Health Service Focus

Community pharmacy: a vital link

Adam Irvine, chief executive of Greater Manchester Local Pharmaceutical Committee (LPC), explains how, unlike many sustainability and transformation plan (STP) areas, community pharmacy has an active voice in all the region’s key forums.

Greater Manchester devolution is now one year old. National requirements such as quality standards and the need for an STP still apply, but the new Greater Manchester Health and Social Care Partnership (GMHSCP) has taken charge of how the city-region achieves them.

There are opportunities to pilot scaled accountable care models in localities, with community pharmacy playing an active role in population health. Shared determination to see devolution succeed has energised joint working and focused minds. Barriers and boundaries have melted away.  

And community pharmacy is seen as vital in all this. Unlike many STP areas, we have an active voice in all the key forums. This was made easier when six bodies representing community pharmacy merged to create Greater Manchester LPC in October 2016. 

What difference has devolution made in practice? Funding has been devolved to GMHSCP but the majority of community pharmacy is still commissioned through national NHS England contracts. CCGs and councils can, however, commission what are known as ‘enhanced services’ such as smoking cessation, weight management, emergency hormonal contraception and needle exchange to meet local needs.  

It is here that the real opportunities of devolution currently lie and Greater Manchester LPC has been working with GMHSCP, local commissioners and other providers. We will present formal proposals this summer, and our vision has three goals: 

• Greater consistency and equity of access so patients across Greater Manchester benefit from the same great pharmacy care
• Innovations that make better use of pharmacists’ clinical skills and expertise
• Freedom to enhance care with services that meet specific local needs 

Consistency and equity 

We want a standard suite of enhanced services across Greater Manchester, minimising the postcode lottery. Currently, a pharmacy on the border between different areas may be providing three different sets of services to patients living just a few streets apart. 

Greater Manchester has made good strides towards consistency. Manchester, Salford and Stockport have long provided the same minor ailments service and, from April 2017, Bury and Rochdale have also come on board. This is great, but we’re aiming for all 10 boroughs. 

Similarly, an adult inhaler-technique service is being relaunched across all 10 boroughs so all patients can access pharmacy support with their asthma and chronic obstructive pulmonary disease (COPD). 

Innovations that harness pharmacists’ clinical skills and expertise 

We’re trialling exciting and innovative services. The Pharmacy Care Plan, launched in March, sees pharmacists ‘co-producing’ care with people with long-term conditions. Patients have regular pharmacist consultations to agree goals, outcome measures and monitor progress. It is pioneering work that will empower patients, enhance self-care and improve outcomes. 

In Trafford, we’re piloting pharmacy-based support for people with atrial fibrillation, a condition that increases stroke risk fivefold. Community pharmacists will manage care with the patient’s GP by undertaking an in-depth anticoagulant consultation. Pharmacist and patient will together discuss medication and lifestyle advice to reduce stroke risk and agree a course of action; the pharmacist will recommend it to the patient’s GP. 

These are just two examples of how community pharmacy can enhance care. Both pilots will be underpinned by greater data sharing between professionals through the ‘GM Connect’ programme.

 The future? 

This is just the beginning, and community pharmacy can offer even more, subject to appropriate resourcing.  

No other profession knows as much about medication, and Greater Manchester has signed a pioneering agreement with pharma to accelerate research on innovative treatments. 

The accessibility of community pharmacy means it is ideally placed to enhance urgent care provision, including liaison with GPs and practice pharmacists through data sharing. We are also open to exploring new funding models – for example, through capitation – if it proves mutually acceptable and workable. 

One year in, the enthusiasm and commitment for devolution has not waned despite constraints including continued pressures on capacity and resources across health and social care. Community pharmacy sees itself as a vital part of the solution and, so far, commissioners in charge of Greater Manchester’s devolved £6bn budget seem to agree. The response to the proposals we put forward this summer will show how committed people really are.

FOR MORE INFORMATION

W: www.psnc.org.uk/greater-manchester-lpc