A crucial 12 months
By Adam Irvine
Frustratingly, the Health & Care Bill is still progressing through Parliament. Whilst we now know a little more about how integrated care systems (ICSs) will likely be structured, it is not yet firm, so decisions are having to be taken with multiple contexts in mind.
The things that have become clearer:
- Direct commissioning: ICSs will have delegated responsibility for direct commissioning functions in primary care (community pharmacy along with general practice, primary dental services and general ophthalmic services)
- Specialised commissioning: ICSs will have some level of more specialised commissioning at their disposal. Creating capacity and bringing services closer and more convenient for patients could be an opportunity for community pharmacy
- Public health: ICSs will assume responsibility for a raft of public health services (screening and immunisation being the most relevant for community pharmacy).
This will all happen at some point between April 2022 and April 2023. Each ICS will be judged on its readiness to assume the responsibilities, so you’ll need to be aware, via your LPC, of both the maturity of the ICS and the complexity of lifting and shifting those services.
This is going to happen at a crucial time for us. With the performance of the Covid-19 vaccination programme, community pharmacy’s stock is high. I’m expecting this year’s flu vaccination programme to beat last year’s incredible performance. We’re seeing more and more referrals from general practice into the Community Pharmacist Consultation Service (CPCS). It’s really important that we deliver well and continue to do so. However, I know what a tremendous challenge it is right now: a woeful lack of funding in the core contract, workforce shortages, sickness/isolation challenges and demand at an all-time high.
We cannot let our patients down, however. Where patients are referred to us, we deal with them in the excellent way I know we can. When we have the opportunity to deliver extra services beyond the core framework (including flu and Covid vaccinations), we do so consistently. This is important because as the ICS forms and prepares, there’s going to be a window where transformation funds are made available, and where the system is looking for quick wins – moving workload, creating capacity and improving quality.
These will be the activities (with appropriate resourcing, funding and support) your LPC will be pursuing over the next 12-18 months, and the system will need to be confident in our competence. It only takes pharmacy not picking up or, even worse, rejecting one or two GP referrals into the CPCS because they’re too busy or the normal pharmacist isn’t in, to damage the whole sector’s reputation. In Cheshire, Wirral, and Warrington, we’re putting some of our implementation and support focus on ensuring that this cannot be allowed to happen.
there’s going to be a window where transformation funds are made available, and where the system is looking for quick wins
Nationally, we’re really struggling to make the case for funding for community pharmacy. The 2021 Spending Review is underway and unless the Treasury changes tack, it’s likely the next few annual settlements will continue with the flat funding (negative in real terms) we’ve seen of late. It is therefore the local movement of services outside the framework that will allow the sector to flourish and contractors are faced with the precarious balance of investing enough to deliver well today, while being frugal enough to survive.
The other challenge we have is to ensure we are represented well at the ICS Board. It’s clear to me that my recent attendance at our board in Cheshire & Merseyside is the first time they’ve had meaningful representation of any primary care discipline beyond general practice. I was there (with colleagues) on behalf of all four primary care contractor groups, so I ensured I did a good job across the board, but I fear others who have attended simply do not have the knowledge or awareness of the other sectors to be able to properly represent themselves.
Our system has recognised this and will be ensuring we have broader representation, but it does worry me that this won’t be uniform across the UK. We have an ideal window for influencing the system in the next six months as the ICSs prepare for launch and the new chairs and chief executives are appointed (interviews are taking place as I write). We cannot get this wrong, or miss the window completely.
As I stated back in June, the four broad areas an ICS will tackle are: improving population health, tackling inequalities, improving quality and increasing value and social value. Community pharmacy is in a strong place to contribute meaningfully to all four areas in every system, place and locality across the UK.
We need to make sure the systems realise that and are not swamped by other sectors competing for funding in the same place. It would be a travesty if our convenience, accessibility and capacity wasn’t more broadly commissioned to help patients. We’re always rated highly by them when commissioned properly and fairly. We just need more of that to help us flourish.