The NHS is changing fast, and it is vital that community pharmacy plays a central role in its evolution.
The NHS Long Term Plan, announced in January, sets out how the government will spend the £20.5 billion NHS budget increase, including the £4.5bn increase in funding for primary and community care. Its ambitious aims include improvements in a range of services, such as community healthcare, maternity services, care of children and the elderly, and mental health provision, as well as a focus on the prevention of conditions, such as cardiovascular and respiratory disease, and diabetes. The document also makes it clear that NHS England is committed to better using the skills of pharmacists to achieve these aims.
The plan signals the next stage in the journey towards more localised and collaborative NHS services. Many of the 44 sustainability and transformation partnerships (STPs) formed in 2016 are now evolving into closer collaborations, known as integrated care systems (ICSs), in which partners take collective responsibility for managing resources and improving the health of the local population. These systems allow services to be closely tailored to local needs as leaders have more control over operations and finance with less involvement of national bodies and regulators. The aim is for every STP to have been transformed into an ICS by April 2021.
AIM OF ICSs
ICSs are made up of primary care networks (PCNs), smaller entities that are at the heart of the NHS Long Term Plan. The aim of these networks is to produce a more personalised, coordinated and integrated model of health and social care by bringing together a range of local providers, including GP practices, mental health and social care services, pharmacies, and some hospital and voluntary services. They are based on GPs’ registered lists and each covers around 30,000 to 50,000 patients. PCNs are already up and running in many areas of the country and the plan is for the networks to cover the whole of England by the end of 2019. The £4.5bn increase in investment will help fund the further development of these multidisciplinary teams.
As they are intended to be responsive to local needs, networks vary in structure and operation. A model that’s already proved very successful is the primary care home (PCH), launched by the National Association of Primary Care (NAPC) in 2015, with the overall intention of creating a system that brings care closer to patients’ own homes. There are now 220 PCHs across England, covering 16% of the population, with many more in development.
Primary care homes
A PCH can be run on a community interest or not-for-profit company model with directors, employees and contractors, or it can be run by providers working together in an alliance contract. It represents a move from the looser and often less successful attempts at collaboration of the past, to a more formal way of working together with a unified capital budget.
“A PCH is a pragmatic approach that provides a template for realising a PCN,” says Michael Lennox, Chief Officer of Somerset LPC and an NAPC council member. “Every PCN or PCH will make its own localised journey, but it’s a journey that is very inclusive and friendly to community pharmacy.”
It’s important that community pharmacists play a part in the development of networks, as it offers the perfect opportunity to accelerate the change from a primarily dispensing role to a much more active role in patient care, he adds. “You hear a lot of platitudes about inclusion, but you have to turn those platitudes into action, and move from inclusion to influence. It’s through influencing the development of these networks that we can achieve true integration, optimising the operational interface between community pharmacy and general practice, as well as developing service innovations.”
There are many examples from around the country of how the integration of community pharmacy into PCNs is working, with pharmacies acting as health hubs for the local community and taking some of the strain off other NHS services. Pharmacies are supporting people with long-term conditions, such as COPD, a frequent cause of emergency admissions to hospital; managing patients with polypharmacy; identifying risk factors, such as high blood pressure; and working with GPs to improve uptake of services, such as the flu vaccine.
Some models also see pharmacists working as part of urgent care teams, along with GPs surgeries and other practitioners, to triage patients seeking same day appointments.
“You have to make sure you’re integrated in both the clinical services through the CCG and the public health interventions through the council,” says Michael. “In Somerset, we’re working collaboratively on creating a system-wide commissioning plan that integrates community pharmacy into key service sectors, for instance urgent and emergency care. We’re also working with the local authority public health team on how we can be a coordinated and optimised contributor to the public health and prevention drive.
He continues: “An idea doesn’t have to be earth-shattering. It might be a better way of working together to triage patients, or a better way of communicating. A lot of positive things happen because we change things by one per cent. Ultimately, we need to get PCNs absolutely right, but that will happen because of lots
of little changes.”
He believes LPCs have a key part to play in helping independent pharmacies integrate into networks and it’s up to them to start the conversation and create the right conditions for this. Building trust is vital, he adds. Last year Somerset LPC, along with the CCG and local medical committee, hosted a series of “Walk in my shoes” exchanges, in which GPs spend time in community pharmacies and pharmacists visit GPs.
“With experiences like these, we’ll communicate better and trust each other. ‘Innovation moves at the speed of trust’ is one of my favourite statements.”