Pharmacy organisations have identified opportunities to integrate with other services and have an impact on patient care within the five-year NHS plan unveiled by NHS England’s chief executive Simon Stevens on 23 October 2014.
‘Five year forward view’ outlines a vision for overhauling NHS service provision, to make it more patient-focused and efficient. The document highlights a need to make 2–3% gains each year to combat a £30bn funding deficit projected for 2020–2021.
It emphasises chances to improve the prevention of ill health by tackling risk factors such as obesity and excessive alcohol use, and making care more personal by breaking down traditional barriers between services, in particular those between acute and primary care.
Published by Monitor, Health Education England, the NHS Trust Development Authority, Public Health England, the Care Quality Commission and NHS England, the document sets out proposed models of care, which it says could achieve the gains needed, with the right infrastructure and operating investment.
One option proposed is the establishment of multi-speciality community providers, where GPs, nurses, hospital consultants, and other providers of community services, including pharmacists, create integrated care organisations which could become responsible for the provision of much outpatient care.
David Branford, chairman of the English Pharmacy Board of the Royal Pharmaceutical Society, says that pharmacy, as the third largest health profession, needs to make sure it is directly involved in new care models. “Instead of thinking I am a hospital pharmacist, or I am a community pharmacist, pharmacists need to see themselves as a player within the local health community and adapt their roles accordingly,” he says.
“This means looking at current roles and skill mix, and thinking creatively about how we can participate in services such as urgent care, how we can work alongside GPs and other service providers such as care homes and improve public health.”
Rob Darracott, chief executive of Pharmacy Voice, says it is encouraging that NHS England has put the expansion and strengthening of out-of-hospital care at the heart of resolving the challenges of an ageing population, but disappointing that the 40-page document does not build on community pharmacy explicitly in other areas.
“Community pharmacy teams already have an extensive and proven track record in delivering the prevention agenda, so we will continue to make the case for greater involvement of community pharmacy teams in public health. Pharmacies already deliver enhanced services and there is capacity to do more,” he says.
“The NHS invests 12% of its budget in medicines, yet there is plenty of room for improvement in the way they are prescribed and taken,” adds Branford.
Darracott says it is clear in the document that there could be a more integrated role for pharmacists in urgent and emergency care networks and in care homes. It talks about ensuring patients get the right care, at the right time, and in the right place, which will require “far greater use of pharmacists” for dealing with coughs, colds and other minor ailments, and of the need “to develop new shared models of in-reach support, including medical reviews, medication reviews, and rehab services” in care homes.
The document also outlines NHS plans to speed up innovation and access to new treatments. They include cutting the cost of conducting clinical trials and streamlining their approval process. The £15m a year “commissioning through evaluation” programme, which examines real-world clinical evidence in the absence of full trial data, may also be expanded, if manufacturers wanting their products evaluated are prepared to contribute to the costs.