If you want an indication of how integral pharmacists have become to the NHS’s future in England, then read its ten-year plan. Indeed, the ‘NHS Long-Term Plan’ contains multiple mentions of the profession in the document — around 20 in total — with pharmacists singled out as having “an essential role to play”.
It is fair to say that pharmacists have become the new fashionable ‘must-have’ for local NHS reformers, struggling with how to tackle the challenge of an ageing population, rising comorbidity and a shortage of doctors and nurses.
This is about to go national, with proposals in the long-term plan to roll out a new series of ‘primary care networks’ across the country with dedicated community teams, including pharmacists. And this is no pipe dream — the NHS is putting some serious money behind the project, with a £4.5bn cash injection designed to tempt GP practices to come together and set up “neighbourhood teams” staffed with pharmacists to review high-risk patients, reduce overmedication and improve the treatment of chronic diseases, such as asthma.
Community pharmacy or community pharmacists are only mentioned by name four times in the whole ‘NHS Long-Term Plan’ document
It is an ambitious plan to use the unique expertise of pharmacists more widely to improve the care of patients in the community and achieve the holy grail of a paradigm shift away from treating patients in hospital. Of course, the eagle-eyed among you will spot that the word most used is “pharmacist” not “pharmacy”. Indeed, community pharmacy and community pharmacists are only mentioned by name four times in the whole document.
There are references to the use of community pharmacies to deliver more NHS Health Checks and a suggestion that NHS 111 will be redirecting more patients to pharmacies for their medicines under the Digital Minor Ailments scheme. Keith Ridge, chief pharmaceutical officer at NHS England, has also confirmed since the plan’s launch that a pilot project will look at a new ‘pharmacy connection scheme’ that will involve GPs referring patients directly to community pharmacy.
But the only substantial new policy contained in the whole document with regards to community pharmacy is that the NHS will “make greater use” of pharmacists’ skills while “exploring further efficiencies through reform of reimbursement and wider supply arrangements”. It is unclear exactly what this means, but that kind of ambiguous phrasing is usually civil servant shorthand for more cuts, which would be a disaster for a sector already struggling with funding reductions of 4% in 2016/2017 and 3% in 2017/2018, in addition to the punishment of a medicines reimbursement system punching holes in their bottom lines.
Of course, the act of omission does not mean that community pharmacy has been overlooked, and the omens up until now had been good. In July 2018, Matt Hancock used his first speech as health and social care secretary to call more investment in community pharmacy and pharmacy negotiators were preparing to start talks on a new services-based contract (although these have yet to begin).
There are many aims of the long-term plan that community pharmacy — the front door of the NHS — can play a major role in
There are many aims of the long-term plan that community pharmacy — the front door of the NHS — can play a major role in, for example in tackling health inequalities, boosting mental health and preventing “major killer conditions” such as diabetes and heart disease. Local commissioners may well still choose to commission community pharmacy to carry out new clinical services, rather than employ pharmacists directly themselves.
But it is worrying that despite hard lobbying from pharmacy organisations, calls for a much greater role for community pharmacy seem to have ricocheted off the walls of Skipton House. Community pharmacy appears to still have a mountain to climb — in England at least — to convince the NHS that it can make a major contribution to the drive to improve healthcare over the next decade.
The long-term plan may mark a high point for pharmacists, in terms of their responsibility for patient care in the health service, and this should be welcomed, but it is not yet showing positive signs for community pharmacy. And for those representing and working in the sector, this should be of huge concern.