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Commissioning community pharmacy

It is time for the NHS to act differently towards Community Pharmacy and start to tie things up properly. The recent changes in the NHS has, in my opinion, made things worse and we need to see some real co-ordinated push for improvement.

The core contract for community pharmacy went to NHS England. This includes all the basic infrastructure costs to create a network of pharmacies that dispense medicines to patients and offer NMS and MUR services. However this has destabilised the link between public health, now in the local authorities, who produce the pharmaceutical needs analysis that may identify improvements in service provision.

NHS England have no additional money to introduce new core services such as minor ailment/common conditions or perhaps even to open up access to patients of NHS Choices in every community pharmacy. The savings that they made in category M has gone to CCGs who have spent it and the independent value for money review on dispensing is just a dream

All of the enhanced services moved to either the CCGs or public health within the Local Authority. Some services or elements of the services were decommissioned just before the move. A worrying part of this is that a significant part of the staff and expertise in community pharmacy development was also lost in some areas. This leaves the NHS in a position where community pharmacy support is variable and public health in particular is looking very exposed.

The LPCs are still there and the LPNs are getting into shape. It is interesting that I have witnessed some of the most exciting projects to improve patient identification, diagnosis, treatment and referral coming from community pharmacists working in isolation or in localities directly with their population. Beacon practice is still isolated and not shared properly.

On the other hand I have been to ground-hog day meetings in which community pharmacy is either not mentioned or when spoken about not understood. What are we transforming in the NHS today – certainly not the whole of primary care together?

As a patient, I am not sure that I have the network of community pharmacies that are best placed to meet my needs. I have limited access to NHS Choices and not in a place where someone can help me. There are services that are provided near my home that are not provided where I work or where I go on holiday. If I find two services are rarely the same. And access to medicines on the NHS through community pharmacy is still a problem with the total and absolute failure of independent prescriber status in the community pharmacy sector

As a community pharmacist, I might feel more excluded and not know who is going to be commissioning the services that I provide. The paperwork and bureaucracy is not getting better. And I am trying to push through service development to improve patient care with limited support. And to top it all NHS England says that 3,000 of us have to close.

So what am I looking for within the NHS? I could talk about leadership and co-ordination, but that is unlikely to deliver short and medium term results. So here we go:

  • NHS England in association with Public Health England should use the core contract to drive community pharmacy forward establishing healthy living pharmacy and access to NHS Choices as a minimum requirement and centrally funded
  • NHS England in association with Public Health England should produce national specifications and contracts for standardised services that can be adopted, adjusted and paid for locally, creating consistency for patients and reducing the ‘reinventing the wheel’ culture. You might want to start with common condition/minor ailment schemes, stop smoking services, EHC as a start, but there are lots more to do
  • NHS England in association with Public Health England should produce a plan that enables better co-ordination and implementation of local pharmaceutical needs assessments
  • NHS England, the Department of Health in association with ministers should produce a review of pharmacist prescribing to increase patient access to medicines through community pharmacy. One solution would be the introduction of Independent Community Pharmacy Prescriber (limited list)
  • NHS England should produce a strategic review of community pharmacy support services in association with CCGs and LAs. This review should set minimum standards around community pharmacy support and development that should be delivered at a local level. Although the CCG has the duty to improve ‘primary care’ they may do this aspect with joint appointments with the LA.
  • And someone – anyone – to formally review the value of community pharmacy to patients with long term conditions and produce a blueprint for CCGs of how to improve patient outcomes through the integration of community pharmacy into pathways and the delivery of meaningful medicines optimisation
  • NHS to produce a blueprint on how to standardise and enhance the role of community pharmacy in the management of common acute conditions and minor injuries to underpin further ‘catch it early’ campaigns and to form a meaningful element of transforming emergency care outside of the hospital

 

I could ask for another community pharmacy strategy, but as Judith Smith said at the launch of ‘Now or Never’ – pharmacy has had more visions than in the Old Testament. It is now time to stop talking about it – ‘manage’ it – and get it done.

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About markmandc (267 Articles)
A pharmacist with experience working in secondary care, primary care, community pharmacy and general practice.

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