Today integrated care boards (ICBs) will assume responsibility for pharmaceutical services along with dental care and general ophthalmic services. Chair of the National Pharmacy Association, Andrew Lane, outlines the potential of community pharmacy in the system
Community pharmacies are a key part of the health service frontline and the most visited of all settings in which NHS services are delivered.
The move to a delegated contract, whereby integrated care boards (ICBs) will oversee community pharmacy commissioning, provides a great opportunity to maximise the potential of these vital assets.
Every day about 1.8 million people visit a pharmacy and 96% of the population can get to their local pharmacy within 20 minutes without a car. Over a billion prescription items are dispensed in England each year.
There are approximately 11,500 community pharmacies in England – a mean average of about 270 in each integrated care system (ICS).
Community pharmacy bucks the inverse care law – there are relatively more pharmacies in deprived areas where people need healthcare the most.
The range of clinical services provided by pharmacies has expanded significantly in recent years – covering urgent care, hospital discharge, weight management, blood pressure, medicines support for people with Parkinson’s disease and much more. Vaccination services including flu are also now well established.
The NHS 10 Year Plan promised to ‘make greater use of community pharmacists’ skills and opportunities to engage patients’ and aspired to a future in which community pharmacy is an integral part of the NHS, delivering clinical services as a full healthcare partner.
More recently, the Fuller Review highlighted community pharmacy developments in urgent care, cancer diagnosis and direct referral to mental health services.
Community pharmacy sees itself as a can-do profession, keen to do even more in terms of managing demand for urgent care, supporting optimal use of medicines and prevention and detection services.
However, the sector is struggling after almost a decade of real terms cuts to pharmacy funding, which has already resulted in hundreds of permanent closures and threatens thousands more.
There is also a serious workforce crisis in community pharmacy, worse in some regions than others. This has been exacerbated by the Additional Roles Reimbursement Scheme, which has drawn away many pharmacists from patient-facing roles in community pharmacy.
This is the context in which we approach the moment when (from April 2023), ICBs will have taken on delegated responsibility for dental, general ophthalmic services and pharmaceutical services.
From our vantage point in community pharmacy, delegation presents us with a variety of challenges and opportunities, and cause for hope.
Here are some of the requirements needed to ensure that the benefits of involving community pharmacy are fully realised (as identified in a joint piece of work by the NPA, NHS Confederation and others:
1. Community pharmacists must be given the time and space to get involved in working through the development of local services with their primary care colleagues.
2. Community pharmacy and general practice need to work through the historical perceptions of their relationship as providers, moving from a position of competition to one of collaboration and a single voice for primary care.
3. Nationally specified services should be properly resourced, recognising that commercial viability is a valid request by contractors in the NHS.
4. ICSs must support the implementation of nationally specified services, locally ensuring there is project management, IT deployment and system-level governance and oversight for implementation. This should be backed up with appropriate mechanisms to involve community pharmacy in decision-making at all levels and resources available to enable this.
5. An appropriate information technology and information governance framework is needed to support data sharing and facilitate the development of local services and the implementation of national services.
Pre-ICS the more progressive clinical commissioning groups (CCGs) and local authority public health teams had a track record in looking to community pharmacy for pragmatic solutions to many health and care standing problems. All too often, however, these imaginative and well-engineered services remained useful but niche in a single small system footprint, only occasionally breaking free and being scaled up at regional or national contracting level.
ICSs were encouraged by the Fuller report to develop a ‘single system-wide approach to managing integrated urgent care to guarantee same-day care for patients’. Given that convenient access is one of community pharmacy’s key characteristics, we anticipate a significantly enhanced role in the urgent care arena.
Cornwall’s walk-in minor ailments service, which has saved thousands of GP appointments, is an example that others may well wish to follow. Patients are able to visit the pharmacy without an appointment or referral for a consultation with the pharmacist that takes place in a consultation room, and receive NHS treatment if appropriate. A record of the service is sent electronically to the GP for completeness.
We recognise that primary care is not just about general practice and pharmacists, it is dentists, optometrists and all the other clinicians involved in the care of patients outside of hospitals.
I want community pharmacy to be an active partner in integrated care and that will mean investing time in building relationships to improve local services. The direction of travel for all of us is already very clear – destination integration.