Community pharmacy leaders have been told they have a race on their hands for pharmacy to be included as part of new NHS working practices – and that time is running out

When the report ‘Now or never’ came out last year, community pharmacy was told that there was limited time to take up opportunities rapidly developing in the NHS. Now, a year on, the report’s author, health service expert Dr Judith Smith, warns that pharmacy leaders have failed to push plans forward and have missed vital opportunities in the past 12 months to do so.

The consequence of this lack of progress could be ‘a bleak future’ for the sector, the Nuffield Trust says in its follow-up analysis ‘Now more than ever’. But waiting in vain for change to happen is no longer an option, with no more time to waste. It’s time to work together to push community pharmacy forward once and for all, Dr Smith explains.

Pharmacy has a distinct lack of impact with many people outside the profession whom it needs to impress, she suggests.

‘Pharmacy is the third largest profession and sees the most amount of patients in the NHS for any one day, but that scale of involvement with patients and size of the profession is not matched by its engagement and influence in policy and management circles in the NHS,’ she says.

This problem needs to be addressed proactively by the profession, despite perceived barriers. ‘I would say that the challenge back to pharmacy has to be why is that, and how can you have that? It’s not sufficient to say we’re left out. Pharmacy is where it finds itself. So it has to work out how to gain better access to the decision-making tables and how to be more involved in externally-facing debates.’

There may be plenty of discussion, but it is too internally focused, suggests the Nuffield Trust in their latest report.

Pharmacy spends too much time focusing on issues that are internal to the world of pharmacy, says Dr Smith. ‘Pharmacy needs to look outwards more and present a much more united, clear message to the rest of the health policy and management world about the solutions that pharmacy has got to the wider issues of the NHS.’

Dr Smith says that before being commissioned to carry out the analysis, she had limited knowledge of pharmacy, and fears that for many others in the health service, that remains the case.

‘It’s interesting that for people outside pharmacy, quite a number are saying that “Now or never” was one of the first times they’ve heard about what pharmacy could and should be doing.’

Although she has enjoyed the experience of observing pharmacy in the research for both reports, Dr Smith appears frustrated at the findings.

‘It’s been fascinating and a really interesting experience. But one reflection that I’d make back is that it’s perhaps salutary to think that, as a national health policy expert who has worked in and alongside the NHS for the past 30 years, I knew very little about pharmacy and pharmacists before this. And I’m not alone in that - many of my peers don’t. There is a concern that all too often, not only that pharmacy isn’t at some of those decision-making tables, but that there is relatively little knowledge among the broader health policy and management community about what actually pharmacy does, how it’s funded and what its potential is.’

Community pharmacy deserves to be much more centre-stage, she says. ‘It’s partly about communication, but I think it’s also more profoundly about influence,’ she adds.

Messages from the ‘Now or never’ report still hold firm one year on, she comments, both for pharmacy bodies and for individuals. ‘Local pharmacists need to be getting in there at the table where those discussions are being held. They need to be part of the discussions about primary care federations and networks; part of the discussion about what the hospitals are thinking of doing about becoming accountable care providers or one of the other options in the Five Year Forward View.’ Dr Smith commends examples where individual pharmacists are working together in networks and federations to gain strength in numbers.

What needs to be done?

‘A very positive part of the Five Year Forward View is that pharmacy and pharmacists are mentioned quite a number of times, and I think, as we say in our report, this is a really refreshing development. You have what’s probably the major policy direction for the NHS for the next few years, mentioning pharmacy and pharmacists so clearly.

‘But again, there’s a real challenge for community pharmacy to step up to the challenge and be there – as part of the local urgent care network, multi speciality community providers and all those different models of care. That’s going to be about engaging at a local level – to work out power and influence at local level; which providers are getting together, and to be part of those.’

The time to act is now, says Dr Smith. And a stronger collective pharmacy view is badly needed. ‘There are many organisations who represent pharmacy or who claim to do that. All those organisations have to find a more effective way of working together – coming up with the collective pharmacy view and presenting those in all sorts of different fora – whether that’s the NHSE, DH, local CCGs, local authorities – in the way that doctors, nurses and other professionals do.

‘There is something there about collectively gaining some of that confidence as a profession – to say that, actually, we have an awful lot to offer here.’

And, in terms of relationships with GPs, ‘I think there is definitely more to do,’ says Dr Smith.

‘Another point we make is that general practice organisations are now employing clinical pharmacists; hospital pharmacy is reaching out in a number of places to develop services in the community. If they develop the new primary and clinical services suggested in the Five Year Forward View, where you see hospitals running services for a whole community, the hospital pharmacy may well see itself reaching out into community pharmacy.

‘The point is that not to change is not an option, or indeed to stay as you are – otherwise market forces might dictate something quite unpleasant.’

What would Dr Smith like to see the RPS, which commissioned both reports, and others to do now? ‘I would like the RPS to absolutely press ahead with the campaigns they’ve got in place on vital topics such as urgent and emergency care and so forth. If they can help pharmacy as a profession create that much more united voice about its potential for the future, bringing together some of the other national bodies and finding ways to have that greater influence and to be at the centre of that debate about the Five Year Forward View, I think that would be a huge contribution to pharmacy and to pharmacists.’

‘They wanted us to challenge, and we challenged. I think it shows a boldness on their part, a readiness to be both setting more of the direction and actually being willing to settle some of the difficult and sometimes the unpopular issues, but which they know are vital to the future for pharmacy and pharmacists.’

How critical does Dr Smith feel when was of pharmacy leadership? ‘We wrote it as an independent review – it’s completely our view and we stand by that. I think it’s a real credit to the RPS actually – it was prescient of them to commission work on models of care 18 months before the Five Year Forward View. It was also very bold of them to commission an independent review and commit to publishing it when they hadn’t seen what was going to be in it.’

What’s at stake?

Community pharmacy is in danger of missing out on some of the opportunities in the Five Year Forward View and the discussions that people are having about, she fears. ‘If they are not in there and part of this they will not be able to get what extra funding there will be in the next couple of years – that I think will come to develop models of care. If pharmacy isn’t part of this, it’s going to miss out on what little extra investment there is going to be. Then, quite frankly, the future then does look bleak.’