The NHS Long Term Plan (2019) signalled a clear remit for community pharmacy to support the prevention agenda and deliver urgent care through more engagement with patients. The pandemic has shown how good pharmacy is at this – and how much patients value the service – so how can momentum be sustained? The Westminster Health Forum conference on The future of pharmacy services in England looked for answers.
Opening the session, Royal Pharmaceutical Society president Professor Claire Anderson said: “There is a real need to think differently about NHS recovery. We did a review of 144 papers which showed a national programme should embed public health services within community pharmacy to tackle local health inequalities and optimise medicines for each patient. This is more cost effective to the NHS and will reduce waiting lists, medicines wastage and the medicines bill.”
Professor Anderson pointed to what England can learn from the Scottish vision for community pharmacy (which calls for a cultural shift from medicines supply to a clinical focus) by “enhancing workforce learning and research – with protected learning time – modernising medicines supply managed by technicians, and a digital infrastructure with a single shared electronic patient record with read/write access for all.”
Mark Lyonette, National Pharmacy Association chief executive, referred to the NPA’s recent document How We Can Help. This, he said, advocates a “pharmacy first approach” to release NHS capacity to clear the backlog caused by the pandemic and then “maximise the capability of the network to tackle future public health challenges”.
Those who adapt and innovate will succeed; those who do not, may not.
Mr Lyonette said pharmacy faced challenges too. “Where can we find capacity to take on these new roles and deliver on that more clinical future?” Mr Lyonette asked. “The Government has put a lot of faith in hub and spoke as a way of releasing capacity, but we remain sceptical about some of the grander claims and think there are other ways that don’t have some of the same risks.”
A workforce shortage had already led to temporary community pharmacy closures, said Mr Lyonette, and could get worse before it gets better: “Our concern is that without any changes to funding, we will see even more closures, and while the new pharmacy minister accepts new clinical services need to be underpinned by public funding, that funding needs to be a sustained public investment and the current sums don’t add up.”
Duncan Rudkin, chief executive and registrar at the General Pharmaceutical Council, referred to August’s Healthwatch report, which summarised what the public thought of community pharmacy services during the pandemic.
While feedback about medicines-related customer services like deliveries and accessibility was positive, especially from communities that struggle to be heard, he said areas for improvement flagged by the public included “the need for better communication between pharmacy and general practice”.
Mr Rudkin said the GPhC can help pharmacists improve record keeping. “We are concerned about the lack of record keeping between online pharmacy services and general practice that we regularly see,” he added.
Integrated Care Systems (ICSs) will make keeping track even more important, said Michael Holden, associate director of Pharmacy Complete, and digital technologies hold the key. Automation is not just about ‘big robots’, he said. “If you can use refined ways of care such as patient record systems to release efficiencies, then you can start to create time to improve delivery of services,” he said. “Those who adapt and innovate will succeed; those who do not, may not.”
Leyla Hannbeck, chief executive of the Association of Independent Multiple pharmacies (AIM) said the creation of ICSs was a pivotal moment. “There is no better place than community pharmacy to tackle inequalities,” she said. “But there are barriers to us delivering this. Local health plans do not include community pharmacy at the early planning stages; ideas look best when the people taking part have been involved.” Pandemic recovery needs to include “a real and genuine shift” in the perception of the profession, she said.
As head of medicines optimisation at NHS Sunderland CCG and interim ICS lead pharmacist for the North East and North Cumbria, Ewan Maule knows the difference community pharmacy could make in an ICS, given the chance.
“We are so closely aligned to the medicines; it’s this that will get us a seat around the table”, he said. “For example, we know medicines make up 20 per cent of the NHS carbon footprint and government finds 10 per cent of drugs dispensed in England are pointless. Eliminating over-prescribing would lead to a reduction in hospital admissions, adverse reactions, primary care capacity and carbon emissions.
“We have done medicines optimisation the old way in pharmacy for a long time, but what we haven’t done is optimise the treatment and culture that underpins all that, and that’s pharmacy’s big challenge over the coming years. We know if we took control of that, we’d do it much better than the system is doing it at the moment.”