Now could be the time for LTC management

The Department of Health is presently reviewing proposals for community pharmacists to manage patients with long-term conditions to relieve the pressure on the NHS. 

Sun dial, concept of time

Now could be the time for community pharmacy to manage long-term conditions (LTCs) as part of its contractual agreement with the government.

Research published in the British Journal of General Practice (online, 12 March 2018) found that 27.2% of more than 400,000 patients registered with GPs in England had multimorbidity, defined as having two or more long-term conditions recorded in the patient’s record.

The study found that the majority of GP consultations, prescriptions and hospital admissions involved patients with multimorbidity, and concluded that all health professionals must be trained to manage the cumulative effects of more than one chronic condition.

The Department of Health and Social Care (DHSC) is currently considering proposals from the Pharmaceutical Services Negotiating Committee (PSNC) that pharmacists manage the care of some patients with LTCs as part of new Community Pharmacy Contractual Framework.

The PSNC based its proposals on the Community Pharmacy Future project, which has included the development of a Pharmacy Care Plan service for patients with LTCs. Pharmacists coached and motivated patients to improve their quality of life through better management of symptoms, lifestyle choices, weight loss and improvement in health conditions.

The project — which is run by the big four multiples: Boots, Lloyds, Rowlands and Well, but includes independent pharmacy — began life seven years ago, in 2011, specifically to provide robust evidence for commissioners and policymakers on how community pharmacy could contribute to patient care.

And over the years while the evidence has been amassed, the clamour for greater pharmacist involvement in the management of LTCs has grown. It reached a peak in 2016, with the ‘Community pharmacy forward view’ suggesting that patients could register with a community pharmacy to coordinate their care and help them manage their LTC; the Murray Review of community pharmacy’s clinical services, calling for the existing Medicines Use Reviews element of the pharmacy contract to be re-designed to ensure pharmacists were part of a ‘multifaceted approach to helping people with long-term conditions’; and the Royal Pharmaceutical Society’s report considering how the role of the pharmacist could be enhanced to prevent, identify, treat and support people with LTCs.

This has now taken something of a back seat, possibly as a result of the cuts to community pharmacy funding, and the subsequently frosty relationship between the PSNC and the DHSC, but now that new contract negotiations have begun, fingers are being crossed.

The All Party Pharmacy Group (APPG) held a two-part hearing on LTCs in March 2018, hearing from charities that pharmacists can and should play an essential role in supporting personalised care plans for patients, and from pharmacists that they were chomping at the bit to work as part of a patient-centred, genuinely integrated, care service.

As MPs on the APPG were told, if things really are to change, a cultural shift is needed — but the way that pharmacies are paid also has to vary from how things have always been done.

If these twin objectives can be achieved, then the health service’s third largest profession could have one of its most exciting opportunities to use its undoubted clinical nous to help ease the well-documented pressures on the NHS.

Last updated
The Pharmaceutical Journal, PJ, March 2018, Vol 300, No 7911;300(7911):DOI:10.1211/PJ.2018.20204537

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