Some personal views on current topical matters
MH 3 February 2016
Putting Community Pharmacy at the Heart of the NHS?
The headline sounded great, however the messages in the letter from NHS England and the Department of Health dated December 17 was not the vision for the future of the sector that the owners and employees of community pharmacies across England would have hoped for. What it was is a wake-up call.
We understand that the NHS has financial and quality challenges and it was accepted that the recent spending review would have some impact on funding for the sector. However, many were unprepared for a £170million funding cut (6% of the global sum) to be delivered in the 6 months from October 2016 (equivalent to a 12% cut in the period) and a potentially further hits in 2017/18. How this will be delivered is to be negotiated, one can but assume that it will come from fees and retained margin. In addition to the many uncertainties that accompany the lack of clarity, one big concern amongst contractors is the government’s expectation that these efficiencies can be made without compromising quality or access, something that the dedicated pharmacy workforce will always strive to maintain. We are already hearing plans of reduced investment in people and premises; this comes at a time when access to primary care services is already under enormous pressure.
The letter highlighted several other plans for the sector including a Pharmacy Access Scheme with a resultant reduced number of contracts - anything between 1000-3000 was quoted by the Minister at the recent APPG meeting. How this will happen is apparently down to the sector itself to determine based on viability in the new funding landscape that also includes a phasing out of the establishment payment currently worth up to £25,000 per annum.
The letter also refers to hub and spoke arrangements and large scale automated dispensing - I have yet to see any substantive evidence of cost-efficiencies from such initiatives. Optimising prescription duration and online ordering of prescriptions with click-and-collect or home delivery are also mentioned. We fully accept that embracing technology and releasing time and talent from within pharmacy teams is highly desirable so that the sector can deliver yet higher levels of pharmaceutical care, clinical services and public health interventions; however, these will require funding to incentivise and reward the value of such services. Under no circumstances should we do anything that increases patient risk by reducing the opportunity for a patient-pharmacist interaction and thus intervention.
Finally, it will be interesting to see the outcome objectives of a Pharmacy Integration Fund. I have always promoted greater intra and inter-professional collaboration and the recent investment (£40million) for pharmacists within GP practices should be an opportunity for the profession and improving patient health by operating within an enabled framework and a collaborative culture. Joined-up working within the profession and with other healthcare professions is the future.
The pharmacy bodies, the sector and the profession have an important job on their hands to ensure that this potential burning platform is turned into a burning ambition and opportunity for pharmacy teams to improve the health and wellbeing of their communities. The sector and the whole profession must create a compelling and relevant offer for the modern health and social care system; one that meets the needs of the systems and the population and delivers quality, value and a sustainable and viable future.
MH 25 May 2015
Governments across the world are universally facing financial challenges plus increased and ageing populations and health inequalities. The need for cost effective treatment of those who are ill and keeping them out of hospital is a common theme and, with medicines being the most frequent clinical intervention, optimising the value of the effective use of those medicines as part of the system cost is increasingly a focus of attention rather than just reducing their cost.
NHS England’s Five Year Forward View states:
“Helping patients get the right care, at the right time, in the right place, making more appropriate use of primary care, community mental health teams, ambulance services and community pharmacies”
Pharmacy, in all its settings (hospitals, GP practices and community) has a responsibility and an opportunity to drive the medicines optimisation agenda shifting the emphasis from cost-down medicines management and supply to value-up pharmaceutical care.
Pharmaceutical care was recently redefined by the Pharmaceutical Care Network of Europe as:
"The pharmacist's contribution to the care of individuals in order to optimise medicines use and improve health outcomes."
This fits well with the movement that is medicines optimisation and should be the core role of all pharmacists wherever the practise, not just the safe and efficient supply channel. However, we must also step up investment in prevention and protection measures to stop people becoming ill. This includes educating the public, supporting ownership of population and individual health, and offering accessible, effective interventions on healthy lifestyles such as smoking, healthy diet, physical activity, healthy weight, sexual health, alcohol and harm reduction plus vaccination services.
To support this, the Five Year Forward View goes on to state that:
“The sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health. The NHS will therefore now back
hard-hitting national action on obesity, smoking, alcohol and other major health risks.”
Pharmacies, being an integral part of the community, are well placed to offer services that improve the public's health and there is increasing evidence through the Healthy Living Pharmacy initiative of the value of these interventions.
The Five Year Forward View is clear that in order for the NHS to be sustainable whilst delivering improved health and wellbeing for the population, new models of high quality patient-centred care must be developed through innovative and collaborative working across health, public health and social care systems and across healthcare professions. Pharmacists and pharmacy organisations at every level must work towards this approach.
MH 10 May 2015
There is a frequently stated myth that pharmacy has too many representative bodies when compared with other professions. In fact this is not actually true, but what creates this perception is that the pharmacy choir are often not singing from the same song sheet. Pharmacists, other healthcare professionals and government officials often observe that medics speak as one, particularly when threatened with change and funding reductions. This is probably true, but that’s because the plethora of bodies representing medics generally talk to each other before they act or speak, something our profession sometimes fails to do.
Collaborative working should be joined-up across all sectors of pharmacy and other health care professions and recognise that we are all clinicians, some generalist, some specialist. Working together as a virtual pharmacy team with the person/patient at the centre of everything we do and abandoning historical hierarchical views (sometimes it seems like that Two Ronnies sketch with John Cleese?) we could achieve much for the profession and hence for patients. We must leverage the accessibility of community pharmacy and grow the role of the whole profession wherever they practise within the health and public health systems and thus create a profession to be proud of and a sustainable future for the community sector who have invested heavily in their premises and people.
To achieve this, the RPS, Pharmacy Voice, PSNC, and the negotiating and representative bodies in the devolved countries, must work together on initiatives with governments, the NHS and other HCPs from the outset. We must drop the competition for kudos and being ‘first to market’ or 'first in the media’ and focus on the end in mind - a strong profession, a sustainable future for all and a population that lives well for longer.
I accept that this nirvana is difficult to achieve with a wide range of disciplines and areas of practise within the one profession, but just because its hard to do doesn’t mean we shouldn’t try? On Twitter I have recently adopted the #oneprofession hashtag to illustrate my passion and determination to create a momentum for this collaborative environment. We all need to make this happen - stronger together.
MH 28 April 2015
I have been following with interest recent correspondence and media activity on pharmacists working in GP practices. The communication at the launch and thereafter failed to get across the true intent of this initiative, resulting in widening divisions within the profession rather than creating a platform to unite all sectors. Since then, I have had discussions with a number of senior stakeholders to express my concerns but also to understand what could be done better. I have noted a change in the language used and more clarity of purpose in recent presentations.
If done right, I do not see this as a threat to any sector, but as an opportunity to take the profession to another level. I have long sought for other healthcare professionals to work closer with me when practising. It took time and effort to build relationships, professional credibility and mutual respect but it made a difference to my professional role and my business but, most importantly, to patients. Having a pharmacist working within a GP practice — not for GPs but with GPs, and not cost-down medicines management but patient-centred value-up medicines optimisation — should make this joined-up working easier to facilitate and enhance the opportunities for the community pharmacy.
There is no reason why this role could not be filled by a pharmacist (funded appropriately by the practice/NHS) from community pharmacy or a permanent position. The key would be the right character, mindset, capabilities and role which must include joined-up inter-professional and intra-professional working and good governance.
In addition, we should increase efforts for additional pharmaceutical care and well-being services within community pharmacy to leverage the skills and intervention opportunities that most people often choose as a point of access to healthcare. This should be part of joined-up individual and population care across health, public health and social care systems.
If we all work on this together, get the plan and implementation right, put aside egos and kudos, eliminate historical hierarchical myths and prejudices, we can make this work for everyone. In my experience, doing the right thing with the right people gets the right results, including recognition and rewards.