Names are changing and new acronyms abound, but further changes need to be made if the voice of community pharmacy is really to be heard, says Shilpa Shah

Like a lot of professional sectors, community pharmacy is full of buzzwords and acronyms. If I was to fill this article solely with all the acronyms we use in pharmacy, I would easily exceed the word limit.

PCTs (Primacy Care Trusts), CCGs (Clinical Commissioning Groups) and now ICBs (Integrated Care Boards), which can be further broken down into ICSs (Integrated Care Systems), ICPs (Integrated Care Partnerships), PBPs (Place Based Partnerships) – the names and acronyms change, but what’s changing for Community Pharmacy? Everything and nothing, it seems.

Like many big organisations, the NHS (National Health Service) restructures itself every few years. We’re told that local is best, which is what we had back in PCT and CCG days. In my experience, ‘local’ can cause a postcode lottery.

For primary care – perhaps community pharmacy especially – it means that you could have two providers across the road from each other offering different services based on their local commissioning.

The move towards an ICS model is better for residents as there is consistency of service across a larger geography, but why stop there? Why aren’t we providing consistent services across regions or nationally?

If we take sexual health services as an example, most areas commission a service from community pharmacy, but the service that is delivered often differs in many ways.

The training for the pharmacies, the PGDs (Patient Group Directions), the criteria for patients to access the service, the remuneration for providers… How can we expect patients to navigate this complicated system?

Now that we have a national PCS (Pharmacy Contraception Service), would it not make sense to have a national sexual health service and offer patients a full solution – EHC (Emergency Hormonal Contraception), condom provision, STI (Sexually Transmitted Infection) screening with an add-on of the PCS. The same could be said for substance misuse and smoking cessation services, to name just two.

Words like ‘collaboration’ and ‘integration’ are popular in healthcare nowadays. We say we need to work together, not in silos. Yet the biggest fix of all would be a better solution for IT (Information Technology) integration between HCPs (Health Care Professionals). Good, fit-for-purpose IT would be a game changer.

I’ve heard of pharmacists in some pharmacies having to sign into seven different portals/web-based platforms/emails, etc, on each shift. The Pharmacy First service IT has been a disaster, causing so many problems for pharmacists who just want to help their patients.

Is community pharmacy truly integrated into primary care? Whilst we have a seat at some tables, it still feels as though we only get invited to half the dinner parties. Our voice is being heard in some areas, but we still have a long way to go; our strengths are still not fully understood. ICSs are in deficit for both funding and staff and are therefore not able to do everything they would like to with pace or, in some cases, at all. Many areas are losing CPCLs (Community Pharmacy Clinical Leads), which is putting pressure back onto other team members in the ICS.

In CP NEL (Community Pharmacy North East London), we have great relationships with the local ICB and the wider ICS, who want to support us more in being able to deliver on the frontline. But generally, staffing levels are the rate limiting factor, when it comes to implementation of new services or renewal of existing ones.

A long way to go

There is still a long way to go before our business model is fully understood. Take switching to branded generics as an example: many ICBs are still doing this without fully understanding the consequence not only on community pharmacy but also on the NHS drugs budget. We understand that community pharmacy is complex. We’re a private business of which 90 per cent is funded by the work we do for the NHS. Closures of community pharmacies are at an all-time high with more to come, it seems.

Many organisations – CPE (Community Pharmacy England), the NPA (National Pharmacy Association), CCA (Company Chemists Association), AIMp (Association of Independent Multiple Pharmacies) as well as CPL (Community Pharmacy Locals) are shouting about the value of community pharmacy within primary care and the local system, but in many cases, we are just not being heard. We need one clear vision (not four or five) and we need to share the same messaging.

We are now at a pivotal point as we embark on the negotiation of a new contract with perhaps a new government to come next year.

It’s hard to predict what this will look like on the ground. We need change as we cannot survive as we currently are. One thing I do know for definite though is that whatever changes do or don’t arrive, the generation of new buzzwords is unlikely to halt any time soon.

Shilpa Shah is chief executive of Community Pharmacy North East London. She writes in a personal capacity.