The NHS is going through one of the biggest changes of its existence. It has to reorganise following the disastrous Health and Social Care Act changes, do it quickly and with supportive legislation lagging behind. I don’t think that the leaders quite know what to do and even the resilient Kings Fund sort of plump for STPs as the best option, despite saying that the money is not available to pump prime major change. So where will this all end? Perhaps with 44 STPs and then a range of accountable care organisations as providers. Boundaries have to be broken, contracts will be amalgamated and contract management will be the responsibility of the providers.
So where does Community Pharmacy fit? That is difficult and I would say both everywhere and nowhere.
Nowhere because there is no route plan and no extra funding for community pharmacies to invest in change. As ever perhaps 90% will achieve their quality payments – which sounds as if this is a bonus for quality, but it is really a penalty for not doing what you have been told to do. There an NHS Alliance document and a Pharmacy Voice Forward View and the beginnings of an implementation dialogue.
Everywhere because we know that Community Pharmacy is the only option in reducing demand in General Practice and OOHs and driving the self care (self pay) agenda. But we have to start moving now and get into pole position – what does that mean?
We need to form federations. Look at GPs and their federations have gone through three stages; grouping to make money, grouping to survive; grouping to engage within new models of care. So lets get this straight – we federate not to win tenders, not to ensure our survival, but to form an entity that can work within a new model of care accountable organisation. Its different and we must understand that.
We need to look more critically at our local populations. We need to understand the local demography and health needs. And work out how to engage the local population and build the relationships with our communities.
We need to develop and deliver a new service every month – it has to have this intensity as each new service will only add a proportion of the income required to reverse the impact of the core funding cuts. And it gives community pharmacy history for when others are looking to commission the service.
We need to engage and educate others. Everyone talks about engaging with commissioners, but, in my opinion, we need to engage with providers (who we will join up with in ACOs) and local people (who need our help).
There are two important elements for this to succeed:
- Pharmacy owners must believe that there is little more to be made out of dispensing and the money is to be made by driving retail and private services – just have to listen to Simon Stevens to realise that.
- Pharmacists, technicians and counter staff have to believe that they can respond to population needs and deliver new parcels of care. And that they want to. Community Pharmacy is an exciting environment to be in – and the opportunities are endless.