On a new strategy

By Rob Darracott

The Pharmaceutical Services Negotiating Committee is commissioning an external partner to support its work on developing a new strategy for community pharmacy in England. So, it won’t be cheap. It won’t be quick either – draft strategy report by next April, final version in June. Nor will it present much of an opportunity to grow inhouse strategic and policy development skills. I suppose it’ll look nice though, so all is not lost.

The indicative timetable suggests a healthy dose of consultation early on (the next two months) with LPCs, contractors and the community pharmacy workforce. That has to be the right thing to do, with more consultation to come, presumably, on the draft next Spring. Let’s gloss over whether to worry that a ‘strategy report’ could leave room for a group, like the Committee itself for example, to lose the bits they don’t like in transitioning to an actionable strategy, although they have got form. 

It’s tempting to cut to the chase – what should be in the strategy – but you can’t just invite all and sundry to suggest what they would write on a blank sheet of paper. Ideas and opinions from across the sector are vital, but they need a framework, or a range of possible futures, or best and worst-case scenarios based on tested assumptions of more, the same or less (!) central funding, to challenge the creativity, as well as test the appetite for change. 

Since I’m unlikely to be asked, here’s some key questions for anyone thinking about the future scenarios against which bright ideas and service options might be tested. 

NHS scope. The political sands are shifting daily, but what happens if we get a slimmed down public offer? Or an expansionist one? The place of medicines in care is changing too, with less use (the Overprescribing Review) and better use (cue pharmacist deployment across the system). So how does independent prescribing in community pharmacy fit into that and what happens to supply if it does? And is social prescribing included in what pharmacists can do? How does all this link to integrated pathway of care? 

NHS priorities. How do population health management and a focus on tackling health inequalities shape local prioritisation? Do they lead to service expansion, contraction or both? How local is ‘local’? What might a real service commitment to inclusion look like? How does community pharmacy’s social capital (location, access, its people, its community culture) open up or constrain the possible futures? What’s the impact of advances in knowledge about medicines in use (personalised formulations, pharmacogenomics) and will that become core to the public service offer?

And then there are the big society questions: what health outcomes do we want and what part might community pharmacy play, not just in achieving them, but in arguing for them? 

That takes us to the ‘vision’ thing. In creating one, it might help to derive options from the possible futures; you might get reinterpretations of the past (say the ‘medicines logistician’) or ambitious variants of a clinical future (the ‘pharmacoclinician’). Given where we are, it’s probably right that the future vision is undefined, because it also needs to be agreed and bought into. It should fall out of the process, not set the direction of travel. But I’d start with the big questions, since the answers will shape everything else.