What does neighbourhood health really mean for pharmacy?

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The NHS has released updated guidelines on neighbourhood health. These are targeted at integrated care boards (ICBs), local authorities, and health and care providers — including community pharmacies — ahead of the Government’s 10-Year Health Plan.

Under successive governments, the NHS has been moving from a ‘national’ service to an increasingly locally-driven yet consistent service funded through devolved budgets. This has major implications for the work of local pharmaceutical committees (LPCs or community pharmacy locals) and their relationships with ICBs.

More LPCs are now co-terminus with an ICB footprint. However, as part of the NHS reforms, we are seeing ICBs merging to meet the Government’s demands to reduce operating costs. The same is happening with NHS hospital trusts.

The move away from primary care networks to neighbourhood health teams requires local pharmacies, supported by their LPCs, to work together to engage and influence their creation and the delivery of integrated care. However, following the transformation of pharmacy representation, more funding from the contractor levy has gone away from LPCs to Community Pharmacy England. So, despite mergers, LPCs often have fewer resources.

Why is this important?

Neighbourhood health aims to create healthier communities, helping people to live independent lives for as long as possible while improving their experience of health and social care, and managing their own care. This requires an integrated response from all parts of the health and care system.

Currently, too many people experience service fragmentation, poor communication and siloed working, which contributes to delays, duplication, waste and suboptimal care. It is also frustrating for those, like community pharmacy teams, who work within the health sector.

How will it be achieved?

With neighbourhood health, integrated working is the norm and not the exception. This will be achieved by better connecting and optimising health and care resources through three key shifts:

• From hospital to community: providing better care close to or in people’s own homes, helping them to maintain their independence for as long as possible, and only using hospitals when it is clinically necessary for their care
• From treatment to prevention: promoting health literacy, supporting early intervention and reducing health deterioration or avoidable exacerbations of ill health (a perfect fit with the healthy living pharmacy model)
• From analogue to digital: greater use of integrated digital infrastructure and solutions to improve care.

What’s involved?

The diagram below shows the aims for all neighbourhoods over the next five to 10 years.

ICBs and local authorities are asked to jointly plan a neighbourhood health and care model for their local populations that consistently delivers and connects the initial core components at scale, with an initial focus on people with the most complex health and care needs.

The initial call to action covers:

• Six components of neighbourhood health to create a common understanding of what lies at its core and set out a framework for action that can be tailored to local needs. The components cover:
  • Population health management
  • Modern general practice (N.B. this must also apply to community pharmacy practice)
  • Standardising community health services
    Neighbourhood multidisciplinary teams
    Integrated intermediate care with a ‘home first’ approach
  • Urgent neighbourhood services
• Bringing together the different components into an integrated service offer
• Scaling up to enable more widespread adoption
• Rigorously evaluating the impact on ways of working, outcomes and effective use of public money.

Community pharmacy at all levels must be at the table when these discussions are happening, particularly influencing the outer two circles of the diagram, and be an integral part of the solution.

What next?

At a national level:

• A national plan for neighbourhood health that can be implemented locally. This requires collaborative community pharmacy leadership
• Define and support consistent implementation and delivery of modern community pharmacy practice. This will require collaboration and unity within community pharmacy, underpinned by the next contractual framework and reflected in GPhC standards
• The healthy living pharmacy model is an ideal platform from which to deliver the ambition of moving from treatment to prevention through more services to address health inequalities and improve population health and wellbeing. 
  This could include diabetes case finding, point-of-care testing for a range of parameters, a broader range of vaccinations and immunisations, and healthier lifestyle support. The HLP model will require a refresh, but it is fundamentally sound if embraced and correctly implemented by all.

At a local level:

• While CPCF negotiations for 2026/27 must move towards a more sustainable model, the national contract will only ever deliver so much funding. Future viability will come from effectively negotiated and delivered integrated local enhanced services together with an appropriate portfolio of self-care and private clinical services
• LPCs must re-map themselves to the emerging ICB footprints, ensure they are appropriately resourced, build effective relationships, influence mindsets and negotiate fairly remunerated local enhanced services on behalf of their contractors
• Pharmacy owners and managers must actively engage in local discussions and become an integral part of local neighbourhood health teams.

Mike Holden FRPharmS FRSPH is managing director of MH Associates.