“I’ve just seen this NHS plan... and we’re not in it,” is how one NPA member reacted when the 10-year plan was published. While it is true there are few references to community pharmacy specifically, there is a lot about community-based services, medicines, workforce, urgent care and prevention, which are all areas inherently in our sector’s sphere of interest.
Encouragingly, the document states an aspiration to “make greater use of community pharmacists’ skills and opportunities to engage patients”, which are welcome words but lacking in detailed commitments. Similarly open to wide interpretation is the phrase, “exploring further efficiencies [in community pharmacy], through reform of reimbursement and wider supply arrangements”.
It is quite right that new investment in NHS services is tied to efficiencies – provided these are genuine, evidence-based efficiencies based on keeping people out of hospitals, not false economies based on cuts to vital support. The NHS may be planning for the next decade, but many pharmacies are currently managing only month-by-month because of overwhelming pressures on their funding and rising medicines costs.
The reference to wider supply arrangements probably relates to hub and spoke dispensing. Again, it is right to consider how technology can be deployed to improve services and create cost-efficiencies. Hub and spoke can take many forms and the general concept has potential. What we must not do is create the conditions for a commoditised, de-professionalised pharmacy service, undermining the bridge between primary care and the patient, bypassing all the reassurance, advice and support that is part of face-to-face contact with the patient.
To its credit, the NHS Long Term Plan does address – albeit at a high level – the tests the NPA set out at the start of the drafting process. One of these was that the poorest patients and communities must benefit from the new investment. So we are encouraged that NHS England will require measurable goals to be set for narrowing health inequalities as a condition for receiving Long Term Plan funding for new schemes.
Another of our tests was that the NHS should use technology to achieve efficiencies but without losing the human touch in health care, characterised by advice, support and treatment delivered face-to-face. The plan duly recognises that “in-person” services will always be there to do what computers can’t and provide personal contact for those who want or need it.
Overall, the NHS Long Term Plan makes a commonsense case for greater investment in community-based care without going into detail on the ‘what and how’. A large part of its purpose is to provide a framework for local planning over the next five years and beyond. At all levels in pharmacy – national and local – we need to stay engaged and pay very careful attention to what our biggest customer, the NHS, is saying and doing.