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What does the future hold for community pharmacy?

Clockwise from top centre: Sandra Gidley, Martin Sawer, Kevin Barron, John D'Arcy and Rob Darracott

C+D asks sector leaders to look into their crystal balls and predict what’s in store

Even if you manage to source a pair of rose-tinted glasses, the future of community pharmacy doesn’t look particularly promising at the moment. For many, it’s difficult not to feel pessimistic. Since the bombshell of a funding cut to pharmacies in England was first outlined at the end of last year, the sector has been preparing for the worst.

Some took comfort from pharmacy minister David Mowat’s video message to the Royal Pharmaceutical Society (RPS) conference earlier this month, in which he spoke about “taking time” to make the right decision for the sector. But now it appears that was only a brief reprieve. A funding “package” will be announced in mid-October and implemented in December – not quite the pause for thought that many had hoped for.

The threat of a £170 million drop in the global sum has galvanised the profession to fight its corner. The National Pharmacy Association’s (NPA) petition gained more than two million signatures from pharmacists and concerned members of the public, and two key documents – the Community Pharmacy Forward View, and a PricewaterhouseCoopers analysis of the value of community pharmacy to the NHS – have spelled out what the sector has to offer.

With a new ministerial team in place, and fresh negotiations between the Department of Health and the Pharmaceutical Services Negotiating Committee (PSNC) starting shortly, there is potential for opportunities. But where do they lie? We’ve asked key figures for their predictions – and what you can do to prepare.

Sandra Gidley, RPS English pharmacy board chair

Everyone is in a state of limbo and no one is quite sure what is going to happen. We do have an opportunity to lobby our case and there is lots of work being planned for the [party] conference season coming up. What we haven’t done very well so far is get allies – we will have to work more constructively with other healthcare professionals.

But for the first time, the pharmacy bodies are working together and have a very coordinated effort putting forward a single case – the Community Pharmacy Forward View document has been very helpful.

Given all the work that’s been going on to show the value of what pharmacy does every day, I would hope that in the future community pharmacy would provide a lot more clinical services and be adequately remunerated for them.

Personally, I would like to see some sort of ‘Pharmacy First’ type scheme – where pharmacies provide clinical advice and short-term drug treatments for certain minor ailments – that is properly resourced. I hope the profession will embrace a wider range of clinical services – I think that is the right thing for the profession and the right thing for the NHS.

There will be a role for pharmacy in the future – the NHS will still need a medical supply function and it’s not quite as straightforward as automation. But we do need to be looking at what pharmacy can do more of for patients – we should be the first point of call when anyone is ill.

Martin Sawer, Healthcare Distribution Association chief executive

The message coming out is that pharmacy needs to take its share of the NHS cuts. The challenge is then for community pharmacy to demonstrate its value. I think everyone is going to take a hit and it is going to be about trying to minimise the impact of that.

If community pharmacy is able to take the cuts on the chin – and if they are not too deep – it needs to make a concerted effort to win more services. The problem is the reliance on prescription income, which is skewing what the government thinks of us.

Community pharmacy as a sector has a huge opportunity. We have new government ministers and it is great that the PSNC and Pharmacy Voice are working together and produced the Community Pharmacy Forward View.

There will be some great, innovative stuff going on locally, but it’s about trying to link that to the national agenda. What we need to do now is bring it all to life, because if the government is going to invest, they need to see it happening.

A year from now, I would like to think we would have more nationally commissioned services in place and that we have rebalanced the way that income is supplied to pharmacy.

You would have thought that the [government drive for a] seven-day NHS and the pressures on doctors would be a great chance for community pharmacy to step up.

Rob Darracott, Pharmacy Voice chief executive

At the moment, we just don’t know what is going to happen with the cuts and nobody really knows how the politics of this is going to play out. I like to think that we have created an opportunity, by working together as a sector, to present a considered view about what pharmacy might look like.

The aspect that is really interesting is the idea of community pharmacy as a health and wellbeing hub. GPs now recognise that they can’t do everything and the wider primary care team can share some of that load, so we want to see proper partnerships between community pharmacy and the NHS.

Pharmacists now need to get engaged with what is happening on their patch – [by finding out] what the local pharmaceutical committee (LPC) is doing and what local GPs think, and contributing to data sets. All of these things build the case for pharmacies doing things differently. Don’t wait for permission, there are things that happen in discrete localities now that are not necessarily recognised from a national perspective, but that can be fed back through the LPC.

I am also constantly persuaded by the need to take a fresh look at over-the-counter medicines. We have been so focused on long-term conditions that we have forgotten that 1.3 million people come into a pharmacy every day for a health-related reason. Other businesses would kill for that kind of footfall.

I wouldn’t like to think that in 12 months’ time there will be another surprise around the corner. The past few months have been a great energiser and now we need to work collectively to get people to buy into community pharmacy, and have more constructive conversations – rather than a bunch of random ideas foisted on us.

John D'Arcy, Numark managing director

The significant thing is that we have a new minister who is saying we are going to have a conversation about pharmacy’s future. The Community Pharmacy Forward View document, and the added support from the RPS, means that for the first time we have a joined-up vision.

More and more people are going to use pharmacies, yet we are the ‘Cinderella service’. The PricewaterhouseCoopers report estimated savings of £3 billion achieved by utilising just 12 existing pharmacy services. Let’s make pharmacy the hero.

There is plenty to be positive about, [such as] a changing attitude to the idea of pharmacy being an integral part of primary care, and we have shown quickly and convincingly we can handle national services like flu. Right now, there needs to be absolute engagement with consumers as part of the preparation for taking on more services.

To make this happen, pharmacists will have to get better at delegating to their staff, and there needs to be a division of labour in a different way. The sector also needs to be getting itself properly IT-enabled, with systems that are fit for purpose.

There has been a transition for a number of years to a more patient-focussed role, but lets see 2017 as the time to set up national services – minor ailments being the obvious one, but why not all 12 services in the PricewaterhouseCoopers report?

However, I would want to see better integration between GPs and pharmacists, and that the Department of Health has bought into the vision that community pharmacy has set out.

At the very least, we need a sensible conversation about what pharmacy should be doing.

Kevin Barron MP, all party pharmacy group chair

I am deeply disappointed that it appears the government has just delayed introducing cuts rather than looking at the impact it is going to have on pharmacy and the communities it serves. PSNC did some brilliant work with PricewaterhouseCoopers to calculate the value of pharmacy. But it does look like [the government] are just going to go ahead – they need to stop just looking at cost and consider values instead.

We need some 21st century thinking about how pharmacies are contracted to the NHS. Pharmacy should be an integral part of the primary care team – of that, there is no question in my mind. We need recognition of its professionalism but also what the cost should be, and make changes in the national contract to recognise that.

It is quite clear there is a role for pharmacy to play in looking after people with long-term conditions – there are some really good things the government should be looking at now which is not about cost, but value to the public.

Something which is really key is that the public need to have healthcare professionals who are engaging with them and advising on lifestyle and health issues, and I see pharmacy as the main gateway for that.

I would hope the government would do some more work with the relevant bodies – a petition of over two million people is not something that can be ignored easily.

4 Comments
Question: 
What do you think the future holds for the sector?

Chris Pharmacist, Community pharmacist

More David Brent style bs and waffle...more 'visions', collaberations and innovative ideas...if I hear 'the future is an increasingly service based (without the funding) and clinical role (the NHS isn't interested)' one more time...well...I'll probably do very little...but its more of the same nonsense from the usual suspects. Its time pharmacy stood up to the government, start by ending free MDS, free repeat ordering and free deliveries. The silence and lack of unity to oppose these cuts from the multiples typifies the apathy and meekness (if its a word) in the profession. Doctors/Nurses wouldn't take it lying down, why do we?

Gerry Diamond, Primary care pharmacist

I agree.....resistance is futile and platitudes while the boat slowly sinks to the depths......

Hemant Patel, Community pharmacist

Kevin Barron: 'We need some 21st century thinking about how pharmacies are contracted to the NHS.' What a hard and unintended smack in the face for PSNC! Yes, roll out the five point plan. Fortunately, PV and RPS have contributed perhaps initiated some new thinking.

To think that water will move uphill is crazy. To continue to hope and pray for a miracle of national contracting for new services is crazy and ignores delibertely, or otherwise, the  thinking around population health and targeting resources where they are needed by provision of integrated place based commissioning.  

 

 

 

 

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

A continuation of the last 20 years - a slow slide into irrelevance and obscurity.

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