Pharmacy risks being sidelined as NHS evolves, report warns

Pharmacists risk missing the opportunity to expand their clinical responsibilities within a changing NHS in England because of a failure to reform funding arrangements and a lack of consistent messages about the role the profession can play, a report by the Nuffield Trust and commissioned by the Royal Pharmaceutical Society (RPS) has warned.

Significant changes to national funding models are needed to shift the focus on to direct patient care and away from dispensing and supply of medicines, according to the report, ‘Now More Than Ever: Why Pharmacy Needs to Act’.

It warns that failing to rise to the challenges posed by the ‘NHS Five Year Forward View’, published in October 2014, risks a “bleak” outlook for pharmacy’s role in the community.

“There’s an increasing understanding that pharmacy has a lot to offer an NHS on an urgent hunt for savings, patients looking for easy treatment on the high street for common illnesses, and people needing support to help them manage long-term conditions,” says Judith Smith, lead author and director of policy at the Nuffield Trust.

“But we are still not on course for pharmacists to become a caregiving profession in the way they can and should. In most areas, there just hasn’t been a change patients would notice.”

The report examines progress made against the findings of the ‘Now or Never: Shaping Pharmacy For The Future’ report, also led by Smith, published in November 2013 after the RPS had established the Commission on Future Models of Care Delivered Through Pharmacy. It looks at the views of stakeholders within and outside of pharmacy to measure the impact of the commission’s original publication.

The ‘Now or Never’ report said it was vital to the future of pharmacy that the profession takes on new “caregiving” roles, an aim adopted by the RPS. This goal was also backed by NHS England in the ‘NHS Five Year Forward View’ for the health service, which presented opportunities for pharmacists to provide frontline services.

The latest Nuffield Trust report finds a growing consensus among policymakers and other health professionals that pharmacy can have a broader role in health and social care at a time of increasing pressure on services. However, the enthusiasm within pharmacy to the ‘Now or Never’ report has since waned, it says.

The role of pharmacists as caregivers has made progress in the fields of urgent and emergency care, public health and general practice. But “disappointingly little” progress has been made in shifting the balance of funding to support the ambition of pharmacists delivering care services.

The report calls for changes to national funding models to enable pharmacists to adopt this wider caregiving role, such as for common ailments. This could be done through the national pharmacy contract and/or the new payment mechanisms that will be introduced to support the ‘NHS Five Year Forward View’, the report says.

The RPS has made “significant” efforts to advocate for the caregiving role, according to the report, but this drive has been “undermined” by divided leadership among the profession.

“Pharmacy still suffers from fractured leadership and continues to spend too much time rehearsing well-known disagreements,” the report says. Owners, employers, professional and policy groups must “speak as one voice about the role pharmacists can play”.

Pharmacy leaders must be at the centre of the national and local debate and planning for how to meet the challenges posed by the ‘NHS Five Year Forward View’, it adds.

“If they fail to do this, community pharmacy in particular risks being overtaken by the inexorable expansion of technology-driven dispensing and supply, and in local pharmacy services being delivered by new NHS organisations,” the report says.

“NHS England has set out a direction of travel that is about integrated local care providers, working in new networks that maximise the use of technology and new professional roles. If pharmacy fails to rise to this challenge, its role in the community beyond 2020 looks bleak.”

David Branford, chairman of the English Pharmacy Board at the RPS, says: “It’s not acceptable for patients to be denied the proven improvements to their care that pharmacists can offer, or for the NHS to miss out on the efficiency savings they can bring.

“Making use of pharmacists’ clinical skills in every hospital, every care home and in all community, primary and social care settings would undoubtedly relieve pressure on the rest of the NHS. But this cannot wait for another year: we are calling on commissioners, employers and the wider NHS to work with us to integrate pharmacy fully into the models outlined in the ‘NHS Five Year Forward View’.”