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Healthy Living Pharmacy News

We've put all of our healthy living pharmacy news in one place so that you can stay in touch with the latest information and implement new healthy living activities.

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HLP Criteria Self-assessment

Healthy Living Pharmacy

The requirement for Healthy Living Pharmacies (HLPs) to reassess against the HLP Quality Criteria has moved from every two years to every three years. More information is available on the PSNC website.

With HLP becoming an essential requirement in the community pharmacy contractual framework from April 2020, monitoring will fall under NHS England Community Pharmacy Assurance Framework so maintaining the criteria remains a key requirement. This evidenced capability will become increasingly important as new prevention services are commissioned either nationally or locally through PCN service sub-contracting or local public health.

Pharmacy Complete can support pharmacy contractors to become, maintain and build on the criteria. Please see our HLP page by clicking here.

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Community Pharmacy in a new NHS

The NHS Long Term Plan sets out its ambitions for transformation over the next decade to ensure the NHS is fit for purpose in the future.

The plan’s key aims are to:

  • ensure everyone gets the best start in life;
  • deliver world class care for major health problems; and
  • support people to age well.

So where does Pharmacy fit into the plan? Key areas that will impact on pharmacy include:

  • make greater use of community pharmacy’s accessibility and skills
  • establishment of Primary Care Networks with £4.5 billion investment
  • out-of-hospital and urgent care
  • supporting self care and self management
  • promoting good health
  • prevention and treatment of cardiovascular disease, stroke, diabetes, cancer and respiratory conditions
  • greater involvement in provision of Health Checks and their outcomes
  • support to improve mental health and wellbeing
  • involvement in social prescribing
  • expansion of digital healthcare and use of technology including automation
  • reducing waste and exploring alternative reimbursement and supply arrangements for medicines

Inevitably there are both risks and opportunities for community pharmacy so planning and executing the next steps are critical for a successful future.

Whilst we now have a new contractual framework, PSNC’s negotiations with NHS England and DHSC on how this evolve are ongoing. Within these conversations, understanding how community pharmacy can be part of the implementation and delivery of the plan’s ambitions is key to our future.

A sustainable future model must be developed at national and local levels and support provided for its implementation and delivery against NHS and public health needs. In addition, the reimbursement model must change to become fair and equitable, and drive the right behaviours.

Integrated Care Systems (ICS) are due to be in place everywhere by April 2021. As they are to be central to delivery of the plan, there is a major influencing and leadership role for Local Pharmaceutical Committees (LPCs) by working with ICSs and CCGs to ensure that community pharmacy is firmly embedded, supported and active within the Primary Care Networks (PCNs).

Over the coming years there will be additional roles employed in these PCNs including an increasing team of Pharmacists and Pharmacy Technicians as well as other healthcare professions such as Social Prescribing Link workers, Physiotherapists, Paramedics and Physician Associates. This multidisciplinary team will work across GP practices and with other health and social care providers including, assuming we proactively embrace the opportunity, community pharmacies.

This is where any new money will flow through so critical for a sustainable future.

Individual pharmacies must start to work together now and engage with their emerging local Primary Care Network to understand who the key stakeholders are and hence who to build effective relationships with, develop an understanding of priority needs and influence pharmacy’s opportunity to be embedded (and funded) in the solutions.

Ask not what the NHS can do for community pharmacy but what can community pharmacy do for the NHS. 

It is now ten years since the Healthy Living Pharmacy initiative was developed in anticipation that community pharmacy could play a bigger and better role in improving the health and wellbeing of the communities we serve and support. It was predictable then that a supply-based contract could not be sustainable in the long term and a shift to a quality-led, service-based contract including pharmaceutical care, supply and prevention would come. Hence the then, and continued focus on organisational development.

The Chief Pharmaceutical Officer, Dr Keith Ridge, has now communicated his vision for pharmacy’s role in the new NHS. That includes opportunities for community pharmacies to support medicines optimisation and patient safety, acute and urgent care, and the prevention agenda.

We have developed an online and on-demand webinar on this topic which can be accessed here.

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New Community Pharmacy Contractual Framework 2019-2024

The English community pharmacy funding settlement for the next five years has been announced the first time that we have agreed a multi-year settlement. The agreement, set out in the new Community Pharmacy Contractual Framework (CPCF) which commences on 1st October 2019, aims to build on the clinical skills of community pharmacists and their teams which must be seen as a positive step.

The Headlines

Funding:

  • The contract sum will remain unchanged at £2.592 billion until the end of 2023/24, £1.792bn for fees and £800m in retained margin.
  • The Single Activity Fee (SAF) will be £1.27 from August 2019 (currently £1.26).
  • Category M prices will increase by £15m a month from August 2019 to recognise that there was predicted to be a shortfall in margin in the current year.
  • Pharmacies will receive monthly transitional payments in the second half of 2019/20 and in 2020/21 to meet costs associated with changes such as integration into Primary Care Networks (PCNs), preparation for Serious Shortage Protocols (SSPs) and implementation of the Falsified Medicines Directive (FMD).
  • Establishment Payments will be phased out by 2020/21.
  • The Pharmacy Access Scheme (PhAS) remains at £24m a year.

Services:

  • A new NHS Community Pharmacist Consultation Service (CPCS) is introduced nationally as an Advanced service in October 2019. This will replace the current NHS Urgent Medicine Supply Advanced Service (NUMSAS) and local pilots of the Digital Minor Illness Referral Service (DMIRS). The new service will operate with a fee of £14 per consultation. Initially using referrals from NHS111, but piloting referrals from GP practices with an intent to implement nationally in 2020/21.
  • Medicines Use Reviews (MURs) will be phased out over the next two years with pharmacists working in PCNs undertaking Structured Medication Reviews (SMRs). Contractors will be able to deliver 250 MURs in 2019/20 and 100 in 2020/21.
  • New Medicine Service is retained with potential extension of therapeutic areas and funding.
  • Medicines reconciliation service as part of transfer of care.
  • Being a Healthy Living Pharmacy will become an essential requirement within the new framework from April 2020 to support the prevention agenda and will include:
    • Mandatory health campaigns aligned with equivalent campaigns in general practice under an integrated programme
    • Hepatitis C testing for people using needle exchange services
    • A testbed programme for:
      • detection of undiagnosed cardiovascular disease (hypertension, atrial fibrillation)
      • stop smoking support from secondary care referrals
      • point of care testing for minor illnesses to support AMR
      • vaccination and immunisation services
      • routine monitoring of patients, e.g. those taking oral contraception
      • activity complementing future PCN service specifications, e.g. early cancer diagnosis and health inequalities.

Pharmacy Quality Scheme (PQS) 

  • This replaces the Quality Payments Scheme (QPS) and pharmacies can earn additional payments for meeting quality criteria. Funding for the scheme will continue at £75m a year.
  • Some elements of the former QPS will become Terms of Service requirements from April 2020, e.g. Healthy Living Pharmacy.
  • The criteria include:
    • A collaborative approach to engage with PCNs
    • Activity complementing the GP QOF Quality Improvement module on safe prescribing, e.g. lithium safety audit, valproate in pregnancy, NSAIDs
    • Checking whether patients with diabetes have had their annual foot and eye checks with appropriate referrals
    • Reduction in sales of sugar sweetened beverages (SSB)
    • Training and assessment of look-alike, sound-alike (LASA) medicines with evidenced safety reporting action
    • Update previous risk review with recorded mitigations
    • Sepsis training with risk mitigation
    • All patient-facing staff are Dementia Friends and a Dementia Friendly environment standards checklist completed.
  • The 2020/21 PQS may include:
    • Suicide prevention training
    • Inhaler technique audit
    • Anticoagulation audit.

Transformation and Technology:

  • A range of reviews with the aim to free up capacity:
    • Legislation to permit wider hub and spoke dispensing
    • Original pack dispensing review
    • Better use of skill-mix
    • Different terms of service for online pharmacies.

The Commentary

Firstly, we should recognise that this will undoubtedly been a big task for PSNC to achieve and remains so as negotiations are ongoing.

It should be no surprise, but will be disappointing to contractors that the contract sum has been fixed at the current level for the five year deal which is less than in previous years against a backdrop of rising operating costs. With prescription numbers set to fall due to various deprescribing initiatives, the proportion of income associated with dispensing will also drop. Hence, those relying on volume alone and not adapting to a service-led contract will struggle to survive. One can only hope that new and sustainable funding will come through on the back of some of conceptual and testbed service opportunities and that the sector is ready, willing and able to deliver.

Unfortunately, the continued use of retained margin to deliver around 30% of funding will perpetuate an unfair averaging system where not all contractors can realise their full funding, and, in some cases, drive the wrong focus and behaviours. In addition, a consultation on a review of reimbursement was announced by DHSC which will impact on this.

The eventual loss of MURs is also disappointing. Yes, they needed reform (Murray Review), but a good consultation on safe medicines use adds enormous value to patients (see our previous Viewpoint article). Not to acknowledge and fund this provision of pharmaceutical care as an adjunct to medicine supply and support medicines optimisation is a lost opportunity for patients, the NHS and pharmacy. Structured Medication Reviews by pharmacists working in a PCN will add value, but will only reach a proportion of patients and misses the opportunistic interventions on adherence and healthy lifestyles which can improve patient outcomes. On a positive note, the New Medicine Service, that also adds value to patients and the health system, is retained and a medicines reconciliation service is to be added to support transfer of care.

The arrival of a national minor illness consultation service (CPCS) should be welcomed and quickly embraced, particularly when GP referrals are included; certainly all GPs we know welcome its coming. This is likely to be a big stream of work and funding in the future and pharmacy teams will need to be ready to deliver against expectations.

Embedding HLP in the contractual framework, rather than just in the quality scheme, should  be celebrated. Many contractors have fully adopted the organisational development, health promoting ethos and criteria which are the foundation of HLP; however, some have undoubtedly just ticked the box. The opportunity to develop the right knowledge and skills within the pharmacy team and deliver a healthy living environment and enhanced customer experience will pay dividends. There will also be new services to build on these foundations. Given the launch of the Prevention Green Paper with which the pharmacy contract is aligned, the opportunities for community pharmacy to be at the forefront of prevention are significant.

One comment I saw on Twitter called it a Curate’s egg, good in parts, less so in others. Undoubtedly true, but it’s what we’ve got and we will have to make the most of it whilst building relationships with PCNs to tap into the funding that will flow through there. Contractors will also need to develop their own business plan around non-NHS services to meet local needs.

We have developed a short animation which illustrates what the new contract means through the eyes of patients that use community pharmacy.

Pharmacy Complete is here to support contractors in ensuring they meet the HLP criteria and optimise the benefits that brings. We are also here to support the engagement with PCNs and development of a business plan for a sustainable future.

Helping you to help others

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Prevention better than cure

The Secretary of State for Health and Social Care, Matt Hancock MP, has launched the Government’s vision to help the population live longer. Perhaps the strapline should be ‘live well for longer’, but this is nonetheless very welcomed as is the recognition of the important role of community pharmacy, in particular Healthy Living Pharmacies (HLP), in the plans.

The Mission is to ensure that people can enjoy at least five extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest. This is supported by the long-term funding settlement for the NHS with an extra £20.5 billion a year by the end of the next five years giving the opportunity to radically change the focus of health and social care onto prevention.

The Minister acknowledges that we cannot continue to invest in the same service models of the past and we will not achieve that ambition with ‘business as usual‘. The vision sets out a greater focus, and spending, is needed on prevention, not just cure. With an ageing society and people living with multiple complex conditions it is imperative that this rebalancing happens – to keeping people well, living in the community, and out of hospital for longer. This means services which target the root causes of poor health and promote the health of the whole individual, not just treating single acute illnesses. In practice this requires greater funding for pre-primary, primary and community care – primary care includes community pharmacy.

Healthy Living Pharmacy was designed from the start to change the way a pharmacy operates from a focus on medicines supply and pharmaceutical care to that PLUS proactive health promotion, prevention and protection services. This we have demonstrated can be achieved by those who fully embrace the enablers of an engaged and developed workforce, the right environment, and engaging with, even leading on health and wellbeing in their community. Its a basic business development model – get the right people doing the right things that the market needs (and will pay for) at the right time. HLP is NOT a tick-box exercise to achieve a quality payment, it is that model.

Just as the Government cannot continue to do business as usual, neither can community pharmacy. We must unite behind this opportunity, demonstrate strong and effective leadership, ask the right questions of the right people in health and social care and public health, co-develop solutions, then, once commissioned, deliver consistently high quality and evidenced services across the sector.