Viewpoint: Hard truths from an ICS pharmacist
The emerging integrated care systems, and the fact that community pharmacy commissioning will be moving into these in April 2023, provide the greatest opportunity in over a decade, says our ‘inside voice’.
Under the ICS structures, community pharmacy is being brought back into local systems in a way it hasn’t been for a long time.
This brings with it both opportunity and risk for the sector. How pharmacy responds will dictate how successful it is under this latest iteration of the commissioning landscape – so may I offer some advice from the perspective of an ICS lead pharmacist?
Embrace the scrutiny – being part of a system means the other parts of that system want to know what you are doing and whether you are a better or worse investment than others. The public loves community pharmacy – we need to show the rest of the system why that is.
Be clear and open about the challenges. There are huge disparities in workforce pressures in different regions and settings. Telling the system about this means it can support fixing it. Be prepared to demonstrate why these things matter to your local population.
Be open to change – the current contracting model disproportionately remunerates based on dispensing volume. We all know this isn’t right, but when your mortgage depends on it I can understand why this takes priority. Others in the system will also understand this if we can be honest and open about why this is a challenge to taking on more clinical services, and it will help the sector transition to a more effective and appropriate service model.
Get your foot in the door – this isn’t specific to community pharmacy. We have always seen ourselves as a bit special, and a bit different to everyone else. Spoiler alert: we are not. But we do have a secret weapon – medicines.
The NHS spends £16bn on medicines in England alone. Being able to demonstrate pharmacy’s role in the appropriate and effective use of this enormous resource opens a lot of doors.
Build relationships outside pharmacy – the PCN is the new unit of currency in the NHS, so the single most important relationship community pharmacies can be building at the moment is with their local PCN clinical director.
Future investment will often arrive at this level and so time spent now in building these relationships will pay off in the future.
Choose your battles – if you want to protect and grow your business or your professional capital, then be judicious in your conflict. Provide solutions to problems others have and be prepared to occasionally ‘take one for the team’.
It is all about being savvy with your time and resources. It is much easier to change a system from the inside.
Stick together as a sector – bare knuckle fighting between multiples and independents, locums and employers, does us no favours. The solution to the problems we face lie not in one sector of the profession versus another, but in the embracing of the opportunities afforded by being part of a much wider system.
If we open our horizons and let our defences down a bit, we will be able to move forward together.
This may seem at times both naive and manipulative, but community pharmacy has an open door to walk through, and if it doesn’t do that successfully, that door will be shut for another decade or more.
I hope this helps. I will be doing all I can to support you – but the ball is in your court.