Most pharmacies in England submitted a quality payments claim to the NHS Business Services Authority by the April 28 review date, clearly demonstrating a desire to meet the quality criteria and a need to receive the payment. (The second review date is in November.)
Pharmacies have worked hard to achieve their quality payments, so it is worth now considering how to optimise this investment beyond the basic funding achieved. Understanding local priorities, and hence opportunities, is a good place to start. There are a number of places to look:
• Joint Strategic Needs Assessment: The local NHS, clinical commissioning groups (CCGs) and local authorities are required to consider the needs of their local populations and how they respond with effective service commissioning to properly meet those needs. Your local assessment can be found on your local authority or CCG website.
• Pharmaceutical Needs Assessment: This is a statutory document prepared by the local authority that assesses the pharmaceutical needs of the local population. While the document includes dispensing services as well as public health and other services that pharmacies may provide, the quality, breadth and depth of these vary significantly – and some may not look outside the box for what could potentially be delivered by community pharmacy. Your PNA should be on your local authority website.
• Health profiles: These provide a snapshot overview of health for each local authority in England. They are conversation starters, highlighting issues that can affect health in each locality. See: fingertips.phe.org.uk/profile/health-profiles.
• CCG, local GP practices and local public health: Start a conversation to understand the specific challenges faced by local commissioners and other health and wellbeing providers in your locality to see where community pharmacy could offer effective and cost-effective solutions.
Let us examine how the quality payment criteria can contribute to meeting these needs.
The Healthy Living Pharmacy (HLP) quality mark was already becoming an enabler for some local commissioners to prioritise locally accredited HLPs for some services. While we do not yet know how many pharmacies self-declared their HLP Level 1 status at the April review, we do now have a consistent quality mark across the whole country with the associated leadership, health champions and increased health promotion and intervention activity in place. The Dementia Friend criterion will further enhance workforce capability.
Patient safety is a significant focus for the QPS with near miss and incident reporting (links in to GPhC standards), safeguarding training and increasing use of the Summary Care Record (SCR). These, together with the clinical effectiveness criteria relating to asthma patients and, in some cases, greater delivery of MURs and NMS, will be of interest to CCGs and GPs. This could reduce GP workload and unplanned hospital attendances and admissions resulting from incidents and poor adherence with prescribed medicines.
Ensuring that your NHS Choices and NHS 111 Directory of Services are kept up-to-date and highlight the full range of services you provide from your pharmacy should also increase patient awareness, footfall and referrals.
What is now needed is a strong case to be built for pharmacy to address some of the health and wellbeing priorities and help reduce health inequalities.
With the significant engagement and commitment to the QPS, and the drivers behind it, there is a natural pathway for its evolution.
Once some of the current criteria are bedded down, you could imagine them becoming essential services within a future contractual framework. These could then be replaced with other quality criteria such as:
• Additional workforce capabilities
• Further activities to enable pharmacy integration
• Risk assessment for (e.g.) high blood pressure, atrial fibrillation and diabetes
• Proactive prevention activities related to key lifestyle issues including alcohol, smoking, healthy diet, weight and physical activity.
The management of stable long-term conditions such as type 2 diabetes, asthma and hypertension could also be considered, as well as support for mental wellbeing.
Some further options could also include:
• Patient safety: Medication contributes to between 5 and 20 per cent of hospital admissions and readmissions, almost half of which are preventable. Admissions relating to adverse drug reactions cost the NHS up to £466m annually. Community pharmacy must play its part, within a joined-up system, through reducing the impact of prescribing and dispensing errors, drug and food interactions, and poor adherence with treatment.
The evidence to support a new quality payment could be linked to providing a case study that demonstrates integrated working.
• Patient experience: Patient expectations continue to rise, not just in efficiency, but also in the quality of their experience and accessibility to services. For example, there could be a focus within a future QPS on tailoring the environment and core services to a specific patient or customer group.
• Public health: ‘Making every contact count’ (MECC) to reduce health inequalities and help people live well for longer through effective health promotion, prevention and protection programmes. Pharmacy could also be involved in the identification of people at risk of hypertension, atrial fibrillation or linking into the NHS Diabetes Prevention Programme.
• Workforce development: Taking the team through MECC training or further RSPH health improvement awards (e.g. behavioural change skills or mental health and wellbeing) could contribute to workforce development and improving the public’s health.
• Digital: Community pharmacy must embrace digital advancement through automation, integration, information and communication. Further embedding the SCR into routine practice would be a great place to focus further quality payments.
• Clinical effectiveness: Effective risk assessment and the management of diagnosed long-term conditions within an integrated primary care team.
The landscape in which community pharmacy is operating will continue to change, so the sector must constantly adapt to remain relevant and compelling to commissioners and consumers. Achieving the quality payment is only the start of that process. Continual improvement and investment in quality will remain essential for a sustainable sector.
There is a natural pathway for evolution of the QPS