Realising the potential of pharmacy will need change at scale

Source: NHE Jul/Aug 2017

Better for patients. Better for the NHS. Better for other healthcare providers. Sue Sharpe, chief executive of the Pharmaceutical Services Negotiating Committee (PSNC), which represents all community pharmacy owners providing NHS services in England, on the priorities for community pharmacy contract reform.

Community pharmacy is a sector playing a key but largely unrecognised role in meeting the health needs of local communities across England. As well as supplying patients with medicines, they can offer clinical advice and services on everything from emergency contraception and headlice, to the use of medicines to treat long-term conditions. 

Research has shown how much patients benefit from and treasure the wide range of services, support and interventions they obtain from community pharmacies. Last year, analysis by PricewaterhouseCoopers found that community pharmacies contributed a net value of £3bn to the NHS, public sector, patients and wider society in England in 2015 through just 12 services over and above the dispensing of medicines. 

NHS policymakers have no knowledge of how people use community pharmacies to support their health needs, and this creates threats that go beyond pharmacy: GPs and hospitals would have to take on the work if pharmacies were not there. But community pharmacy is today largely valued by the NHS only for the medicines supply function, partly because much pharmacy support is simply undocumented, making it easy to overlook. 

Significant services offered by community pharmacies are not funded, and many may not survive. Funding for the sector was cut last year after several years of no increases as dispensing volumes and workload rose. Although at a local level we have seen some real innovation, with pharmacies in some parts of the country making a positive difference in areas such as sexual health screening and helping people to avoid hospital admissions due to asthma, the hands of many local commissioners are now tied by impossible increases in demand which they must manage within restricted budgets. 

The sector has also struggled with an image created by its contractual funding arrangements. The government has used pharmacies to drive down supply costs, incentivising them to purchase medicines effectively and accounting for the savings.

This has reduced the NHS drugs bill by billions of pounds. Pharmacy funding provision is too closely linked to dispensing prescriptions, contributing to the disregard of the multitude of other services that pharmacies are providing. It is folly to reduce community pharmacy to no more than suppliers of medicines. 

Pharmacies are major providers of public health messages and advice in their local communities. Pharmacy teams are often the first port of call for people with minor conditions, and the health professionals that people with long-term conditions most regularly see. As GP appointment waiting times grow, or when the NHS struggles with winter pressures, pharmacies are a vital safety valve. 

Community pharmacies want to build on their contact with and understanding of patients to reduce demand for GP appointments, prevent unnecessary and expensive A&E attendances, and help people to manage their long-term conditions more effectively. Crucially, they need recognition as an integral part of our healthcare services. 

To realise pharmacy’s potential will need change at scale, with a range of services available from all pharmacies and promoted to the public and with relevant information sharing. The national contractual arrangements must drive this change. Rather than focus on paying just for supply and reducing funding levels, which is exactly opposite to the government’s stated aim to develop a clinical community pharmacy service, the NHS must instead identify the use and value of pharmacy properly and reward good services. 

There is an apparent government interest in driving large-scale warehouse pharmacies, replacing dispensing of regular, repeat prescriptions from community pharmacies. If this is implemented it would lead to very widespread community pharmacy closures: most would not survive. Closure of a vital health location on which GP services, as well as many people, are dependent is dangerous with the fragility of the NHS. 

Community pharmacy today serves the NHS well, providing an efficient and safe dispensing service combined with accessible health advice and support for patients. We are ambitious for contract reform that builds on the current service, rewards quality and is truly patient-centred. We would like recognition as the first port of call for health advice and self-care. And we would like to see pharmacies offer better care to patients with long-term conditions throughout their lives, working in close concert with GPs and other local health services to give the best value where it is most needed.




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