You’ve heard about an old car with a new engine. Well, the so-called new NHS is like that. Familiar to most of us until you open the bonnet and see that it is capable of doing speeds unheard of before and with a better performance.
The Health and Social Care Act 2012 brought in reforms to the NHS: the most wide-ranging since it was founded in 1948. However, then came the consequences of banking crises and the resultant economic austerity, which have affected all parts of the organisation.
Many changes have taken place: at local level clinical commissioning groups and health and wellbeing boards were created, and at national level economic and quality regulators, public health were created, with all working under the NHS. Then in 2014 came the NHS Five Year Forward View. Once the NHS was re-organised the next step was to integrate health and social care. Sustainability and transformation partnerships (STPs) have been developed by NHS and local government leaders in 44 parts of England. The plans offer a chance for health and social care leaders to work together to improve care and manage limited resources.
With a strong focus on ‘local choice’ STPs have been said to undermine the ‘national’ in the National Health Service, and even to accentuate geographic variation in care provision. The reality is that STP areas are forced to make hard choices about the services they provide, and to whom. Between six to eight CCGs normally form Sustainability and Transformation Partnerships.
How long the CCGs continue to exist is a matter of opinion, but development continues. In some areas – before the ink has dried on the paper creating some of the STPs – STPs will evolve to form integrated care systems (ICSs), a new type of even closer collaboration.
ICS leaders gain greater freedoms to manage the operational and financial performance of services in their area. So, understanding local context and having a working relationship with the STP leaders becomes even more crucial for community pharmacy playing on the periphery of GP-led primary care.
Community pharmacy, unlike the GPs, does not have a place on the CCG and health and wellbeing boards. As part of the STPs, there are also new boards and committees that align across boroughs and, in places, two or more LPCs are covered under the arrangements.
I expressed my concerns directly to the pharmacy minister, Steve Brine MP, about barriers to local engagement and trying to get community pharmacy integrated into the local primary care networks. To say it’s hard work is an understatement.
The Minister acknowledged the problem and replied, “I encourage pharmacy leaders from all sectors to work with local Sustainability and Transformation Partnerships (STPs), highlighting the contribution that pharmacy can make. I am aware, however, that community pharmacy has not always found it easy to engage with and feed into this important work. To address this, NHS England is planning regional pharmacy integration events to run throughout 2018, inviting STP leads, pharmacy providers and wider stakeholders to continue the discussions and engagement that was started at the national Pharmacy Integration event on 16 November 2017. The focus will be on system leadership across STP geographies and how the pharmacy workforce is an essential resource to deliver medicines optimisation for patients as well as making a contribution to prevention.
“Following a review of the NHS Pharmaceutical and Local Pharmaceutical Services 2013 Regulations, the Department of Health and Social Care will also be considering how guidance could be updated to better link the development of Pharmaceutical Needs Assessments and local Sustainability and Transformation Plans.”
I see this as an invitation to a party. You cannot go there empty-handed. You need to research your host’s wants and needs and like a good guest try and help out rather than demand or impose your wishes. This is where I feel community pharmacy is facing a challenge. Our representatives need to know what the STPs want to do and how they are going to be structured. Despite the variabilities in the STPs, they will have a common set of requirements.
The first of these should interest community pharmacists. Population health management is a new approach that pays little respect to professional boundaries. It requires:
Only a multi-disciplinary team can deliver the above objectives. So, community pharmacists will have to learn a new language, and have a new set of skills. Perhaps, that is why the NHS, through CPPE, is providing the Mary Seacole programme, designed to develop clinical leadership, negotiation and management skills.
STPs are the future. It is time to engage. Go for it.