We do not know exactly what 2019 will bring, but community pharmacy is sure to face fresh challenges, both those specific to the sector and those related to the wider drive to reduce NHS costs and the ongoing economic uncertainty in the UK.
The political turmoil already contributing to the slowing of the economy is likely to put further financial pressure on the high street, including pharmacies, throughout 2019
Funding across the NHS is expected to increase by only just over 3% each year for five years which, given the current heavy pressures on the health service, will not be sufficient. And the political turmoil already contributing to the slowing of the economy is likely to put further financial pressure on the high street, including pharmacies, throughout 2019.
Since joining the Pharmaceutical Services Negotiating Committee (PSNC) in May 2018, I have seen the pharmacy sector working flat out to serve local patients and communities, and I have also met business owners battling for survival. The government and the NHS — community pharmacy’s paying customers — also seem bruised, and when I took up the post as chief executive, constructive dialogue had reached a standstill. The good news is that there is now willingness from both sides to engage, and the new ‘NHS Long-Term Plan’, published on 7 January 2019, gives us some idea of where our payer is headed.
Collaborating to realise our new clinical vision
The crucial thing for pharmacy now is to work out how it fits into this plan for the NHS, and the PSNC’s next step will be to work with the government and the NHS to explore what community pharmacy’s contribution will be.
Pharmacy must articulate how it can meet health secretary Matt Hancock’s priorities, including illness prevention; developing technology; and reducing pressure on GPs and urgent care services.
We are pleased that the ‘NHS Long-Term Plan’ has committed to making greater use of community pharmacists’ skills, but we must now continue to work with others to set the vision and to make the case for community pharmacy
As the negotiator, the PSNC will lead on discussions about finances and the contractual framework. Our aim, as a committee of pharmacy contractors, is to get the best possible funding deal for pharmacy; however, we also want to start working towards a new, more clinical vision for pharmacies. We are pleased that the ‘NHS Long-Term Plan’ has committed to making greater use of community pharmacists’ skills, but we must now continue to work with others to set the vision and to make the case for community pharmacy. Collaboration between pharmacy organisations will continue to be essential — if any of us break ranks, we risk finding ourselves divided and conquered.
At the PSNC, we have set out visions for the clinical services that pharmacies could offer and we would now like to engage with the government on what it wants pharmacy to achieve. Our aim is to agree a multi-year settlement, so that pharmacy professionals know what they are working towards and how to get there, as well as how much money will be available for doing so. To do that, we need to deliver what the government wants, while also working to influence it when and where we think we have better solutions.
We need to have a clear position and a plan at the ready for difficult issues for the future, such as working with new technologies like robotics and automation, and the implications of hub-and-spoke dispensing models, which make use of an external ‘hub pharmacy’ to dispense medicines on a large scale, to be collected by patients across a number of ‘spoke’ pharmacies. We also need to consider the role of distance-selling pharmacies, such as Pharmacy2U, which the PSNC also represents.
As a sector, we need to consider whether we have the right community pharmacy funding models: the current model, for example, appears unsustainable. Pharmacists need the training and skills to take on new clinical roles and services, as well as the time to deliver them, so we must think about how core responsibilities can be delegated to trained pharmacy technicians and dispensers. We must also be frank and ask if we have the right numbers of pharmacies in the right places.
There is much in community pharmacy’s favour … because any reduction in pharmacy capacity could increase demand on other healthcare providers
It is not for the PSNC alone to answer these questions — we will continue to work closely with the other national pharmacy organisations and local pharmaceutical committees (LPCs) as we tackle these topics.
There is much in community pharmacy’s favour, not least because pharmacies provide a safety net for the NHS, and because any reduction in pharmacy capacity could increase demand on other healthcare providers. GPs and hospitals are already failing to cope with current demand, and pharmacies can help. We will continue to use these and other arguments to make the case for the sector.
Pharmacy stepping up
One thing we do know is that through 2019 and beyond, community pharmacies will need to work even more closely with GP colleagues to deliver the services for the benefit of patients. As well as an understanding of the direction of travel, and what funding will be available for pharmacies to do this, this will require progress, including:
- Successfully rolling out existing pilots (such as the Digital Minor Illness Referral Service and the NHS Urgent Medicine Supply Advanced Service) with suitable remuneration;
- Commissioning new pilots (such as atrial fibrillation screening; managing conditions including asthma and chronic obstructive pulmonary disease; as well as sexual health and emergency contraception initiatives) and subsequent rollout, as appropriate;
- Capturing and using data on the enhanced efficacy of community pharmacy in the event of changes to the law on supervision;
- Ensuring effective IT connectivity between GPs and community pharmacies;
- Updating the clinical skills of pharmacists and better training and recognition of the skills of pharmacy technicians;
- Better communication with all stakeholders about what community pharmacy can provide its customer — the NHS — and patients.
Plans for 2019
Local leadership will be essential to delivering a more integrated future, with LPCs spearheading work to integrate pharmacy within emerging primary care networks. Leadership is easy when the organisations are making substantial profits, but leadership is much harder when community pharmacy is in the position that it is now. LPCs will need to step up to this challenge and the PSNC will aim to give LPCs the tools they need to do this job throughout 2019.
The PSNC also needs to continue the range of work that it does to support pharmacies. My teams have a wealth of expertise in pharmacy funding and economics, dispensing and supply, regulation and community pharmacy services and IT. Collectively, this small group of people carries out a range of important jobs from ensuring that pharmacies are paid correctly and getting price concessions granted, to helping pharmacy professionals to understand what is expected of the pharmacy sector.
For instance, the guidance PSNC provides on such topics as the EU General Data Protection Regulation (GDPR), flu vaccinations and quality payments saves each contractor thousands of pounds in consultancy and professional services fees each year.
And while prices remain unstable, work to source medicines will continue to be difficult; but the PSNC will do all that it can to make this as manageable as possible to reach the fairest reimbursement prices. This issue has already been raised with the Health and Social Care Select Committee and, in 2018, the PSNC’s pharmacy funding team prevented potential losses to pharmacies of some £330m through its negotiation of concessionary prices.
At a 2019 planning meeting in November 2018, the PSNC discussed how it aimed to tackle many of the issues detailed above. We are eager to begin funding negotiations, and while we are not going to find answers to all of our questions, by the end of 2019 the PSNC needs to have made significant inroads, with a clear plan on what it will make happen in the future.
Being open to change
One thing we can be sure of as the new year begins is that if community pharmacies are to thrive long term, we need to be open to making changes in how pharmacy works and to the core services that pharmacies offer on behalf of the NHS. This will not be easy, and I would encourage all pharmacy professionals to consider their pharamcy business’ ability to adapt to the sorts of challenges and changes that the PSNC foresees.
For the PSNC’s part, it is increasingly important that we support pharmacies and LPCs, and we will be focusing on how best we can do that. We look forward to working with the pharmacy profession throughout 2019.
Simon Dukes is chief executive of the Pharmaceutical Services Negotiating Committee.