A barrage of recent national initiatives and consultations may have left many pharmacists rather overwhelmed and confused. Is the future direction any clearer? The pharmacy bodies give a progress report

The ‘Now or Never’ report into future models of care, NHS England’s Call to Action and Scotland’s Prescription for Excellence are just three of the groundbreaking documents launched in recent months. There can be no doubt that political momentum is building towards a significant change in the way that community pharmacy is practised. But what does all this mean for the average community pharmacist?

Over the next few years, the pharmacist’s role will become increasingly centred on improving patient care, says Neal Patel, RPS spokesman. ‘We hope pharmacists will be empowered by their employers and commissioners to focus their time and energy on improved patient care, deploying their skills to improve medicines use.’ The Society hopes the outcome of the Call to Action, expected to be published later this year, will bring this about.

Changing public expectation is ‘vital’, says Mr Patel. ‘Patients expect a great standard of care from pharmacists and pharmacists deliver this in spades, but we all know the statistics of how few people take medicines correctly.’ The Society wants the public to expect pharmacy services that improve the safety and quality of their care, building on existing Medicines Use Review and New Medicines Services. It is working on a medicines charter for patients to fulfil this aim, which it hopes to publish by the end of this year.

The Now or Never report called for better co-ordination across the sector, and identified the potential of local professional networks to bring pharmacy together and work across the commissioner landscape. Following on from this, Pharmacy Voice wants to see pharmacy bodies working together more collaboratively on key issues.

‘There’s already a good deal of innovation going on within the sector as we’ve seen great examples of forward thinking such as pharmacy teams carrying out health checks in local pubs and garages,’ says Rob Darracott, chief executive of Pharmacy Voice. ‘The real issue is around scaling up these services and innovations, to ensure they’re of demonstrable benefit to patients.’ He suggests that pharmacists should be considering how they can make persuasive arguments to their CCGs and local area teams to ensure that services are re-commissioned.

Last chance to change

The Call to Action consultation is the first overarching review of community pharmacy by NHS England, with the current financial status of the NHS increasing its importance, says Gary Warner, chair of PSNC’s service development subcommittee. ‘The Health Service is simply not sustainable as it is. If it doesn’t adapt and make radical changes now, there may be no other chance. The good news is that we have lots to offer. We know the difference we can make helping people to take medicines properly, stay healthier, live independently and manage their conditions. Extending our services in these areas could greatly reduce pressures and costs in the NHS.’

And this is what exactly what PSNC says it hopes to see over the next few years – the gradual development of services around the core supply function, at both national and local levels. This could be through a national minor ailments scheme, letting pharmacies bid to deliver flu vaccinations, or extending medicines optimisation services so pharmacists can help vulnerable patients in their own homes.

Response to the CTA has been positive’, says Mr Warner. ‘Pharmacy teams have said they do want a future at the heart of the NHS, and they do see themselves helping patients with their medicines, long-term conditions and general health.’

Pharmacy teams have said they do want a future at the heart of the NHS, and they do see themselves helping patients - Gary Warner

Fin McCaul, chairman of the Independent Pharmacy Federation, is convinced that significant change is on the cards, and expects the consultation to create a blueprint for the next five to 10 years. Community pharmacy is in a good position to take on more roles because it is at the forefront of patient care, which the new NHS is focused on delivering more effectively, he says. ‘We would be astonished if there wasn’t a greater importance put on community pharmacy.’

But while it remains unclear what form this new emphasis might take, Mr McCaul suggests that contractors concentrate on developing their teams and their relationships with patients and local professionals such as GPs, dentists, CCGs and health and wellbeing boards. Independents should consider local colleagues as collaborators in the provision of better care, rather than competitors, as in the past.

While pharmacists’ level of response to the consultation could have been better, ‘we’re all in a position where it’s hard to do the day job’. It is the role of pharmacy bodies to raise awareness among pharmacists and others, and they have proved successful. ‘I’ve never, in my long time in pharmacy, seen so much written by other organisations about the value of community pharmacy. Now we’ve got to make sure that we’ve got the people to deliver.’

The price of failure could be enormous. ‘There is no plan B. If we don’t engage properly with the Call to Action and come up with a cohesive solution then we will be out in the cold for the next 10 years – there’s no doubt about that.’

As a rally driver himself, Mr McCaul uses the analogy of the 10-second countdown before the start of a race to describe this period. He suggests that pharmacists use this preparatory opportunity to get their teams ready for action.

Plenty of independents have engaged with the consultation, says Stephen Fishwick, head of communications at the NPA. ‘Independents want NHS England to be ambitious about community pharmacy as a uniquely accessible health and social care resource – maximising the potential of the bricks and mortar network and the face-to-face, therapeutic relationships between pharmacists and patients,’ he says.

Turning policy into action

There is wide political and NHS support for giving community pharmacists access to patient records, says Mr Patel. The RPS is seeking endorsement from patient groups and health professionals for the policy this year. ‘Turning the policy intent into a change on the ground will require many parts of the NHS, pharmacists, GPs and IT system suppliers to work together.’ The RPS is working collaboratively with NHS England, the Health and Social Care Information Centre (HSCIC) and IT system suppliers and other pharmacy bodies to bring about this change as soon as possible. It expects that the technology will be enabled to allow this to happen in 2015.

Pharmacists will need access to patient records if they are to take on a larger role in self care and the management of long term conditions, says Mr Darracott.

Excellent, but slow

Prescription for Excellence was launched September last year as a 10-year vision and action plan, but the Scottish Government has still to form its working groups to support implementation. At least partly because of the scale of change proposed, many stakeholders are still busy engaging with each other to determine what the implementation might look like.

To further complicate the issue, the Scottish Government has not announced its plans for market entry regulations following the recent consultation. These could also affect the face of community pharmacy in Scotland and delivery of the vision. Also in the melting pot, the Public Bodies (Joint Working) (Scotland) Bill was recently agreed by the Scottish Parliament, but implementation details are likely to be in secondary legislation and guidance, which are still to be developed.

Despite this uncertainty, Numark’s director of pharmacy services, Mimi Lau, summarises changes in store as set out by Prescription for Excellence:

• Pharmacists will need to better co-operate with patients, their carer (where applicable) and health professionals in designing, implementing and monitoring a person-centred pharmaceutical care plan. Patient data will need to be shared.
• Pharmacists will need to up-skill and be accredited by the NHS as clinical pharmacist independent prescribers. Pharmacists will need the time and funds to invest in this.
• Patients will need to be registered with a pharmacist who is listed with the Health Board in order to access pharmaceutical care. Managing patient choice and expectation will be necessary.
• Pharmacists will continue to have an enhanced role in preventing ill health, co-production and minimising health inequalities.

NHS wakes up to self care

The NHS has recently been encouraging patients to use ‘pharmacy first’. Examples include the ‘Treat Yourself Better’ campaign, the winter pressures pharmacy initiative, and NHS England’s ‘The Earlier, the Better’ campaign. ‘It seems that the NHS has woken up to the fact that pharmacy can contribute positively to alleviate increasing pressures on GPs and A&E time and costs,’ says Ms Lau.

Pharmacy should capitalise on this public awareness, she says. The increased footfall should present more opportunities for pharmacists to interact with customers through OTC sales and advice and to signpost other pharmacy services. Pharmacists should add value to every contact made. Staff should be involved, too, as they are often the first point of contact. They should be suitably trained in OTC sales and advice and good customer care.

If the NHS awareness campaigns and Pharmacy Voice’s Dispensing Health initiative have the intended effect, the number of GP and A&E attendances should fall, and there should be fewer people attending with minor conditions or those that could be managed at more appropriate locations, says Mr Darracott. In the long term, more people should be asking for public health advice in pharmacies, which in turn should lead to increased commissioning of pharmacy services.