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Our reflections on the latest changes in the pharmacy and healthcare landscape.

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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).

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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!

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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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Eye Health training for Community Pharmacy

Good eye health is important to everyone and pharmacies are often the first port of call for patients suffering with conditions such as dry eye and blepharitis. These are an important patient group to community pharmacy for self care advice and effective treatment so knowledge of the conditions and the best treatment is critical if we are to deliver good health outcomes and a great customer experience.

Dry eye syndrome is estimated to affect up to 33% of the adult population and is more common in people aged 50 years or older and in women. Symptoms of dry eye  include dryness, irritation or discomfort, and intermittent blurring of vision and these typically worsen with prolonged visual tasks, exposure to wind and air conditioning.

Blepharitis is a common chronic inflammatory condition affecting the margin of the eyelids and usually develops in middle-age but may occur at any age. It accounts for about 5% of all ophthalmological problems presenting in primary care. Treatment can control symptoms and help prevent complications.

Both of these conditions are covered as part of a series of free webinars aimed at pharmacists and pharmacy teams. Subsequent webinars also covered:

These webinars are delivered by Pharmacy in Practice and supported by Théa Pharmaceuticals. Click on the relevant topic title to access either the recorded or register for the live webinars.

Pharmacy Complete

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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.