During a debate in the House of Lords last month, the health minister, Lord O’Shaughnessy, stated that community pharmacy must “play its part” in helping the NHS find £22 billion in efficiency savings. Given the current precarious nature of NHS funding – with more trusts finding themselves in deficit – Lord O’Shaughnessy’s comments are hardly surprising, but they rather miss the point.
If ministers want to achieve such ambitious efficiency savings then they need NHS England to fundamentally redesign patient care pathways. For example, there are countless authoritative reports and studies which demonstrate beyond doubt that community pharmacy can provide a high-quality minor ailments scheme at less cost to the NHS than current arrangements, which funnel patients into GP surgeries already struggling to meet patient demand.
Redirecting patients to community pharmacies would also allow GPs to spend more time with patients who have complex conditions. That improves clinical outcomes by helping patients understand and manage their health and medicines better, which in turn reduces avoidable complications resulting in hospital admissions.
This ultimately means it is good for patients: with improved access to healthcare; good for GPs: with better outcomes for those patients who need their support most; good for hospitals: with fewer costly admissions; good for community pharmacists: providing them with a stronger clinical role and income stream; and it would contribute significantly towards the government’s £22bn efficiency target.
The logic is compelling, so are we likely to see a national minor ailments service in England any time soon? Probably not, if chief pharmaceutical officer for England Keith Ridge’s and pharmacy minister Steve Brine’s recent declarations that “things have moved on” from minor ailments commissioning are anything to go by.
Much of the national commissioning budget is, of course, devolved to clinical commissioning groups and the reality is their focus is on short-term cost cutting, not achieving long-term efficiency savings. That is why we see salami-slicing measures such as decommissioning services from community pharmacy. It is always much easier to manage a problem – or at least be seen to be trying to do something about it – than actually solve the problem itself.
My response to Lord O’Shaughnessy is this: community pharmacy and the medicines supply chain already operates very efficiently and provides the NHS with incredible value for money. According to a 2015 PricewaterhouseCoopers report, 12 services provided by community pharmacy delivered £3bn of net benefit to the NHS, the public sector, patients and wider society.
So, Lord O’Shaughnessy, if you want us to do more, then the government has a role to play in unlocking the full potential of community pharmacy. A national minor ailments scheme would be a good starting point.
Current funding problems should not be used as an excuse for lack of action on minor ailments. NHS England just needs to look north of the border, where NHS Scotland has managed to achieve a national pharmacy-based scheme within the financial constraints it has faced.
As for Dr Ridge and Mr Brine: if things really have “moved on”, then surely that reinforces the need for the Department of Health and NHS England to respond formally to the ‘Murray’ review, in order to set out clearly what exactly has “moved on”, why and what it means for community pharmacy, and the sector’s place going forward in providing primary care services.
Steve Anderson is managing director of Phoenix Healthcare Distribution Ltd in the UK, part of the Phoenix group of companies operating across Europe