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Pharmacists to form primary care practices with GPs in 'radical' five-year NHS shake-up

NHS England has pledged to educate the public to use pharmacies for minor ailments

Expanded GP practices will shift the majority of outpatient consultations out of hospital, NHS England says in a five-year strategy document

Pharmacists will form large-scale primary care practices with GPs and other healthcare professionals under "radical" plans to reorganise the NHS over the next five years.

The "majority" of outpatient consultations could shift out of hospitals into these expanded GP practices, known as multispecialty community providers (MCPs), which will include consultants and senior nurses, NHS England said in a strategy document published on Thursday (October 23).

MCPs would target patients with "complex ongoing needs" and work intensively with them, as well as making "fuller use of digital technologies, new skills and roles", the commissioning body said. It suggested they could even take over the running of local community hospitals and assume responsibility for managing the health service budget of their registered patients "in time" as part of its goal to reduce the burden on secondary care. 


NHS England stressed that MCPs were just be one of the options for achieving its aims, and that local areas would have the choice of adopting alternative strategies, such as opening viable smaller hospitals or developing primary and acute care systems, which would involve collaboration between GP, hospitals, mental health and community care services.

It stressed that "radical" action was needed in many areas to meet the demand of rising patient numbers and specified that barriers would need to be broken down between professions.

NHS England also pledged to invest more in primary care and hand CCGs more control over the budget.

Prevention the priority

It named tackling obesity, smoking and alcohol as a priority for the next five years and stressed that a greater emphaiss needed to be placed on prevention and public health.

The NHS would look to simplify emergency care and ensure patients got "the right care at the right time", which would involve more patients going into community pharmacies and more "flexible" referral from ambulance services, it said. 

As part of this strategy, NHS England pledged to make "far greater use of pharmacists" in urgent and emergency care and educate the public to visit their pharmacist for "coughs, colds, and other minor ailments" rather than GPs or A&E.

NHS England's overall strategy for primary care, which will incorporate views from the pharmacy Call to Action, is due before the end of the autumn.

What do you think of NHS England's five-year plans?

We want to hear your views, but please express them in the spirit of a constructive, professional debate. For more information about what this means, please click here to see our community principles and information

Qaisar Sheikh, Community pharmacist


Brian Austen, Senior Management

None of this will happen because:
It would require another major reorganisation
The NHS does not have the funding to realise this strategy
The investment needed in premises and infra-structure to form the 'super-surgeries', (which is actually an old idea resurrected) would be massive
The GP contract and pharmacy contract would require changes, which would make the current contracts unrecognisable.
The only ways of funding such a strategy would be with state funding through a substantial increase in taxes for both middle-income and high-income earners or with private money and there would be 'strings attached', opening the way for even greater amounts of privatisation.
The government that put up taxes to fund the ever increasing demands of the NHS will only be in power for one term, then out of power for a generation. You can tell that no party will risk that, you just have to look at the small increases in funding being quoted, e.g. £2.5 Bn, when the NHS is already heading for a £1Bn to £1.5Bn overspend by next April.
So it looks like private money will be needed. Maybe that is what this new strategy is actually aiming to prove and justify!?

Kevin Western, Community pharmacist

Or, the nhs could simply take the amount of money it is paying in an area currently and say there is a contract going worth this ammount to provide services xy&z and when it comences, the others will cease. It would require some legislation but little in the way of funding and would probably be offered at a lower cost.

Mr C, Locum pharmacist

Completely agree with Mike Jarrett. I have come across many PCT pharmacists and had the same opinion. Community pharmacists generally work hard and should not be ashamed of getting the correct medication to the patient, as this is an important job. I'm all for new roles, but not at the expense of our core role, which can't be done by ACT's no matter what you say.

Many PCT pharmacists have found out just how challenging this can be after their cushy numbers came to an end with the dissolution of the old PCT's.

Mark Galloway, Pharmacy

This is a quite depressing response if you don't mind me saying.

Unfortunately technology will take the role away in my view and as a former contractor pharmacist my push is to ensure that there is a future for pharmacists.

Simon Steven's vision for MCPs is a good one and for the first time played in pharmacist as part of that team. However, in my view, it would be wrong to assume that this means bringing in the old but rather it should be about a new model.

I have no doubt community pharmacist work hard, I know that I was one, and consistently I argue the case for my colleagues in practice whne challenged by others at the CCG. In fact I would go as far as to say that it is one of the most efficient servcies in the NHS with over 1 Billion prescirption items dispensed last year. However there is nothing to say that it couldn't be made even more efficient with new technologies!

Anyway back to work for me but newver mind mine is, afterall, such a cushy number!

Stephen Eggleston, Community pharmacist

"Large scale practices" - owned by who? GPs? Pharmacists? Joint ventures? - The first and last of these always makes pharmacy the loser as the GPs want their cut of the profits generated by the pharmacy for no additional work. Practices owned by third parties? - Which third parties? They will undoubtedly want a premium for any pharmacy becoming involved (I don't know, but seriously doubt, if they charge GPs a premium). And, as others have said, transferring to service based contract is all well and good but the level of reimbursement does not provide a sufficient income. The idea is not without merit but I do not see how pharmacy will manage to do much more than "lose the argument" if we are not allowed to have a seat on the CCGs or Health & Well Being Boards, since all either are focusing on are cutting their spend ie not commissioning new services such as a minor ailments scheme - all very interesting when certain CCGs have blogs promoting pharmacy (which is good) but don't then back it up!

Mark Galloway, Pharmacy

The question is - Which pharmacists and what would their role be?

For me pharmacists have to chuck in the item chasing, get up to speed clinically and offer services as part of MCPs that play to their skills.

The days of pill counting and box labelling are numbered and good riddance to them I say! Problem is too many of my colleagues are wedded to a modus operandi that is not in any way sustainable long term.

Medicines optimisation means optimising care relating to drug therap, i.e. tailoring medicines to need and reducing polypharmacy for example.

"The days of pill counting and box labelling are numbered and good riddance to them I say! Problem is too many of my colleagues are wedded to a modus operandi that is not in any way sustainable long term. "

This attitude is a common one, and I can see where it comes from. The problem is, its really not helpful.

Medicines provision is our niche. We do it bloody well, and we have done through the years, coping with changes efficiently and safely along the way. Far from tramping all over it and undermining it ourselves in favour of "sexier" clinical services and roles, we should be shouting from the rooftops about how well we do it and how important that role is.

After all, you can medicines optimise all you want, but the patient has to actually have the medicines physically in their hand, otherwise its all pointless. What we should be doing is spreading the message about how important our role is in ensuring that the patient gets the right medicine, at the right time, and that they know what to do with it. It's what we are known for, its our core business, and it always has been. It's almost like we're ashamed of it, but it is arguably *the* most important step in improving patient's health.

Without the practical aspects of medicines provision, we lose our niche in the healthcare world. Our roles- over all sectors- get much more nebulous, less visible. We need to stop acting like its the embarrassing uncle no one wants to talk to at family parties, and start telling the world just how important it is.

Mark Galloway, Pharmacy

See my responses to others on this. Technology will inevitably erode this niche in my view. All I am arguing is for the global sum to be re-engineered to allow for pharmacists to take on the roles that others suggest could be delivered through pharmacy.

I beleive that they/we certainly can but only when the pressure of delivery of the medicines to the patinet is reduced through appropriate service redesign.

All that is needed is a bar code, a scanner and a robot and hey presto, the community pharmacy dispensing function disappears off to Amazon.

Mike Jarrett, Community pharmacist

Hear hear !!!

Paul Mayberry, Community pharmacist

Pharmacy should use its USP, being the most accessible health professional, on every high street, available without appointment or registration.
We are in the ideal situation to screen for & refer long term chronic conditions, BP, AV , Diabetes, etc.
After a GP confirmed diagnosis the patient gets a Rx that we dispense, but we shouldn't wash our hands of that transaction as soon as we have confirmed we are giving the meds to the correct patient.
We should be looking for the correct outcomes.
BP under control? No night-time coughing? Glucose levels ok? Feeling happy?
If yes , great - long term damage averted.
If no, why hasn't the meds worked?
MUR to ensure patient knows how important the drug is, and to identify & avert side effects.
MDS if patient has difficulty remembering to take their meds at the correct time.
If the patient understands how important their meds are, what they are for and they take them as prescribed, we achieve the correct outcome.
If we achieve that outcome, no catastrophic event, not only is that good for the patient, their quality of life & longevity, its much, much cheaper for the NHS, saving them £1000's per patient.
All Pharmacy needs to do is explain this to the decision makers, they would gladly pay us a few £'s per intervention to save millions later on, as long as they are looking to the future & not just the next election.

Mark Galloway, Pharmacy

I agree but my argument is that whilst community pharmacy is straightjacketed by its current contract the services whihc you aspire to simply won't be commissioned in my view

Mike Jarrett, Community pharmacist

The trouble with a lot of PCT pharmacists is that they've seen the sharp end , (community practice) didn't like what they saw, or couldn't cope , or both , then find ways to lecture the rest of us how to proceed.
In my experience (44 yrs ) , the way forward to this utopia will have to be paid for and carried out by people who want to work hard, and not sit contemplating their navels.
Naturally, Kevin, I am sure you are the exception that proves the rule .

Clive Hodgson, Community pharmacist

All very well saying good riddance to pill counting and box labelling, but that is where the money to pay the bills comes from.

Simple fact is that if a Pharmacist performed every service on offer today (and then a few more on top) it would not come close to giving a living wage.

Medicines Optimisation is great idea but there is any indication a cash strapped NHS is going to fund it an any substantial way?

Mark Galloway, Pharmacy

The in my view the profession will die as someone will soon twig that that function doesn't need highly qualified clinical personel.

Clive Hodgson, Community pharmacist

And just to add to my comment.

There is a LOT more to Medicine Provision than "pill counting and box labelling".

Kevin Western, Community pharmacist

in principle this sounds good tho how the competing pharmacys work together with a surgery is going to be fascinating to set up, The worrying part is the
"As part of this strategy, NHS England pledged to make "far greater use of pharmacists" in urgent and emergency care and educate the public to visit their pharmacist for "coughs, colds, and other minor ailments" rather than GPs or A&E."
bit - if all we are going to get is a few more benylin sales rather than a proper minor ailments scheme or support for prescribing then that would be disappointing.

Mark Galloway, Pharmacy


That surely rests with our profession itself? We cannot expect others to do our bidding and what services MCP will contract pharmacies to pick up will depend on how the profession's leadership present the options.

If it ends up being cough bottle sales then pharmacy has lost the argument.

Mike Jarrett, Community pharmacist

Sorry Kevin Western, meant Mark Galloway, lol !

Mark Galloway, Pharmacy

I was a contractor for 12 years and moved into primary care as I wanted to be a clinical pharmacist and saw no route for this whilst a contractor bean counting.

I don't have time to sit and "contemplate" my navel I'm afraid but will continue to argue for the global sum to be distributed in a way that release pharmacist into the role that I think we are destined for.

Tunde Sokoya, Community pharmacist

The future of pharmacy is in adding value through provision of services.This is what i see as our reason for being.Not a week goes by without identification of a serious intervention not a day goes by without the potential to report a drug side effect. 10% of hospital admissions are directly related to drugs in one form or another.It is time pharmacist stepped up to the plate.This is a unique oppurtunity and we need to take it.Some wise person once said that "insanity is doing the same things but expecting a different response". The break through in life come with a break from the norms or traditional way of doing things.The transition wont be easy but it will be worth it in the end!!

Mike Jarrett, Community pharmacist

Don't you think that we've been intervening and advising since the 70's onwards! I have always taken a pride in giving the best possible service to patients.
If you think that I've been doing the same thing all these years you are very wide of the mark. I have been very pleased with the way technology has made our life easier in explaining to patients how to use inhalers, give them information to take away with them whilst conducting MUR's , NMS's etc. I am certainly no dinasaur stuck in the past.
When you are still waiting for all this brave new world to come about it may be that you might recall our exchange of views . I repeat, who is going to pay, and still ensure that Mrs Jones still gets her prescription dispensed accurately and on time.
I've been qualified since 1970 would be interested in knowing how long you are prepared to wait!!

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