Pharmacy Complete

Pharmacy Future

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HLP – more than a tick box exercise

When we first developed the concept of Healthy Living Pharmacy (HLP) and evolved the quality criteria there was no Quality Payment Scheme (QPS). Pharmacy contractors and local commissioners chose to invest the time and energy because they saw it as the right thing to do.

HLP’s roots are in change management and organisational development – developing workforce capability, ensuring premises and facilities are fit for purpose and engaging with the community to deliver consistent high quality health and wellbeing services alongside the provision of our core pharmaceutical care services.

When QPS came into the contractual funding as a public health quality mark it was inevitable that some would treat it as a tick box exercise, opting for the cheapest possible solution such as online training to meet the criteria without considering or understanding the benefits it could bring to their business or the local population.

Developing any business requires creating and sharing a vision, taking your team with you through effective leadership, engagement and empowerment, understanding local needs and aligning a business plan to those needs.

The true benefits can only be realised if the action plan to implement and build on the foundations of HLP is joined up and reaches into the hearts and minds of the whole pharmacy team to achieve the required changes in behaviours. Only then can we live and breathe the HLP ethos and make every contact count for a healthier future.

So when looking at you business and the challenges you face, please consider carefully whether you are just ticking a box with HLP or whether you really want to transform your pharmacy business to become one that is fit for the future by taking the right approach and working with the right people to help you get there.

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Pharmaceutical Services Report 2017/18

What is it?

NHS Digital have released their latest report on services provided by community pharmacies in England between 2007/08 and 2017/18.

What does it say?

  • The total number of community pharmacy contractors fell by 80 (0.7%) on 2016/17 to 11,619 with the proportion of independents (5 or less pharmacies) remaining at 38%
  • The number of 100 hour contracts fell by 10 to 1,179
  • The number of distance selling pharmacies rose by 29 to 350
  • The total number of prescriptions dispensed in community pharmacies in 2017/18 was 1,013.3 million, a fall of 2.3 million on 2016/17 with the average number of items per pharmacy at 7,267 per month
  • 97.3% of pharmacies provided the Medicines Use Review service (MURs) with the average per pharmacy being 299 which was no improvement on 2016/17
  • 89% of pharmacies provided the New Medicine Service (NMS) with an average of 90 per pharmacy
  • 77% of pharmacies provided the NHS Flu Vaccination service and delivered 1.34 million vaccinations (an average of 150 per participating pharmacy and a 40% increase on 2016/17) to improve the reach of this important protection intervention. This was worth £12.3 million in fees
  • 3,930 pharmacies delivered one or more locally commissioned Enhanced Services, a 3% drop on 2016/17

What does it mean?

  • Its tough out there!
  • The number of pharmacies serving communities are declining, i.e. no longer viable and/or through consolidation
  • The number of DSPs are increasing and the number of items they are delivering are increasing against the normal trend
  • A potential 1.4 million MURs were not completed equivalent to £35 million left on the table, despite the funding cuts, to the detriment of patients and the contractors involved
  • 318 (11%) pharmacies chose not to deliver the NMS
  • 2613 (23%) pharmacies chose not to deliver the NHS Flu Vaccination service. If they all engaged and delivered the 2017 average of 150 vaccinations, this would be mean an additional 391,950 patients would be vaccinated which would be worth £3.6m in fees to those additional pharmacies
  • We could move the flu median up by using the whole pharmacy team to effectively implement and promote the flu service
  • Local services continue to be decommissioned for whatever reason, e.g. funding challenges, poor understanding of commissioners of the benefits of using community pharmacies, poor or inconsistent delivery by some pharmacies

Conclusions?

Community pharmacy’s ‘cheese’ has moved and, in the rapidly changing health and consumer ecosystems in which we operate, we must constantly adapt to remain relevant and compelling to commissioners and consumers of our services. In addition to pursuing an effective contractual framework and new locally commissioned services, we must plan for a sustainable future, embrace the digital healthcare revolution, be more effective at supporting self care and explore opportunities for private services to reduce dependence on  NHS revenue which is declining in value and profitability.

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Putting community pharmacy at the heart of the NHS

The headline sounded great, however the underlying messages in the letter from NHS England and the Department of Health dated December 17 were not the clear vision for the future of the sector that the owners and employees of community pharmacies in England would have hoped for. What it was is a wake up call.

We understand that the NHS has financial, quality and access challenges and it was broadly accepted that the recent government spending review would have some impact on funding for the sector. However, many were unprepared for a £170 million cut (6% of the global sum) to be delivered in the 6 months from October 2016 (equivalent to a 12% cut in the period) and potential further cuts in the future.

How this will be delivered has yet to be negotiated, one can but assume it will come from fees and retained margin so difficult to predict the impact on individual pharmacies. In addition to the uncertainty that accompanies the lack of clarity, one big concern is the expectation that it will not impact quality or access to pharmaceutical services, something that the dedicated pharmacy workforce will always strive to maintain. We are already hearing plans to reduce investment in people, technology and premises at a time when access to healthcare services is already under enormous pressure.

The letter highlighted several other plans for the sector including a Pharmacy Access Scheme with an intent to reduce the number of contracts (the Minister stated between 1000 and 3000 less at a recent APPG meeting). How this will happen is apparently down to the sector itself based on viability in the new funding landscape that also includes the phasing out of the Establishment Payment currently worth around £25,000 per annum and meant to underpin some of the core running costs of a pharmacy.

The letter also refers to Hub and Spoke arrangements and large scale automated dispensing – we have yet to see any robust evidence of cost-efficiencies from such initiatives but should keep an open mind on the potential of remote assembly. Optimising prescription duration and online ordering of prescriptions with click-and-collect options are also mentioned. These may have some merit given the ever increasing volume related workload but will require a different funding model based on care including supply, not just supply activity. However, we should be concerned at the thinking around increasing home delivery. We must do nothing that reduces the opportunity for a face-to-face pharmacist-patient interaction and thus intervention to improve outcomes from the safe use of medicines; medicines are not commodities!

We must embrace technology and innovation; releasing the talent and time of pharmacy teams is highly desirable so that we can further increase and improve the delivery of pharmaceutical care, clinical services and healthy lifestyle interventions. However, these will need funding to appropriately incentivise and reward the value of such services.

Finally, it will be interesting to see the outcome objectives of a Pharmacy Integration Fund. I have always sought greater intra and inter-professional collaboration and the recent investment (£40+ million) for pharmacists in GP practices should be an opportunity both for patients and the profession as a whole, but this must operate within a culture and an enabled joined-up framework with all pharmacy sectors to succeed.

The pharmacy bodies, the sector and the profession have an important job on our hands to ensure that this potential burning platform is turned into a burning ambition and opportunity for community pharmacy teams to improve the health and wellbeing of their communities. We must create a compelling and relevant offer for a modern health and care system; one that meets the needs of the system and the population and delivers quality, value and a sustainable future.