Everyone knows that the NHS is under pressure. Demand seems to be increasing and services point often at breaking point. The direction is, however, fairly clear. Demand in hospitals have to be reduced by managing these patients better in primary care. So primary care will need to manage more patients, with more complex conditions better.
The NHS Alliance recognise within their manifesto that boundaries have to be broken and primary care needs to build new partnerships and new ways of doing things. The NHS Alliance also supports a new pharmacy contract that has a focus on clinical services. They ask for new payment mechanisms that pay for service rather than activity.
Community pharmacy is well placed to offer services to patients as an integrated part of primary care. Often they are trained and delivering activities that can be converted easily into services.
Many community pharmacies offer activities for patients with asthma. Inhaler technique monitoring, NMS and MUR are common and within these, pharmacists often check personal management plans, complete simple spirometry and advise on treatment. So why not commission the whole service? Patients with asthma could select through choose and book to obtain their asthma care package through a community pharmacy and co-register with their GP Practice for this service. The pharmacy may well offer more convenient opening times in a more convenient location and a consistent service provider. With a range of treatments that are licensed as both preventer maintenance and reliever, step up and step down can easily be achieved. The contract could include three quarterly checks and one annual review developed around a self-management plan all for a single annual fee.
Many community pharmacies offer elements of sexual health services, including emergency hormonal contraception. It would seem a small advance to commission an oral contraceptive service which includes advice and supply and an annual health and pill check. With a wide range of drug interactions with oral contraceptives, the pharmacist may be best placed to advice on these.
I could go on to describe services for dyspepsia, IBS, various skin conditions and several others, but I think that by now the concept is clear. The service delivery would be further enhanced with independent prescriber status and direct links to GP clinical systems which would facilitate immediate data entry.
Better use of community pharmacy to deliver services can free up valuable GP and practice nurse time, while offering patients an alternative service that may have more convenient access and location, with a fully trained and capable healthcare professional that they already know and trust.