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‘The long view of NHS reform: why pharmacy is always relevant’

Some aspects of the healthcare agenda haven’t changed in 20 years, but community pharmacy has never been closer to the centre stage of health service policy and planning, says Andrew Lane

What do Sajid Javid and Gordon Brown have in common?

I think I have the answer: it’s the Wanless review, commissioned in 2002 by the then chancellor Gordon Brown, which has striking echoes in the current health secretary’s speech on NHS reform last week.

The NPA’s public affairs manager was among a select group invited to hear the speech in person at the Royal College of Physicians on Wednesday (March 8).

The three pillars of the argument put forward by Derek Wanless in Securing our Future Health were:

  • the NHS is precious and its key principle of offering care, free at the point of access is sacred;
  • the NHS in its current form is insatiable with regards to its need for funding;
  • and fundamentally reorienting the health service towards prevention and self-care is necessary to make the system financially sustainable.

Twenty years on and a Conservative health secretary is making the same points, but using language suited to his small state political credo. Mr Javid promised a “decisive shift from the state to individuals, families and communities”.  This is the way to address the currently unsustainable financial trajectory, he argued.


The prevention agenda remains consistent


Mr Wanless and Mr Javid both acknowledged the role pharmacies could play at the heart of the prevention agenda. The latter’s remarks come in the week that a national stop smoking scheme begins in pharmacies across England and as the hypertension case-finding service begins to find its stride.

A glimmer of hope for pharmacies struggling financially is in the health secretary’s plan to baseline and assess how much is being invested in prevention in comparison to expenditure further upstream in secondary care. He expects NHS England and NHS Improvement (NHSE&I) and individual integrated care systems (ICSs) to prepare delivery plans to reduce the biggest preventable diseases – starting with cardiovascular disease and in time expanding to include diabetes, cancer, and poor mental health.

The NPA is currently thoroughly engaged with NHSE&I’s stocktake of primary care integration, which is preparing the way for statutory ICSs and we will highlight the community pharmacy opportunities in relation to population health, prevention and health inequalities.

Mr Wanless described a “fully engaged scenario” in which “individuals will be responsible for more of their healthcare” and people manage minor illnesses with the support of pharmacists. Mr Javid, in his turn, says he supports a “pharmacy first” approach and we hope he will be more ambitious than the rather modest 2% shift of GP activity envisaged by Mr Wanless.

Of course, there are certain aspects of Mr Javid’s speech that relate to today’s challenges and opportunities and could not have been on the Wanless agenda two decades past. For example, he was emphatic that “genomics is the future of post-pandemic healthcare”. What’s more, the Wanless report was in part intended to warm the public up to the idea of large increases in NHS spending (real terms increases of 7.4% annually for at least five years). The funding context is rather different today, given the pandemic’s toll on the economy. But overall, it’s remarkable how much the analysis and the proposed solutions have remained consistent over the years.

Community pharmacy is, I believe, closer to the centre stage of health service policy and planning than it was two decades ago. This is due to a range of factors, including the sector’s stellar performance during the pandemic and persistent advocacy by the NPA and other pharmacy leaders in recent years. 

What we want now is for speeches and policy papers to be reflected in action, on workforce, pharmacy funding, NHS governance (including ICSs) and integration.

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

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