The message that pharmacy should be integrated with the rest of the healthcare system is not new and those who attended the recent Sigma conference in Aamby Valley City, India, were continually reminded of the overall conference theme, “partnering for purpose.” However, the sessions were not simply packed with the usual rhetoric, but instead gave pharmacists real practical guidance on steps they could take at a local level in their own practices to partner with other organisations and healthcare professionals. Such advice included renting out consultation rooms on certain days to individuals, such as podiatrists or physiotherapists, to allow patients to access a more complete service. Many such tips were delivered in a presentation from Ash Pandya, chief executive officer of Essex local practice forum, and John Zucker, partner and director of Matthew Arnold and Baldwin Solicitors.
In addition, the opportunities that the NHS England five-year forward view, published in November 2014, presents to pharmacy were mentioned by several speakers including Fin McCaul, chief executive of the Independent Pharmacy Federation (IPF), who described the document as “an important fundamental change”. He explained that pharmacy is rarely mentioned in the report, but added: “It is not about the professional bodies, it is about how much you want to engage to make a difference at a local level.”
Nicola King, who previously worked at NHS England, pointed out that the report provides a different approach to commissioning, and that there are suggestions that can apply to pharmacists. For example, the NHS view describes seven new models of care including multispecialty community providers, which would combine core primary medical services with wider community-based NHS services and, potentially, pharmacy and social care.
King said: “These [models] are not prescriptive, they are ideas. And Simon [Stevens, chief executive of NHS England] is looking for people to come forward to say ‘that rings with me, I’d like to put forward an idea about how we might do this — how we might make it work’.” After a discussion, one suggestion from delegates at the conference was to set up a local diabetes service, with podiatrists, opticians, community pharmacists and hospital consultants working together, led by a GP.
Local control, local services
If pharmacy is to work as part of a multidisciplinary team, it must have a solid identity of its own, one delegate highlighted. This means ensuring the core services are delivered successfully, as Ian Strachan, chairman of the National Pharmaceutical Association, emphasised. “The heartbeat of the profession is the supply function, and the distribution of that supply function is through the community pharmacy network,” he said. He added that whatever other vision and services you are working towards, the supply function must form the basis of your practice.
This was echoed by Ash Soni, President of the Royal Pharmacy Society (RPS), who said: “In 12,000 pharmacies, we supply 1 billion prescriptions a year. Supply is a key component [of what pharmacists do] because that is what keeps people well.”
Sue Sharpe, chief executive of the Pharmaceutical Services Negotiating Committee (PSNC), emphasised the importance of other potential national pharmacy services, including a national minor ailments service, which she described as a “no-brainer”.
However, McCaul later said that pharmacists can help empower patients to manage their own conditions at a local level. He said: “Everything is going local. No matter what the PSNC may say about national services, the change is coming up [from the bottom].” As an example, Zucker said that if a lot of your patients are keen travellers, you could consider setting up a travel clinic to deliver vaccinations.
Some services can be offered locally and cheaply with the use of technology, according to Collette Johnson, medical director at Praxtec Consulting. She described several healthcare “apps” that pharmacists could use to help screen for certain conditions and monitor them. As an example, she mentioned an app from Cambridge Cognition that asks patients questions to help screen for dementia. She explained: “When a patient goes to a GP to test for dementia, it can get confused with geriatric depression because they show the same signs.”
She added: “[The system] is used in 20 CCGs [clinical commissioning groups] but two CCGs have now taken this away from the GP clinic and have given it to community pharmacies.”
Another theme that emerged from the conference was development on a more personal level. Ash Soni and Helen Gordon, chief executive of the RPS, both mentioned the importance of joining the Faculty. Soni said: “The Faculty will be the simplest route to continuing fitness to practise”, which the General Pharmaceutical Council intends to introduce in 2017.
Additionally, Lesley Johnson, faculty development lead at the RPS, discussed the importance of mentoring. She explained that pharmacists are involved in on-the-spot mentoring as part of their role and can develop their skills by attending workshops or becoming an RPS mentor.
Claire Ward, chief executive of the IPF and chair of the Sigma conference, summarised the conference. She explained that over the past seven annual Sigma conferences, change has always been the key message. However, she added: “Even the change message has changed. Back then, it was change because of fear. But now I sense it is change because it is progress. It is change because of purpose. It’s change because you know that you can and must do something different — not simply to survive, but because you have a passion for what you do.”