Proposals on neighbourhood health contracting models are “too centred on general practice and NHS providers”, the Royal College of Pharmacy (RCPharm) has said.
NHS England (NHSE) last week closed a consultation on multi-neighbourhood provider (MNP) and single neighbourhood provider (SNP) contracting models to support the rollout of neighbourhood health services.
It said neighbourhood health services are “a key part of the 10-year health plan” and called for views on MNPs and SNPs to “make it easier to commission” them.
Read more: Pharmacy must be ‘strengthened’ before neighbourhood care shift
The government revealed in March that it had begun rolling out the first 27 of the neighbourhood health centres announced as part of its 10-year plan for the NHS.
In its response to NHSE’s consultation, the RCPharm said community pharmacy and other healthcare providers “must be equal partners in design, governance and delivery”, highlighting that none of them are “explicitly mentioned” in the consultation.
It added that the pharmacy sector is an “extraordinary neighbourhood asset” with “significant population reach” and medicines expertise, and that its clinical workforce “must be embedded within neighbourhood health services”.
Read more: First 27 new neighbourhood health centres roll out
The RCPharm also stressed that neighbourhood health “cannot achieve its stated objectives of prevention, access, demand reduction and tackling inequalities without fully utilising community pharmacy as an equal primary care partner and, where appropriate, a contract holder”.
“The frameworks should explicitly recognise community pharmacy as part of the neighbourhood delivery model,” it said.
The college called for pharmacies to be paid for “clinical outcomes, not just individual interventions” when commissioned to deliver services, and said the sector should also have “a key role in strategic commissioning”.
Proposed contracts
NHSE said that both MNP and SNP contracting models would be commissioned locally, and local organisations “would decide how most services in the contracts are designed and funded”.
The contracts aim to make services “simpler and more joined up for patients”, organise them around “local population needs” and support “strong, sustainable GP and community services”, it said.
It added that it wants to help local organisations “work together more easily” and “make it clearer who is responsible for delivering a service”.
Read more: Timeline: The NHS 10-year plan for pharmacies at a glance
Under NHSE’s proposals, MNPs would plan and organise NHS services including “both primary medical and non-primary care elements across several neighbourhoods”, which usually cover around 250,000 people.
It would either help local providers such as SNPs work together or take “full responsibility for outcomes across multiple neighbourhoods”, and bring existing services under one contract.
SNPs would plan and organise NHS services for one neighbourhood, building on the current Primary Care Networks (PCNs) but with greater flexibility in how staff and services are organised.
Read more: HSCC: No neighbourhood health without community investment
They are intended to be “broader than just general practice” and will deliver “enhanced primary medical care services”, NHSE said.
In its consultation response, the RCPharm asked for clarity on how community pharmacy can participate in neighbourhood delivery through referral pathways, in integrated neighbourhood teams and “without every service requiring a complex chain of subcontracting”.
“There is a need to bring all primary care providers along on the journey and for them to understand what the new contracting models mean and what they might be able to deliver to improve patient outcomes,” it said.
Pharmacists’ clinical role
The RCPharm noted that eligibility requirements such as access to registered patient lists “risk excluding community pharmacy and other providers by design”, despite the sector having “reach” and “expertise” in prevention and medicines optimisation.
It said that there may need to be “different approaches to leadership, commissioning and accountability” for community pharmacy than those proposed for general practice.
Read more: CPhO: Neighbourhood health will transform community pharmacy
The college said that once the models develop, the “expanding clinical role” of pharmacists offer an opportunity for them to become “much more integral to neighbourhood care”.
“Medicines optimisation, deprescribing, prevention and the safe and effective use of medicines should not be seen solely as functions of general practice or hospital-led services,” it said.
And it added that NHSE’s proposal for GPs to be able to opt into SNPs “reads as an extension” of their work, rather than a “true neighbourhood model encompassing all of primary care plus social care and voluntary sector”.
Read more:Government wants pharmacies to be a ‘first point of contact’
“Neighbourhood health services should be based on multidisciplinary partnership, rather than exclusive endorsement by any single provider group,” it said.
NHSE said further consultation periods on both the MNP and SNP contracts will take place “later in the year”.
It comes after a report on the economic viability of pharmacies being part of the new neighbourhood health service found that the sector’s “economic foundations will need to be strengthened” first.
