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Reforming pharmacy reimbursement and supply in NHS long-term plan

NHS England said it would make greater use of community pharmacists’ skills

NHS England has pledged to “explore further efficiencies” in community pharmacy, by reforming the sector's “reimbursement and wider supply arrangements”, it announced this morning.

In its long-awaited long-term plan, published today, the commissioning body said it aims to “make greater use of community pharmacists' skills and opportunities to engage patients”.

In an effort to “improve the effectiveness” of public health approaches, such as NHS health checks, NHS England will work with community pharmacists, voluntary sector partners and GPs to test patients for “high-risk conditions”, such as high blood pressure, raised cholesterol and atrial fibrillation, it said in the document.

It also referred to community pharmacy’s role offering medicines reviews and inhaler technique advice to patients with respiratory disease.

However, it did not offer specific details on these schemes and any potential funding.

Pharmacists within primary care networks

As part of a plan to “boost ‘out-of-hospital’ care”, NHS England will fund “expanded community multidisciplinary teams”, including pharmacists, GPs and “allied health professionals”, it said.

CCG-led “pharmacy connection schemes”

NHS England’s focus on multidisciplinary teams will also see the creation of “pharmacy connection schemes”, which would be set up by clinical commissioning groups for “patients who don’t need primary medical services”.

NHS 111 referrals

From this year, NHS 111 will begin booking GP surgery appointments, NHS England said.

Patients may also be referred to “community pharmacies who support urgent care and promote patient self-care and self-management”, it added.

“Clinical” pharmacists

NHS England made repeated references to “clinical” pharmacists employed by GP practices in its long-term plan, including hailing them as “a key part of the general practice team in primary care networks”.

The commissioning body promised funding to “substantially expand” the number of pharmacists in these roles over the next decade.

Aligning pharmacists with care homes

NHS England also referred to the national scheme to assign pharmacists to care homes, announced by Prime Minister Theresa May in November. The model will be “rolled out across the whole country over the coming decade as staffing and funding grows”, it said. As part of the scheme, “care home residents will get regular clinical pharmacist-led medicine reviews where needed”.

Cracking down on medicines spending

NHS England also reiterated its intention to minimise the routine prescribing of “low-clinical-value medicines”, in an effort to save more than £200m a year.

The latest treatments to be given “low priority for NHS funding” – as C+D reported in December – included amiodarone, dronedarone and emollient bath and shower products.  

Read NHS England’s long-term plan in full.

Why is the plan so important?

Prime Minister Theresa May first announced in June 2018 that the budget for NHS England will increase by £20.5 billion by 2023-24. When asked by C+D whether community pharmacy will be allocated some of this money, the Department of Health and Social Care (DH) said at the time: “We will need to await the autumn statement for further details.”

However, in his autumn budget announced on October 29, chancellor Philip Hammond did not divulge the full details of how this money would be spent across the NHS, promising this would be set out in the NHS long-term plan.

6 Comments
Question: 
What do you make of the NHS long-term plan?

Keith McElrea, Pharmaceutical Adviser

Flawed thinking, the NHS has already cut pharmacy remuneration to the bone and now wants to seek further efficiencies in medicines purchasing.  The little margins that remain in medicines purchasing for community pharmacy are what currently keeps the sector afloat.  To cut them further the NHS will need to contribute more to pharmacy businesses to prevent collapsing the network.  

I had a bill from an architect today, based in a rural setting, who charges £65 per hour for their professional services.  Average Pharmacist remuneration is around £19.29 per hour(indeed.co.uk).  Vets are making £35 per hour, GP's £38 per hour, nearly double!

Perhaps its thine the DoH took the knife out of Pharmacies back and looked elsewhere?

 

Keith McElrea

Inphaserve

A.S. Singh, Community pharmacist

As John says the government are short term thinkers but they cannot change an integral part of the medicine supply structure. In no country does a pharmacy not supply medication and the UK will be no different. We must learn to adapt slightly in order to evolve.

 

In the meantime a new goverment will come and change things around anyway!

John Ellis, Community pharmacist

Community pharmacy has always been an integral part of the NHS. If people want a socialised healthcare care system, they should be willing to pay for it, simply closing down community pharmacy will save some short term money in terms of consolidation, but what happens when all dispensing is put into the hands of a few super monopolies? These companies will ultimately control supply from manufacturing to distribution, they will no doubt artificially increase their profits, and the NHS will have no choice but to pay. We are actually seeing the beginnings of this with the current 'stock shortages'. We may even end up in a situation where the costs of medicines supply might be even more than the current model.

Leon The Apothecary, Student

Barry hits it on the head here, dispensing is becoming less the bread and butter of pharmacies these days, so I suspect we will see another big push towards the hub and spoke models within pharmacy to minimise the cost of dispensing per item, along with eRD prescribing being encouraged again. 

Barry Pharmacist, Community pharmacist

The document gives us a clue, if more were needed, that funding will continue to move away from dispensing. Interesting to see that 2 hours after publication PSNC have only said "comment to be issued shortly".

Clinical pharmacists get mentioned in a positive manner in several places so students need to plan their futures accordingly.

Clarke Kent, Community pharmacist

Demoralising, and it paints a bleak picture for pharmacy. (Very bleak indeed). Should’ve sold up a long time ago, hey ho, we’ll see it through to it’s bleak end now. 

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