Pharmacy Complete

Integration

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The future is local?

As we continue to work our way through a pandemic and all that means to the day-to-day operational pressures of pharmacy practice, the Government and NHS England are looking ahead to 2022 with enabling legislation to further integrate local health and care through a new White Paper now backed up by a new Health and Care Bill. With it comes wide-ranging changes and powers which will impact on pharmacy at a national and local level.

Primary Care Networks (PCNs) will increasingly becoming the building block of out-of-hospital care at the so-called ‘neighbourhood’ level. Integrated Care Systems (ICSs) will have delegated powers for primary care services with a single pot of funding to commission health and public health services, including pharmacy services, at the ‘system level’ with the planned demise of CCGs. Local Pharmaceutical Committees (LPCs) influence on their local ICS, and Community Pharmacy’s relationship with PCNs will therefore be critical to its future.

So what does this mean? The skills to effectively engage, communicate with and influence ICSs and PCNs will be key – we have to be in it to win it! This is not about selling what pharmacy does, it’s about effective influencing and creating the opportunity to ‘buy’ from community pharmacy. At the same time, community pharmacy must redefine and reposition its core purpose as community-based health clinics which also supply medicines safely and efficiently.

These changes in the healthcare landscape will also impact on the current review of pharmacy representation and support. There is a need for greater alignment of LPCs with ICSs and improved support for Pharmacy PCN Leads in addition to the appropriate resourcing of PSNC to negotiate a better CPCF.

To date Pharmacy Complete have worked with LPCs across England to develop over 400 Pharmacy PCN Leads. Initially through face-to-face workshops then from the start of the first lockdown by utilising web-based technologies and blended learning to transfer the required knowledge and skills. This has inspired and enabled Pharmacy PCN Leads to not only engage with their PCN, but also with fellow contractors in their area. That collaborative approach across contractors at a local level is as important, if not more so, as it is at a national level.

Our Effective Engagement and Communication leadership development programme is designed to provide Pharmacy PCN Leads and others in local leadership positions with the capabilities to maximise the positive impact they can have and be ready for a more integrated local health care system.

The healthcare landscape is changing so pharmacy must adapt. The future is local.

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Collaboration, integration and transformation

As we all move forward into a reset, reform and recover phase, it is critical that we learn from and build on community pharmacy’s excellent and dynamic response to the COVID-19 pandemic.

Collaboration

If there is one of the many hashtags doing the social media rounds over the last two months that best fits the Coronavirus response it is undoubtedly #allinthistogether 

We have complete admiration for pharmacy teams who are putting outstanding and safe patient care, often ahead of personal safety, at the heart of their communities. This is against a backdrop of current underfunding, major cash flow and workload challenges, late and limited supplies of personal protection equipment and poor recognition, beyond a few words of thanks from politicians and NHS England, of the critical role we play in the current pandemic crisis.

One of the many objectives of the Healthy Living Pharmacy programme when we created the concept, was and remains to collaborate better for the greater good of pharmacy and the health and wellbeing of our communities. If there is any silver lining to this dark COVID-19 cloud, then it is the way in which pharmacy teams, other healthcare providers and local volunteer groups have all worked together for the benefit of the population.

Integration

This could be a defining moment for pharmacy. What we are doing now will cement in the minds of the public, other health professionals and, one would hope, NHS commissioners, the role of bricks ‘n’ mortar community pharmacy at the frontline of healthcare in the heart of our communities.

What we must all ensure is that this intra and inter-professional collaborative approach continues beyond the pandemic and drives the need and opportunity for pharmacy in the community to be fully integrated into the local health and care systems. To be sustainable, this must also extend beyond (yet still include) the important safe supply of medicines to a broader role in clinical care and prevention.

Before COVID-19, which seems an age ago now, the NHS long term plan, the GP contract and the community pharmacy contractual framework began to align behind this integrated approach. Once this is all over, we must go back to the key objectives which are and should still be to focus on:

  • the prevention of illness;
  • personalised care;
  • utilising data and technology; and
  • making the best use of collective resources across all local health and care providers.

The only way these objectives will be achieved is through effective collaboration and integration. How we achieve that to support the delivery of the objectives requires individual, organisational and system transformation.

Transformation

We are going to experience a radical and rapid evolution in what community pharmacy looks like and does in the next five years, those who adapt will continue to successfully operate as healthcare providers.

Healthy Living Pharmacy was never just about brief advice and interventions on healthy lifestyles, although that is an important output. The HLP model was, and remains for those who fully embrace it, an organisational development framework to transform pharmacy in preparation for what was to come. One based on workforce and premises development plus effective engagement with the local population and other providers of health and care.

What we see now is a shift from a contractual framework almost totally reliant on procurement and supply of medicines to one which is increasingly more service-led and quality based, driven by financial, population health and consumer demand.

Digital healthcare is now moving at such a pace with web-based information, consultations, algorithms and ‘health-bots’ now common place. Distance selling pharmacies now provide around 3% of prescriptions and growing fast, so transacting product alone is no longer a unique option nor a sustainable model for bricks ‘n’ mortar pharmacy.

We need to find a new model which can only be provided face-to-face. Turkish barbers and coffee shops are everywhere. Why? – because you cannot get a haircut or a cup of coffee online! So, what is our new unique face-to-face offer?

The fixed funding in the contractual framework is insufficient to support the existing community pharmacy estate. This means that new skills and skill-mix must be developed; operational efficiencies must be found; technology must be embraced; we must develop new services and products that people and commissioners want to buy; consistent high quality consumer experience must be delivered; community pharmacy must collaborate and be fully integrated into local health and care systems; and we must effectively promote what we do.

All this change needs to be actively led at all levels but, as with most effective change, it must start at an individual level.

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