to co-create a two-year forward view for community pharmacy in Somerset. 

And this is all happening in partnership with the full support of our local health system – the STP, CCG, LMC and local authority – and with the input of a number of pharmacy bodies, including PSNC, the Company Chemists’ Association (CCA) and the National Pharmacy Association (NPA). The resulting development and delivery plan will pave the way forward for the next phase of our journey. 

I’m optimistic that 2019 will be a good “growing season” for new ways of working in Somerset – both for community pharmacy and for the wider primary care system. Watch this space because, in conjunction with P3pharmacy, I’ll be bringing you regular updates on our progress throughout the year.

In the current climate, pharmacy is not for the faint-hearted or the closed-minded. But being bold, and being recognised as a key part of “team primary care” – living in the same primary care home as general practice – seems a positive way forward.

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