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‘Javid’s pharmacy reforms should start with healing the great divide with GPs’

If Sajid Javid is going to reform primary care pharmacy, he will first need to heal the great divide between GP and community, writes The GP Pharmacist

The health secretary Sajid Javid recently announced plans to reform primary care, starting with pharmacy. The implication that a focus on pharmacy is crucial to improving primary care service provision must be seen as a positive for the profession, and a reflection on the huge contribution made from all sectors of pharmacy in maintaining patient access to care during the pandemic.

I’m not sure whether to feel nervous or excited in anticipation of the changes ahead. The initiatives over the past seven years to get more “clinical” pharmacists working in general practice were ultimately hugely divisive for our profession. This time sustainable change will require a well-founded definition of primary care pharmacy that fully includes the community sector.

Since 2015, NHS England and NHS Improvement (NHSE&I) has invested heavily in pharmacists working in general practice. They have funded the network roles and comprehensive training including the CPPE Primary Care Education Pathway and Independent Prescribing (IP). In contrast, negotiations for the community pharmacy contract seem never-ending, and while referencing the need for community pharmacists to become more integral in primary care service provision, rarely produce tangible and fully-funded services.

Most community pharmacy businesses are still shackled to a model of high volume, low profit dispensing that requires cost-cutting within the teams and makes it prohibitive to provide the primary care services that would enhance patient care and professional job satisfaction. The primary care minister, Maria Caulfield, has recently acknowledged that many of the valuable services provided by community pharmacy have no funding attached.

We are now seeing closer working between general practice pharmacy teams and community pharmacy, such as increased referrals to the Community Pharmacist Consultation Service (CPCS), and the incorporation of the Discharge Medicines Service (DMS) as an essential service. I can also see more collaborative working around development of disease case-finding initiatives such as hypertension, and the proposed signposting for cancer diagnosis. However, there are still significant obstacles due to the poor quality of current IT systems.

I love the idea of an inclusive primary care pharmacy sector, that draws on the natural accessibility of community pharmacies and fully utilises the clinical abilities of all pharmacists. For patients, the benefits would be huge – easy access to experts in medicines who are able to autonomously treat patients. But if Mr Javid is going to reform primary care pharmacy, he will first need to heal the great divide between GP and community by addressing three areas: training, information technology, and funding.

Community pharmacists need access to funded independent prescribing courses including a designated prescribing practitioner (DPP). The latter is not currently funded in England for any IP students; it is difficult enough for pharmacists based in GP surgeries to get free access to DPPs, and likely to be impossible on a large scale in community where benefits of these roles are yet to be realised.

There needs to be more investment in information technology that works across different sectors; both the new DMS and CPCS have been hampered by unwieldy referral processes due to lack of seamless technology.

Adequate funding will be crucial to any successful change.

I look forward to more details on what the plans will entail, and the opportunity for pharmacy to reap the benefits of all the commitment and hard work demonstrated during the pandemic. It’s time for the government to replace high praise with hard cash.

The GP Pharmacist is a former community pharmacist working in a general practice

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