NHS England has announced plans to recruit over 20,000 ‘clinical pharmacists’, paramedics, physiotherapists and link workers by 2023-24 to work in primary care networks (PCNs).
The NHS says the “clinical skills of community pharmacists” will play an important role in the new care landscape and that it is "likely" that some will undertake training to work in PCNs.
There has been a mixed response from pharmacy bodies to the announcement, with some saying it pointed to new opportunities for community pharmacists and others suggesting it was not sufficiently clear on community pharmacy’s role and could “intensify” a drift in the profession from community pharmacies to GP surgeries.
The recruitment drive, which is aimed at alleviating GP pressures and reorganising how healthcare is delivered on the NHS, is to be funded out of £4.5bn set aside for community health services under the NHS Long Term Plan. It was announced as part of the new five-year contract agreed with the BMA’s GP Committee.
These services are to be delivered by primary care networks made up of GPs supported by healthcare professionals such as ‘clinical pharmacists’, whose responsibilities will include promoting self care, performing medication reviews for patients most in need (including those with dementia and CVD), and reducing inappropriate antibiotic use.
The Pharmaceutical Services Negotiating Committee notes that NHS England has “confirmed that these PCN pharmacists will not necessarily need to be employed by GP practices, but they will need to work as part of the integrated care team that makes up the PCN”.
An NHS England statement says the move will “help forge stronger links between local high street community pharmacists” and “clinical pharmacists” working in GP surgeries, hospitals and care homes.
All pharmacists working within PCNs will need to have completed an 18-month clinical pharmacy diploma, NHS England has said.
On funding for the additional workforce, NHS England said: “Reimbursement for the clinical pharmacists (up to 70 per cent) will be conditional on enrolment in training or existing attainment of mandatory competencies.
“The funding for additional roles will be subject to agreeing and delivering seven national service specifications for primary care networks, which set out a consistent approach to care. Many of which will use clinical pharmacists’ skills.”
In a special ‘Pharmacy and Medicines’ bulletin on the GP contract, NHS England gives more detail on how it expects the community pharmacy sector to interact with PCNs, saying that there will need to be "strong links" between community pharmacy and PCNs.
It is "likely that some community pharmacists could be recruited to work in clinical pharmacist roles," for which they would need to complete the 18-month diploma, NHS England says.
The bulletin adds: “The NHS is already making better use of the clinical skills of community pharmacy professionals to advise and treat patients, and under PCNs this will continue. The NHS needs the clinical skills of community pharmacy professionals to achieve its vision for better safety, outcomes and value from medicines.
“As set out in the NHS Long Term Plan, and subject to contractual negotiation, the Digital Minor Illness Referral Service may be extended and NHS111 could start referring patients with minor illnesses on to all community pharmacies to support urgent care. Also this year, with further Pharmacy Integration Fund money, we will start testing the referral of patients with minor illnesses from GP practices to community pharmacy in several PCN areas.”
NHS England chief executive Simon Stevens said the drive “represents the biggest boost to general practice in more than 15 years, giving patients more convenient services at their local GP surgery while breaking down the divide between family doctors and community health services”.
NHS England chief pharmaceutical officer Keith Ridge said: “Today’s deal is a boost for patient care and a tremendous vote of confidence in the pharmacy professions.
“This historic, five-year GP contract is one of the first steps to delivering our NHS Long Term Plan and I’m pleased to see such clear recognition of pharmacists’ role at the heart of people’s care.
“From medication review for people on too many medicines, to the reduction of inappropriate use of antibiotics, the skills of clinical pharmacists and pharmacy technicians working with patients, and the wider primary care team, will make a real difference to the communities we serve.”
Nigel Edwards of think tank the Nuffield Trust expressed scepticism that the recruitment targets would be met. “We need to hear more about where these staff are coming from – after all, many parts of the NHS have their own serious shortages,” he remarked.