It is no surprise that governments in the UK are transitioning contractual funding into services at the expense of remuneration for the core dispensing and supply model. The future for community pharmacy has to be heavily focused on the provision of services, which for me makes absolute sense.
In its simplest and most obvious manifestation, this supports patients to adopt a healthier lifestyle, stay well and manage the onset of chronic conditions such as diabetes and heart disease. Achieving positive health outcomes through lifestyle improvement will surely ease increasing pressure on the NHS by reducing hospital admissions and medicines administration.
As well as the obvious financial benefits of this ‘triage’ type of approach, this has to be good for patients. Theresa May this month announced the rollout of a national scheme for pharmacists to support patients in care homes, with the aim of “providing more personalised care”. This is part of a package of investment in primary care worth £3.5 billion by 2023-4.
Health secretary Matt Hancock also shared his desire for primary care to be instrumental in the support of patient health, stating “10 times more money is spent on treating disease than prevention, which doesn’t stack up”. Furthermore, according to Mr Hancock, the UK is spending £97bn of public money on treating disease and only £8bn preventing it.
In Scotland, the funding model for services is robust and progressive. In June this year, Community Pharmacy Scotland (CPS) announced a £2.6m increase for 2018-19. The CPS negotiating team worked extremely well with the Scottish government to agree a financial package that facilitates the provision of services centring around the prevention and treatment of early onset chronic conditions. The Scottish government fully recognises the benefits inherent in investing funding appropriately, using primary care channels to improve health outcomes.
The Welsh government also outlined that, while it values pharmacy as part of the local community health resource, it needs and wants pharmacy to do more. Akin to the Scottish pharmacy contractual model, Andrew Evans, Wales’s chief pharmaceutical officer, has laid out a roadmap for the sector, with a focus on delivering core pharmacy services – recognising not only investment in the development of “traditional and innovative” services, but also the need to upskill pharmacists to deliver services effectively and efficiently. Here, here.
Then the announcement that community pharmacies in Northern Ireland will receive an additional £11.1 million in funding up to March 2020. While widely criticised by Community Pharmacy Northern Ireland as “totally inadequate”, £6m will be spent on “medicines adherence support services to support domiciliary care and up to £2.1m of “transformation funding” will be available for a Pharmacy First service for the winter period. This is aimed at supporting a minor ailments service that not only helps pharmacy to manage common conditions, but also help reduce the risk of complications of ill health for vulnerable patients. However, we must acknowledge that there is still an overall funding challenge for contractors in Northern Ireland and this funding injection falls short of a fair overall funding arrangement.
It is very clear from the strategies adopted across all four countries, whether funded appropriately or not, that the move towards service provision is the most compelling it’s been for decades. Mr Hancock’s commitment to ensure that of the extra £20.5bn injection of funds for the NHS over the next five years “the proportion spent on primary care goes up“ is as strong an indication as we’ve had that pharmacy will be critical to an integrated patient-centric healthcare service.
However, we must not stand idly by. We must push to get community pharmacy more involved in the provision of services and demonstrate how these types of funding frameworks make a significant difference to the lives of people. We need to do more to engage policy makers and commissioners to ensure they fully understand the importance of the role of community pharmacy in supporting patient health now and into the future.
I fully acknowledge challenges we have surrounding the pharmacy contract and reimbursement model, but we must be proactive at engaging and delivering services. It’s the only way governments will fully acknowledge the role we can play in the future of integrated healthcare.
Jeremy Meader is managing director of pharmacy support group Numark