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Community pharmacy in a unique position

Mark Robinson, New NHS Alliance pharmacy lead, explains why the NHS needs community pharmacy to do more in order to deliver sustainability and transformation plans (STPs).

The NHS Alliance described community pharmacy as being in a unique position in its recent report, ‘Supporting the development of community pharmacy’. It is an interesting phrase to use, but has important meaning to community pharmacists, commissioners and communities around the country. 

NHS needs community pharmacy to do more 

Community pharmacy runs as an NHS contracted business. Some pharmacies are almost exclusively contracted by the NHS, with up to 95% of their income coming from the NHS. 

The NHS needs community pharmacy to do more. In fact, I believe that the NHS needs community pharmacy to step up their game if they are going to have any chance to deliver their STPs. You can’t reduce demand in general practice, widen access to healthcare out of hours, tackle the determinants of poor health and create a step change in self-care without community pharmacy. NHS is already struggling financially and NHS England, some CCGs and local authorities are all cutting back when they need to be investing to create change. It is a poisonous conundrum that we have to live with. 

Community pharmacy has a contract with the population that it serves, similar to other businesses. Each pharmacy has a catchment population of about 5,000 people and approximately 1.6 million people walk into a community pharmacy every day – 1.2 million with a health need. It is their duty to provide services to those people to fill the gaps in NHS provision and satisfy the needs of their population. 

People are interested in their health, but their increased expectation means that they want high-quality services at a convenient location at a time that suits them. This increasing demand drives a never-ending spiral trying to match demand and service provision. The NHS has rarely taken advantage of the longer opening hours of community pharmacy in a co-ordinated manner, or seriously looked to community pharmacy as a solution to managing demand in general practice, particularly in England where minor ailment services are patchy at best. 

A need for advanced practitioners 

The NHS Alliance understands this tension. Every pharmacist is a clinical pharmacist, but we do need advanced practitioners and independent prescribing pharmacists based in community pharmacy, but with a clear relationship with general practice. 

We recognise that many pharmacy owners have already invested heavily in their premises and their staff. We are always amazed at the number of community pharmacists who attend evening training events while there is absolutely no protected learning time provision. And we have seen some examples of great practice that are rewarded by recognition within the profession, but not by spread and diffusion throughout the country. A thousand flowers bloom, but we still don’t have a single community pharmacy led Vanguard or PM Challenge Fund. 

Greater support needed 

Community pharmacy must be supported to develop properly. It is not as if the STP is something new for pharmacy – we saw similar requests in the Pharmacy White Paper from 2008 and many documents both before and after, but the NHS has consistently failed to make it happen. 

There is little doubt that many community pharmacists on the frontline feel pressured and unfulfilled in their careers. They want to do more for their patients, have time to engage properly, use their clinical expertise and deliver the step change in self-care and patient outcomes that are desperately needed. 

The NHS Alliance report is intended to describe ways in which the NHS can recognise the importance of community pharmacy and provide some support for their development. When the owners know that other health professionals and commissioners recognise the unique position of community pharmacy, they may be inclined to invest even more in their premises and their staff. When pharmacists feel respected for their clinical expertise as well as their role in the provision of medicines safely, then they will be enthused and funded to further personal development. 

When we recognise and reward these skills, then we will create a step change in community pharmacy service provision. Perhaps NHS England should create a system where community pharmacists could be co-funded to become independent prescribers. 

The NHS Alliance is proud to start the discussion of how we develop the capability and capacity of community pharmacy to deliver the STPs. We can clearly see what community pharmacy could deliver for their populations, for general practice and for the wider health and social care agenda.

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