Action to match ambition required

Screenshot 2022-05-06 at 11.34.28.png
Screenshot 2022-05-06 at 11.34.28.png

Action to match ambition required

By Malcolm Harrison

Secretaries of state have long grappled with reform of the health service and sought to leave their mark. Speaking in March, Sajid Javid outlined his ambitions for reform centring on ‘three Ps’ – prevention, personalisation and performance – before later adding a fourth - people. I’ve been reflecting on how we in community pharmacy can help.

Prevention is core to community pharmacy practice. The sector already provides a range of preventative services and there are opportunities for more. Personalisation is synonymous with community pharmacy. Pharmacy staff, who reflect the communities they work in, endeavour to build enduring relationships with patients. 

Community pharmacy has performed with aplomb, demonstrating its importance during the pandemic. The sector has delivered an often understated but impressive return on investment to reach all parts of the country. And all of that cannot be done without that fourth P – people. I’ll come back to that later. 

Reality match

Despite its undoubted value, it’s now time for the reality to match the ambitions set out by the secretary of state, who has reiterated his desire for a ‘Pharmacy First’ model in England on several occasions. Unfortunately, the sector continues to be subjected to flat funding, a lack of a coherent workforce strategy for primary care and no clear voice within the emerging NHS system of ICSs. 

This divergence is, of course, particularly stark when we examine funding. While 2020 and 2021 were exceptional years for healthcare expenditure, the trends pre-Covid are instructive. Between 2014 and 2019, healthcare expenditure per capita rose from £2,415 to £3,104 – a rise of 9.5 per cent. In contrast, the pharmacy sector saw a decrease of 10.7 per cent in spend over the same period. This divergence has continued and is set to keep on growing through to 2024. 

At the Company Chemists’ Association, we believe there are several areas where concerted investment could turbocharge the prevention agenda and yield longer term benefits. As part of our submission to the 2021 Spending Review, we stated that an annual investment of £656 million would yield benefits of up to £1.9 billion – a return of 190 per cent, which would take vital pressure off general practice in the process. 

Mr Javid has spoken of taking learnings from the Covid-19 vaccination programme into a ‘national vaccination service’. Community pharmacies are a natural fit. We estimate that empowering pharmacies to deliver a conservative 10m vaccines every year would cost £91m, increase vaccination capacity and coverage, and deliver £153m worth of benefits. Annually. 

Access to emergency contraception is a vital part of public health policy. Community pharmacy is already a leading provider of EHC, providing over 370,000 consultations a year. However, commissioning through local government has led to a postcode lottery. A yearly investment of just £15m could deliver 500,000 consultations, improving coverage and access, and helping the Government in its ‘levelling up’ agenda. 

We see a particular role for community pharmacy in cardiovascular care. NHS England and NHS Improvement’s Core20PLUS5 approach to reducing health inequalities includes cardiovascular disease as one of five clinical areas of focus. Those in the most deprived decile of the population are almost twice as likely to die because of cardiovascular disease than those in the least deprived decile. 

Between October 2021 and January 2022, 45.4 per cent of community pharmacy blood pressure checks were delivered in the top three most deprived cohorts. We calculate that additional funding of £130m a year could help identify 5.5m undiagnosed cases of hypertension, delivering a recurring financial benefit of £739m. 

The case for value

Community pharmacy continues to demonstrate the benefits it can deliver to patients, the NHS and the taxpayer. What we desperately need now is funding and investment that recognises the value we provide, and boosts our capacity to do more. This cannot be done without the fourth P – people. The CCA has long been campaigning for the NHS to produce a robust workforce strategy for the whole of primary care and for policymaking to be evidence-led. 

Ultimately, decision making will need to shift from one centred on political cycles to more transformative long-term thinking. Investment in prevention may not yield immediate benefits but will deliver over the long term to help the nation ‘level up’. This requires the Government to look at examples in Scotland and Wales and work with the sector to agree the ambition, and underpin that with realistic milestones. 

Malcolm Harrison is chief executive of the Company Chemists' Association

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