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NHS England's deputy chief pharmacist Clare Howard is leading on the medicines optimisation agenda but has strong views on a variety of issues currently affecting community pharmacy. Interview by Asha Fowells

In some ways it feels like NHS England has always been around. Every month the body is in the news because of a new initiative, campaign, event or policy, and a quick glance at NHSE's website confirms a constant stream of news stories and announcements. Certainly there has been a lot going on €“ yet NHS England is only one year old.

A former community pharmacist and pharmaceutical adviser, Ms Howard was seconded to the Department of Health in 2012 to lead the national medicines use and procurement QIPP work stream. She was announced as chief pharmaceutical officer Keith Ridge's deputy just ahead of the NHS reforms coming into force in April 2013.

While some deputies prefer to work in the background and leave someone else to be the public face of an organisation, this has certainly not been the case for the NHS England pharmacy team. Ms Howard has been vocal on a whole range of topics affecting the profession and is also leading the work on the medicines optimisation agenda.

Not another buzzword

There has been criticism from some quarters that medicines optimisation is simply the latest in a long line of DH catchphrases. Ms Howard is adamant that this isn't the case.

€Is it another buzzword? Absolutely not. The project recognises that we have over the last few years focused on the cost of medicines at the expense of fundamental areas that we now recognise have led to the use of medicines in this country being sub-optimal.€

Medicines optimisation aims to shift the emphasis away from drug costs and towards achieving better value by supporting patients to get more out of their medicines, she explains.

€Patients are clearly telling us they want more information, better consultation and to understand what services are available, particularly from community pharmacy, to help them [with their medicines],€ says Ms Howard. The work will also filter through to local level, she adds.

€We are in the process of developing a sort of prototype 'dashboard' with measures that aim to help CCGs think about what they need to be looking at locally, to make sure that patients in their area get the most out of their medicines.€

This is clearly a huge programme of work with a broad remit. Ms Howard describes a couple of examples, such as how the programme is looking to improve services for patients with long-term conditions and support those recently discharged from hospital, and is clear that it sits comfortably with other NHSE priorities. €Things like the better use of EPS and electronic patient records will make sure that medication use is as safe as possible,€ she says.

A national contract is often quite a blunt instrument to resolve all the issues

Call to Action

Talk to anyone prominent in pharmacy €“ or even primary care €“ and the NHS Call to Action consultation soon crops up. It's the major topic of the moment. And quite right too. As Ms Howard puts it: €It is the opportunity for pharmacy to help the NHS and shape the way that primary care services are organised in the future.€

NHS England has been delighted with how the profession has risen to the challenge, she adds, explaining, €I am really encouraged by the sorts of things that pharmacists have put forward and have been thinking about€.

What is also reassuring is the fact that the views of healthcare professionals seem aligned with what patients want, she says. €I think that some of what we are hearing chimes with what we have already heard through the medicines optimisation work, which is that patients want more support around their medicines taking.€

However what is increasingly evident is the lack of public awareness of what community pharmacy can offer in addition to dispensing. Campaigns such as NHS England's 'The earlier, the better' and Pharmacy Voice's 'Dispensing health' clearly have an important role to play here, she says.

The €conversation€ phase of the community pharmacy Call to Action ended on March 18 but Ms Howard is keen to emphasise that this wasn't a paper-pushing exercise with an already decided outcome. €We don't want to pre-empt things... we'll need a period of time to reflect on what's come in.€

The responses will also be considered with the Calls to Action for other areas of primary care, such as general practice and dentistry, and the review of emergency care services, she points out.

Although NHS England will take its time to sift through the ideas and suggestions that have stemmed from events and online replies, Ms Howard stresses that the process is about more than just deciding overall NHS strategy.

€Call to Action isn't just about what happens nationally. It is there for [NHSE's] area teams, who over the next few months will be developing their five-year plans around community pharmacy, primary care and out-of-hospital care in general. My sense is that area teams will be using what they have heard at their events to shape their strategies.€

The trick will always be about achieving a balance between the national need for consistency while at the same time making sure that local areas have the ability to innovate and develop services, she says. €A national contract is often quite a blunt instrument to resolve all the issues.€

€If we hadn't had that local flexibility, then some of the amazing services and great innovative work that has come out of community pharmacy in recent times wouldn't have happened. At a local level, things can happen quite quickly.€