Community pharmacy has much to contribute to the goals of the ‘NHS long-term plan’

MPs are in the midst of examining the readiness of pharmacy services to capitalise on future opportunities, in light of the ways in which healthcare delivery is changing.

Many of these changes, such as the Community Pharmacy Smoking Cessation Service and the Community Pharmacist Consultation Service, were set in motion following the publication of the ‘NHS long-term plan’ in 2019 — a milestone in the evolution of healthcare. The plan highlights the need to address the social determinants of health, engage in collaborative partnerships, leverage digital technologies, and ensure equitable access to healthcare services, paving the way for a more integrated and patient-centric approach to care.

For community pharmacists, the plan provides the opportunity to contribute their unique expertise and make a significant impact on population health. But there is more that community pharmacy can do. By working in close collaboration with other healthcare professionals, community pharmacists can provide comprehensive medicines management, preventive care, health promotion and disease management services.

The aims of the plan can be divided into ‘7 Ds’: devolution of powers to NHS regions, devolvement of decision making to healthcare professionals, digital enablement, demarcation, democratisation, deprescribing and diversification. By embracing these principles, community pharmacists are poised to play a transformative role in the healthcare landscape.

Devolution and devolvement

Devolution and devolvement within the ‘NHS long-term plan’ empower regional authorities and local organisations to address the wider determinants of health at a local level. This aim has largely been realised through the implementation of integrated care systems in July 2022 and the delegation of pharmaceutical services commissioning to those systems in April 2023.

But their set up has not been without issue. In 2021, Community Pharmacy England (then the Pharmaceutical Services Negotiating Committee) and primary care providers raised concerns regarding the representation of community pharmacy on integrated care boards​[1]​.

By aligning healthcare policies with broader social, economic, and environmental factors, however, community pharmacists and primary care providers can work collaboratively to promote health equity. This could include initiatives to address social determinants of health, such as housing, education, employment, and access to healthy food.

Research from the University of Buffalo in the United States has suggested that community pharmacies are the ideal place to screen patients for these wider issues that may affect their health​[2]​. The pharmacies included in the study incorporated community health workers into their team, who bridged the gap between the healthcare system and community services. Other pharmacies offered specially trained pharmacists to connect patients to community resources.

The researchers highlighted that fostering partnerships with local authorities and community organisations were essential to driving positive health outcomes.

Digital enablement

The ‘NHS long-term plan’ places a strong emphasis on digital enablement to enhance healthcare services. For community pharmacy, this means leveraging digital technologies to optimise medication management, streamline prescription processes, and engage patients through online consultations and education.

Digital platforms should facilitate seamless communication and information sharing among community pharmacists, primary care providers and patients, leading to better coordination and continuity of care.

However, seamless communication is not universal in pharmacy. A recent expert panel commissioned by the Health and Social Care Select Committee found that “IT systems were typically inadequate for sharing patient information efficiently between community pharmacies and hospitals and general practice”​[3]​. They concluded that this contributed to “poor uptake of services” for referring patients to community pharmacies.

But there are parts of the country where community pharmacies are forerunners in digital enablement, accessing care records that allow for patient information to be shared between secondary care, general practice and mental health services​[4]​. Pharmacists with access to these records have said that they have allowed care to be more “personal, joined up and safer”, adding that the records “will be key” for providing nationally- and locally-commissioned clinical services in community pharmacy​[5]​.

These digital advancements align with the NHS’s goal of integration and enable community pharmacists to provide enhanced patient care, improved medication management, and facilitate communication with patients and other healthcare providers — ultimately leading to improved patient outcomes and experiences.

Demarcation

While the ‘NHS long-term plan’ promotes integration, it also recognises the importance of clearly defining the roles of different healthcare professionals. The plan seeks to clarify the roles of community pharmacists, doctors and other primary care providers, ensuring that each professional can contribute their expertise to the best of their abilities.

There will be further opportunities for community pharmacists to demarcate their role through the independent supply of medicines in the coming years, as the NHS drives towards launching an independent prescribing service and a minor ailments service in community pharmacy​[6,7]​.

This encourages collaboration and joint decision-making, facilitating more efficient and effective care delivery. By working together as part of multidisciplinary teams, healthcare professionals can provide comprehensive and holistic care to patients, enhancing outcomes and experiences.

Deprescribing and prevention

The ‘NHS long-term plan’ recognises the significance of deprescribing — the process of reducing unnecessary or inappropriate medicines. Community pharmacists are encouraged to actively engage in medicines reviews, identify potential drug interactions and collaborate with prescribers to optimise medication regimens.

A review of 24 studies involving more than 4,000 patients, published in the British Journal of Clinical Pharmacology in 2021, found that community pharmacy-led deprescribing interventions led to successful deprescribing of high-risk medication, as well as improved quality of life in patients with severe mental illness​[8]​.

By championing these deprescribing initiatives, community pharmacists can play a heightened role in reducing the risk of adverse drug events, improving medicines adherence and ensuring patient safety.

Democratisation

Democratisation emphasises the importance of involving patients and the public in decision-making processes and ensuring equitable access to healthcare services. Within the context of population health management, community pharmacists can actively engage with local communities to understand their specific health needs and co-design interventions that address health inequalities.

Examples of such initiatives were particularly visible during the COVID-19 pandemic, when community pharmacies ran vaccination sites in places of worship to reach communities with high vaccine hesitancy​[9]​.

This participatory approach empowers communities and helps bridge the gap between healthcare providers and the diverse populations they serve, ultimately reducing disparities and promoting health equity.

Diversification

Diversification of community pharmacy services aligns with the goal of addressing health inequalities, which is a vital part of the ‘NHS long-term plan’.

By providing culturally-sensitive care, targeted health education and personalised interventions, such as through ensuring the availability of language barrier services, community pharmacists contribute to reducing health inequalities and promoting equitable access to healthcare services​[10]​.

Community pharmacists are well positioned to engage with local communities, identify health disparities and implement targeted interventions to address these disparities. By leveraging their accessibility and community presence, pharmacists can play a vital role in health promotion initiatives, health education and early detection of health conditions​[11]​.

In conclusion, the ‘NHS long-term plan’, with its focus on the ‘7 Ds’ and population health management, presents a transformative vision for primary care and community pharmacy.

By embracing the principles of integration, access and prevention, community pharmacists can play an even more substantial role in addressing health inequalities and delivering patient-centred care. As they actively contribute to the implementation of the plan, community pharmacists are poised to make a lasting impact on the health and wellbeing of individuals and communities across the country.