Last month, I gave a speech at the NPA’s centenary dinner, declaring that “the future is clinical”. It’s going to be about integrated, patient-facing and community-based services, married to medicines supply. “Good luck to anyone who thinks they can out-flank Amazon on supply alone,” I said at the time.

C+D asked me to expand on this theme. I’m very happy to do so, because this is a fundamental matter for the community pharmacy sector and certainly for independent pharmacies. Independents are innately strong in the clinical space, as patient-focused providers who are used to going the extra mile to deliver excellent care.

First of all, let me be clear that the safe supply of medicines remains, and must continue to be, the centrepiece of the community pharmacy offer.

However, it is not going to be enough going forward, with the challenges presented by online suppliers and the expectation of our NHS paymasters for added value.

I should add that bricks and mortar and online should no longer be seen as an either-or equation. Pharmacies can provide a responsive, personal service in the community and add the extra convenience of online ordering and digital communication with patients. By integrating technology, we can achieve the best of both worlds, maintaining the face-to-face offer the public likes so much.

Urgent care is one sphere in which a local, bricks-and-mortar presence is key (public health being an obvious other). When you think of what pharmacies have done during the pandemic – being the place people have come for advice and reassurance in the community – it’s clear that the NHS would not have been able to cope without a vibrant network of community pharmacies located near to where people live, work and shop.

 

“No one should have to wait to see a doctor unnecessarily”

 

It was encouraging to hear health secretary Sajid Javid reveal that plans are being worked up for a “Pharmacy First” model in England that will direct more patients to pharmacies without having to go to see their GPs.

Let’s imagine for a moment what a Pharmacy First service could look like in England.

Might it be a copy of the much admired NHS Pharmacy First service in Scotland? More than two million consultations have taken place within this scheme since its launch in July 2020. It’s spared GPs and hospitals 200,000 avoidable appointments in the past year.

The pharmacist can treat certain conditions such as urinary tract infections, shingles and impetigo without the need to see a doctor for a prescription. NHS Pharmacy First Plus takes this to a new level. The interventions are made by independent prescribers (rather than via patient group directions), thereby extending the range of potential support and closing more episodes of care in the pharmacy without the need for onward referrals. Cue pharmacists looking into people’s ears, eyes and throats.

Scotland is not the only place to look for inspiration in the urgent care arena. Wales is taking significant steps forward and in England there are shining examples too, Cornwall being one (with its newly expanded walk-in emergency supply service).

The NPA will work with its members and stakeholders to develop the thinking in this space.

Whatever form a national Pharmacy First approach in England might take, it ought to have the effect that for the treatment of minor illnesses and the routine medicines management of long-term conditions, no one should have to wait to see a doctor. With community pharmacy as the front door to the NHS, we can contribute greatly to busting the NHS care backlog caused by the COVID-19 pandemic.

There is already a promising degree of consensus about what a sustainable, clinically-based future service offering could look like, as a Future of Pharmacy video premiered at our centenary dinner featuring chief pharmaceutical officers, GPs, pharmacists and patients shows.

How we get there is more contentious, as can be seen in the ongoing debates around hub-and-spoke dispensing, supervision and the allocation of resources. What’s more, the current levels of funding in England cannot possibly sustain the service developments we could otherwise deliver.

Nevertheless, let’s be bold with our clinical offer to patients and the nation at large. We are a can-do profession, with a can-do vision for the future.

 

Andrew Lane is chair of the National Pharmacy Association (NPA)