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Pharmacies as high street clinics

A vision of community pharmacies as “high street clinics”, integrated into new care and referral pathways, and utilising technology to manage long-term conditions, collect population health data, screen and monitor disease, and keep people healthy, was described at a conference held before Christmas at the London Stadium, Queen Elizabeth Olympic Park.

Hemant Patel

Organised by North East London LPC, secretary Hemant Patel outlined a series of “disrupters and trends” in healthcare that would impact on pharmacy over the next decade. These included greater patient empowerment, personalised medicines, body sensors and gene therapy, perhaps even extending to artificial intelligence, 3D printed drugs and medicines delivery by drone.

“The landscape is changing,” Mr Patel said. “It is no use pharmacists burying their head in the sand.” In the future all providers of health and social care – including pharmacy – will be required to pool data and budgets, meet shared goals based on local needs using evidence-based interventions, work with other care providers, and engage effectively with their community, he said.

New contractual arrangements will support integrated primary and community health services. Moreover, the public wants locally based health centres, shorter waiting times and “onestop shopping” for prescriptions and other health needs.

Pharmacists must engage with this rapidly changing agenda – but he questioned whether this was the case. “Is the sector ‘sustaining the fortress’ by orchestrating near-term operational goals or providing a clear mandate for innovative long-term growth, and identifying and monetising new opportunities, such as providing more homecare services?”

The evolution of community services and integrated care contracts would be a recurring feature of the next tranche of NHS reforms, as highlighted in the Government’s long-term plan for the NHS, Mr Patel said. Pharmacists should not sit back but instead adopt a system leadership role.

He described a redesigned care pathway in North East London for atrial fibrillation in which community pharmacists are involved, and explained how pharmacists in the area are now providing physical health checks for people with mental illness and encouraging them to make lifestyle changes such as quitting smoking – all as a single package.

“We must think big and transform community pharmacies into high street clinics and make sure they are included in the new integrated care systems. With thousands of GP and nurse vacancies unfilled, and with more GP practice closures inevitable, there is now a significant clinical under-capacity in the NHS. Community pharmacy can help."

Social prescribing: a force for change

Social prescribing is a vehicle that can drive a social movement for health across London – and pharmacists must get involved with new care models of this kind. So said Dr Jagan John, proactive care clinical lead at NHS England’s Healthy London Partnership and chair of Barking and Dagenham CCG.

Social prescribing, which features prominently in the NHS Long Term Plan, enables people to access non-health-related activities like clubs or classes in their local community that meet their wider emotional, physical and social needs. This improves their health and wellbeing, he explained.

“By 2023 the Government will support all local health and care systems to implement social prescriber connector schemes, available nationally in GP practices,” Dr John said. Such schemes are already operating in 25 London boroughs including North East London STP.

Pharmacists need to consider how they can support Government plans to tackle isolation and loneliness in local communities. “Contractual levers and funding is coming through. [Social prescribing] is a big thing and should be wider than GP practices. So how are you going to deal with frailty, loneliness and the older population in your area?” he asked delegates.

Convenience the key

The convenience of community pharmacies is a major trigger for people seeking care for minor ailments. This could be utilised to improve long-term condition management as well, the conference was told.

Around 18 million GP consultations and 650,000 emergency department consultations could be handled in community pharmacy, said Professor Margaret Watson, chair of health services research at the University of Bath.

However, research has also found that patients with chronic conditions like hypertension or diabetes prefer pharmacist intervention versus usual care. Convenience of location is the most common reason for choosing a consultation setting, said Professor Watson.

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