Pharmacy Complete

Pharmacy consultancy

Leadership

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.

A new year, a new Government, a new NHS… what’s new for community pharmacy?

The Secretary of State for Health and Social Care, Matt Hancock, recently gave a speech on the newly elected Government’s priorities for the NHS:

  • Prevention: because prevention is better than cure
  • People: because we need more people working smarter
  • Technology: because patients and clinicians demand better
  • Infrastructure: because buildings matter too.

The following extract from the speech relates to Community Pharmacy and the prevention priority building on the Healthy Living Pharmacy foundations:

And we will also “unleash the potential” of our pharmacies because there really is so much more they are capable of doing.

Over the next 5 years, they will become the first port of call for patients with minor illnesses. More than 10,000 pharmacies are ready to receive referrals from other parts of the health service – and that number will grow.

The prevention agenda is incredibly important because prevention is better than cure. We also know the challenges the NHS faces: demand is rising faster than at any point in history. Baby-boomers are reaching the age where they need more and more healthcare.

So, as well as investing in infrastructure, we need to make the 2020s a decade of prevention of ill health:

  • Support everyone to take more care of their own health. I don’t believe in the worried well – I want healthy people to be concerned about their own health so they stay healthy.
  • Vaccinate against preventable diseases.
  • Redouble our efforts to be smoke-free, redouble our efforts on obesity, and embed a more proactive, predictive and personalised approach across the NHS.

So what does this mean for community pharmacy? Whatever the colour of your politics, the fact that there is continued mention of the role that community pharmacy can play within an integrated NHS must be a positive. That focus has carried over from the NHS Plan, the Prevention Green Paper and the new CPCF into the newly elected Government’s plans for the next 5-years.

At a national level, building on the platform that the new CPCF provides, the first step is to deliver what is now in place whilst continuing negotiations to embed new services. This would mean that the currently unallocated funding (around £250 million) is accessible to all contractors and we must sort out the reimbursement mechanism following the recent consultation to make it more equitable for all.

At a local level, contractors, supported by their LPC, must engage more than ever before – firstly with each other and then with PCNs to ensure that they understand their needs and priorities. PCN Clinical Directors and all other health and care providers must also understand what pharmacy could offer to address their needs, particularly their real pain points. The skills of the identified PCN Community Pharmacy Leads will be crucial. This is why we created our award-winning portfolio of HLP support and launched our new Effective Engagement and Communication leadership programme which a number of LPCs have already embraced.

Apologies for plagiarising an over-used political phrase – Let’s get it done!

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

Planning for a sustainable future

The announcement of the funding settlement for the remainder of the 2018/19 financial year will not be well received by pharmacy owners in England. That, together with reinstatement of the temporarily postponed Category M overspend recovery, will create further cashflow and sustainability challenges for many owners, particularly independents.

Unfortunately, this was predictable on the back of almost three lost years whilst the judicial review of the previously imposed and poorly implemented funding settlement was pursued rather than asking the right questions of the right people to understand where pharmacy could support the very challenged NHS and public health systems.

We have written many times about the need to change the contractual framework and the funding formula to incentivise the right behaviours and reward quality delivery through a fairer system that is not based on a non-existent average pharmacy that benefits a few and penalises many.

To support pharmacy contractors, Pharmacy Complete has developed a unique Business Development Programme. Planning for Growth enables owners and their managers to take control of their future by developing a robust business plan.

This course, which builds on our Leadership development programmes and the platform of Healthy Living Pharmacy, provides essential business knowledge, skills and tools at a time when community pharmacy can no longer wait for someone else to create their future business model nor be so dependent on the NHS for profitable income.

Pharmacy Complete – enabling pharmacy for a healthier future

SMARTER Goals

Most of us have come across the acronym SMART when developing goals or making plans, but how many of us have made these goals and plans SMARTER?

So often our life or business goals are not sufficiently specific or measurable and many do not have an ‘achieve by’ timeline all of which are critical to achieving those goals. Even if these elements are all in place, we often fail to measure whether we are on track to achieve or have achieved the desired goals. This is where the ER in SMARTER comes in.

 

We use this approach in our Knowledge into Action workshop and MECC course for Health Champions where they are applied to healthier lifestyle goal setting. Our Business Development Programme course, Planning for Growth, also explores and supports the effective use of SMARTER goal setting when creating a business plan.

What gets measured, gets done!