There is a significant amount of work to do at both grassroots and national strategic levels if community pharmacy is to thrive in the modern NHS, attendees at this year’s Pharmacy Show were told.
Cormac Tobin, speaking when he was still managing director of Celesio UK and Ireland, called on the sector to “embrace technicians” in order to “release the skill and genius of pharmacists”.
AIMp chairman Peter Cattee – who, alongside Community Pharmacy Scotland communications director, Matt Barclay, and NPA chairman Ian Strachan, was involved in a panel discussion that took place in the Keynote Theatre at last month’s event – stated that technicians taking on a wider role was “an inevitable move” and urged the sector to “build slowly from the bottom up so as to ensure stability”.
While pharmacy was well versed in innovating and delivering at a local level, Mr Cattee said this was at odds with the national picture in England.
“There is no vision from Government about how many contracts are needed or how much money is spent on pharmacies,” he said.
Department of Health and NHSE officials often told community pharmacy how much it had to contribute, yet also gave “a contradictory message, particularly in terms of remuneration”, he continued.
CPS’s Matt Barclay said that funding for services north of the border was more secure because the money came from outside the global sum that covers dispensing.
“Scotland is not perfect and doesn’t have all the answers, but we understand what customers need – both patients and the NHS – and collaborate with [our] Government to deliver policy,” he said.
The sector had used the GP crisis as an opportunity to prove that pharmacies could fill the gap, he pointed out, but went on to emphasise the need to “follow through on promises” and evaluate services so an evidence base emerged that supported new initiatives being rolled out beyond pilot projects.
Leadership continues to be an issue within the profession, said Cormac Tobin. “People are not saying the right things in the right way to the right people…the dialogue and narrative are wrong.”
He urged PSNC to push forward with funding negotiations, despite the legal action the body is taking against the DH. “If you pick a fight with our biggest customer, you are going to lose,” he warned.
The Primary Care Home model from the National Association of Primary Care – which brings together health and social care professionals to provide integrated, personalised care that caters for the needs of local populations – means patients get the care they need at the first point of contact with the NHS, the NAPC president explained.
Dr James Kingsland, who is a GP in Merseyside, outlined that this new way of working aimed to improve population health outcomes by moving towards proactive and preventative care. Aggregating GP lists so that registered populations of around 30,000-50,000 patients are looked after provided “the right size to scale and the right size to care, without losing personalisation and continuity”.
The primary care home initiative is not well known across the NHS – possibly because Vanguard projects are higher profile – but there are now around 200 serving one in seven people in England, Dr Kingsland said. In Medway CCG, for example, 45 out of 50 GP surgeries have signed up to the programme and are aiming for universal coverage.
Having pharmacists involved in such initiatives is “a good start”, he said, but “it doesn’t seem right to take the pharmacist out of the pharmacy”. A better approach is to think of pharmacy as part of a wider team that worked out how and where care is best delivered. This required careful planning and aligning clinical and financial drivers, “so we don’t end up having a bunfight over who does what”.
Antimicrobial resistance (AMR) is second only to terrorism as the biggest threat to the UK. Richard Seal, regional pharmacist working jointly between NHS Improvement and NHS England in the Midlands and East, said that AMR is high on the agenda of the Government’s emergency response committee, COBRA, set up to respond to national or regional crises.
Pharmacists need to be aware of the NHS Medicines Value programme, which spans both NHS England and NHS Innovation, and includes NHS Digital and Health Education England. The initiative aims to improve patient outcomes while maintaining an affordable drugs bill, Richard Seal said. Resources and infrastructure have been aligned in order to optimise use of medicines and support an efficient supply chain. Community pharmacy can feed into this work through specialist pharmacy services, which look at medicines optimisation (MO) at a local level and then escalate it upwards to regional MO committees. These, in turn, look at regional and national implementation, said Mr Seal.
Community pharmacies’ integration into NHS networks is making the sector increasingly vulnerable to cyber-crime. NHS Digital’s Toby Griffiths said that the WannaCry attack, which caused widespread disruption to NHS hospitals in May this year, had brought the issue into sharp relief. “People focus on unsupported networks and operating systems… but phishing is a massive threat.” He recommended some simple steps pharmacies can take to maintain e-safety, including not clicking on or forwarding any emails from unknown senders in case they are phishing attempts, following the latest guidance on password security and being honest if things go wrong, as this is the only way in which improvements can be made.