Pharmacy Complete

Pharmacy consultancy

Prevention

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.

Let us help you to help others.

Pharmacy Transformation

Some would say that transformation in pharmacy will never happen, some that it is overdue; others would say its on the horizon, but most are witnessing that it is here and now! 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.

In 2009 we looked ahead at what was fairly predictable and being looked for by commissioners. That led to the development of the Healthy Living Pharmacy (HLP) initiative. Ten years later it will be embedded as an essential requirement in the contractual framework and we finally have prevention high on the agenda for the Government and the NHS. HLP 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 community, the population (the consumers of our services) and other providers of health and care. That was the first time that the need for unilateral leadership development was identified and implemented in pharmacy to lead the required change in culture and activity.

What we see now in the shift from a contractual framework almost totally reliant on procurement and supply of medicines to one which is more service-led and quality based, driven by financial, population health and consumer demand was inevitable. The need to get upstream of what creates much of ill-health, both physical and mental, – the prevention agenda – puts community pharmacy in a good place providing we have the capacity, will and skill to occupy that space.

Digital healthcare is now moving at such a pace that community pharmacy and other healthcare providers are struggling to keep up. Web-based information, consultations, algorithms and ‘health-bots’ are now common place. Distance selling pharmacies now provide around 3% of prescriptions and growing fast. Yes, Pharmacy2U grew 80% last year, admittedly at an operational loss due to investment write-offs. Echo (Lloyds) and Well are also increasingly significant players in the online market. Now enter the giant… Amazon Pharmacy is now trademarked in the UK in addition to the Far East, US and Australia. Their cost base will be much lower as they have the established infrastructure and distribution networks plus a massive consumer base. So transacting product is no longer a unique option nor a sustainable model for ‘bricks and 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 unique face-to-face offer? You cannot have a vaccination given online; diagnosing effectively and supporting individuals to change their behaviours around safe medicine use or healthy lifestyles is difficult to deliver online. It is said that to change people’s hearts and minds you need to look them in the eyes – we listen with our eyes as well as ears, or at least we should do.

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 must must promote what we do effectively.

All this change needs to be actively led at all levels but predominantly at an individual pharmacy level, no-one is going to do it for you. This requires an enhanced level of leadership and business planning skills. Our recent experience of delivering our Effective Engagement and Communication workshops for PCN Pharmacy Leads has demonstrated a real hunger for these leadership skills and a passion to transform what we do. We have also developed a Transformation workshop to help create the time, capacity and capability to implement and deliver more services.

The future is bright, but only if we truly understand why we must change, how we do it and move fast.

People buy why you do things, not what you do (Simon Sinek).

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!

NICE touch – but will NHS England listen?

Will the recent NICE guidance, which focuses on how community pharmacies can help maintain and improve people’s physical and mental health, also focus the minds of NHS England and Public Health England? Mike Holden from Pharmacy Complete hopes so. Read more in the Pharmacy Magazine article he recently wrote.

NICE Guidance on promoting health and wellbeing in Community Pharmacies

NICE have launched this guidance – Community Pharmacies: promoting health and wellbeing.

It is important that pharmacy owners, pharmacists and pharmacy teams, particularly Health Champions, and local commissioners of both health and wellbeing services understand what the recommendations are and what this means for them.

Overview

This guideline covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners.

Summary of key recommendations

  1. Local commissioners, Health & Wellbeing Boards, community pharmacies and their representatives (e.g. LPCs) should work to integrate community pharmacy into existing care and referral pathways as health and wellbeing hubs.
  2. Interventions should be focused on local needs, be consistently of high quality, tailored to the individual, use professionally produced support materials and pharmacy team members delivering them should have the right skills and knowledge, e.g. in line with NICE guidance on behaviour change.
  3. Local commissioners should promote community pharmacy as an integral part of NHS primary care services.
  4. Community pharmacies should publicise their skills and services to increase the public’s knowledge and confidence in those services.
  5. Community pharmacies should proactively seek opportunities to promote people’s physical and mental health and wellbeing. This includes raising awareness, providing information, advice and support, and signposting or referral to and from other services. This could happen when responding to requests for advice, selling OTC medicines or supplying prescription medicines and supporting a patient with a long-term condition such as diabetes or hypertension. The brief interventions could include the self-management of mild to moderate back pain, physical activity, smoking, healthy weight and diet, and alcohol consumption. A minimum dataset should be used to capture these interventions and referrals.

What does this mean for community pharmacies?

We believe that the guidance is a very good fit with the objectives and ethos of the Healthy Living Pharmacy (HLP) model which we have supported since its conception. So those pharmacies that are already accredited HLPs and maintained their capability and activity in line with the HLP Criteria will be well placed to meet most or all of these recommendations.

At Pharmacy Complete we have gone beyond the core HLP criteria with our award-winning Health Champion development programme that we have created for pharmacy teams which includes our Knowledge into Action workshop, the RSPH Applied award in Health Improvement and the Supporting Behaviour Change Level 2 award plus Making Every Contact Count (MECC). We have also developed our Health Campaign service which uses only evidence-based, professional materials plus a topic knowledge piece and hints and tips to support the provision of the required minimum of six campaigns a year.

There will undoubtedly be some work for local public health, NHS and CCG commissioners to do on the integration and publicity recommendations; LPCs and Local Healthwatch should be holding them to account on this.