Government plans to transform the NHS in England, outlined in its ‘Five year forward view’, are in jeopardy unless it recognises the social care crisis and funds the necessary shift in services out of hospital into the community, the King’s Fund think tank has warned.
The comments come in its report looking at the progress of the 44 sustainability and transformation plans (STPs), which are being drawn up by local heath and care services to deliver the Five Year Forward View locally.
, published on 21 February 2017, says the most urgent priority is to recognise “the claims of social care which is already in crisis” and which in turn is putting significant pressure on health services.
But appropriate NHS funding is also critical if STPs are to succeed: “It is no longer credible for the government to argue that it has provided ‘the funding needed to deliver the NHS’s own plan’ when most of the additional funding identified in the 2015 spending review is being used to keep services afloat rather than to transform care, which was the proposal at the heart of the Forward View.”
The King’s Fund report reveals that a number of STPs propose moving services out of hospital into the community, which will mean hospital closures as acute services are centralised onto fewer sites.
That shift away from hospital is matched by an expansion and redesign of primary and community health services, which includes more care being delivered directly into people’s own homes, it says.
At the core of all STPs is the need to prioritise preventive healthcare and early intervention to help people stay healthier for longer and there are calls for a “step change” or “radical upgrade” in these kind of services.
The King’s Fund highlights the potential role of pharmacy in STPs in two cases — in Somerset, pharmacists are involved in proposals to widen membership of the primary care team while the Hertfordshire and West Essex STP proposes pharmacy-led smoking cessation services as a way of tackling unhealthy behaviours.
Michael Lennox, chief officer at Somerset Local Pharmacy Committee (LPC), says the reference to pharmacists in Somerset is likely to apply to the development of roles for pharmacists based in GP practices (PIGP).
“Somerset LPC is working in partnership with both the [local] vanguard and the Somerset STP primary-care development forum to inform and develop an innovative and integrated way of working that sees community pharmacy recognised and used as a key part of the primary care team,” he says. “The development of PIGP as a platform is being viewed as an enabler of that.”
Lennox adds that work is also ongoing to build a broader clinical pharmacy system that links pharmacy services across hospital, GP and community pharmacy settings.
“We are making some progress in developing a sustainable future for community pharmacy in Somerset against the backdrop of the collective pressures of the national contract changes and local clinical commissioning group (CCG) medicines management initiatives,” he says, adding that “building positive stakeholder relationships and momentum with the relevant agencies, such as the local medical committee, STP structures, CCG and NHS England regional and area teams, is key to that”.
The focus of STPs to shift services out of hospital into the community was welcomed by the Pharmaceutical Services Negotiating Committee (PSNC), the negotiating body for community pharmacy contractors in England.
Alastair Buxton, the PSNC’s director of NHS services, says: “This could be good news for community pharmacy. However, as the King’s Fund has noted, this shift of workload needs to be preceded by increased investment in primary and community care provision.”
He adds: “Community pharmacy is currently seeing the opposite approach being taken by the Department of Health and NHS England, which will clearly not help to maximise the value community pharmacy teams could be bringing to patient care and the successful implementation of health service reform, via the STPs.”
His views were echoed by Graham Phillips, superintendent pharmacist at Manor Pharmacy Group in Hertfordshire and member of Hertfordshire Local Pharmacy Committee.
“STPs and clinical commissioning groups are fiddling around the edges, for example, suggesting that GPs stop prescribing over-the-counter medicines. What we need is a paradigm shift towards primary and secondary prevention. Pharmacy can be really in the ascendancy of that.”
Pharmacy-led health checks, screening for diabetes, pre-diabetes, hypertension as well as “treating to target” in appropriate cases would make a significant contribution to help STPs deliver on preventing chronic conditions developing, as well as supporting those with long-term conditions, he says.
Providing dietary and lifestyle advice — including smoking cessation — are core community pharmacy services, adds Phillips. “However, I don’t think STPs will deliver very much because the whole health and social care system is broken. The potential of the network of community pharmacies is simply ignored by those at the top of the NHS — how else could you explain government plans to close 3,000 community pharmacies?”
The King’s Fund report comes as the Royal Pharmaceutical Society is sending a letter to all STP leads outlining the potential of pharmacy to help them deliver their local plans.
Sandra Gidley, chair of the RPS English Pharmacy Board, says: “There is a need to think more creatively about how to use the medicines skills of pharmacists and involve them more in the teams which are being developed as there is growing evidence that they can help provide better outcomes and save money.
Source: The Pharmaceutical Journal
“The King’s Fund comments are no surprise but it is disappointing that they haven’t really considered the use of pharmacists who can provide advantages in a variety of settings when working with other members of the health care team.”
Gidley says the department and NHS England should now put their full attention into responding “sooner rather than later” to the recommendations for pharmacy made in the Murray review
, published in December 2016. The independent review, which looked at the future of community pharmacy clinical services, recommended greater use of repeat dispensing and independent prescribing and called for pharmacists to have full read and write access to the patient medical record.
The official response to the Murray review, expected from England’s chief pharmaceutical officer Keith Ridge, is still awaited.
 Ham C, Alderwick H, Dunn P et al. Delivering sustainability and transformation plans: from ambitious proposals to credible plans. King’s Fund. February 2017. Available at: https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/STPs_proposals_to_plans_Kings_Fund_Feb_2017_0.pdf (accessed February 2017)
 Murray R. Community pharmacy clinical services review. Available at: https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/12/community-pharm-clncl-serv-rev.pdf (accessed February 2017)