Cast your mind back to March. That was the deadline for pharmacy to respond to NHS England’s Call to Action on pharmacy and hopes were high. The sector thought hard, attended local events and submitted more than 800 responses to the consultation on its future. NHS England said it was “overwhelmed” by the feedback, which would inform its primary care strategy.
But pharmacy’s high hopes were dashed last month when NHS England revealed there would be no grand plans for the sector published in a primary care strategy. In fact, the Five Year Forward View – a document published in October that made just four references to pharmacy – was the highly-anticipated strategy in question.
With this in mind, C+D looked back at what the sector called for in its consultation responses and how NHS England responded, or failed to respond, to its requests.
Call 1: A national minor ailments scheme
What we called for: A national minor ailments scheme in England has long been on pharmacy’s wishlist. So, it was no surprise when Pharmacy Voice and the Pharmacists’ Defence Association (PDA) both made the case for its introduction in their Call to Action responses. Their case was well supported – last year, independent health service regulator Monitor said it could save the NHS at least £64 million.
What we got: The Five Year Forward View specifically mentioned pharmacy’s role in treating minor ailments – eliminating unnecessary GP appointments and A&E visits. It also stressed the need to build public awareness of pharmacy's capabilities in this area. But it gave no indication that a national minor ailments service would be on the cards. That doesn’t necessarily mean all hope is lost, though. Last year, PSNC chief executive Sue Sharpe said it could take until 2015 to get a national scheme commissioned – meaning it could be part of the next funding package.
Call 2: Enable independent hub pharmacies
What we called for: Medicines legislation was denying independent pharmacies the opportunity to take advantage of the hub-and-spoke dispensing model, Pharmacy Voice said. It therefore called on the government to relax rules specifying that the hub and pharmacy must be owned by the same business, which would enable independents to operate from a communal hub. The PDA also stressed the need for independents to be able to move the dispensing function out of the pharmacy more easily.
What we got: Er, nothing. The Five Year Forward View made no mention of dispensing legislation or the hub-and-spoke model. This could prove a disadvantage for independents given that the document did set out vague plans to make “far greater use of pharmacists”. While multiples will be able to rely on hubs to carry out some of the dispensing functions, leaving them freer to conduct services, independents won’t enjoy the same privilege.
Call 3: Professional autonomy
What we called for: Community pharmacists could use their skills outside the traditional roles of pharmacy employee or business owner, the PDA pointed out. It stressed that pharmacists’ medicines expertise would be used “to best effect” by operating more widely in the community – whether in GP surgeries, care homes or virtual wards. This would give the workforce more professional autonomy and improve patient care, the PDA argued.
What we got: NHS England appeared to recognise this wish for a wider role in the community. It set out various potential models for future primary care – one of which was large-scale primary care practices. Under these plans, pharmacists could work with GPs and other healthcare professionals such as consultants and senior nurses to provide joined-up care to patients. The collaborative ethos was generally welcomed by pharmacists, but some questioned whether it would simply amount to pharmacists working for GPs, rather than with them.
Call 4: Greater prescribing powers
What we called for: Pharmacists have been able to train as independent prescribers since 2006, but few have taken the opportunity to gain the qualification. Even when they have qualified, many pharmacists feel there is little opportunity to use their skills. This was the trigger for the Royal Pharmaceutical Society (RPS) to call for greater clarity around pharmacist independent prescribing. Trained pharmacists should be able to annotate and alter prescriptions independently and supply all medicines on the NHS unless they are specifically excluded, the RPS English Pharmacy Board said.
What we got: There was no mention of pharmacist prescribing in NHS England’s strategy. This could prove a detrimental omission – the strategy names pharmacists as a crucial partner in helping to reduce unnecessary GP and A&E appointments. But, unless pharmacists can prescribe treatments, their ability to meet the needs of these patients will be limited.