Politicians, officials and pharmacists talked at NPA’s first virtual conference about the critical role community pharmacists have played during lockdown and will continue to play in the future
Community pharmacists are a “critical part of the NHS family” and an “untapped resource who, when asked and supported to do more, can provide better care in our communities and make sure people get a better service from the NHS,” Matt Hancock told the first ever virtual NPA conference in July.
The Secretary of State for Health and Social Care thanked community pharmacists for “stepping up to the plate” during the coronavirus pandemic and said they should play a bigger role in primary and pre-primary care.
“You are far more than just experts at dispensing, although you are the best in the business at that. You are far more than the ability to sell all sorts of goods and products that people need,” he said. “You are our eyes and ears on the ground and you understand the patients you serve.”
He said he wanted to restore the expansion of clinical services into community pharmacy under the roll out of the community pharmacy contractual framework, temporarily paused as a result of the pandemic. “I am keen to see people with minor illnesses referred to community pharmacy to take pressure off GPs and, crucially, deliver a better service. The opportunities are huge – 20 million GP appointments could be referred to community pharmacists every year.
“But if we are going to ask pharmacies to do more it has to be paid for. As we offer pharmacies more and more services we need to make sure that we are paying more for those services,” Hancock said, adding that he is “very much alive” to concerns within the sector in England that £370 million of advance payments to pharmacies for additional COVID-19 costs may need to be repaid.
However, he was unable to make a commitment about how this money will be treated.
Hancock also emphasised that pharmacies will play “a critical role” in what he called “the biggest flu vaccination programme in history” later this year.
“We’re going to need to use all the resources at our disposal,” he said. “I hope you will come with me on this common mission: to ensure that our pharmacies play the fullest role they possibly can as the frontline in the community of our NHS.”
Pride and positivity
The work pharmacy manager Shaheen Bhatia and her team at P&S Chemist in Ilford, London, have done during the pandemic demonstrates this. While most services that involve close contact were stopped during lockdown, her pharmacy continued its Buvidal programme begun in 2019 – the first NHS UK pilot for the administration of the Buprenorphine depot injection for opioid substitution treatment.
“There was no way we could halt the service,” she said. “In my borough, it was only my locum and I who could provide the injections.
“We had to come up with instant standard operating procedures on how to give the injection and come up with ways to protect ourselves as well as the client by giving out masks and putting on full PPE.”
This process has enabled her pharmacy to be well prepared for the flu vaccination programme for winter, and she is advising NHS Grampian in Scotland on starting its own pilot.
“Depot injections were never issued by pharmacists in the past,” she says. “NHS Grampian was using Buvidal injections but only within the drug and alcohol clinic, they weren’t passing the process out to pharmacies. They have looked at our model in the London Borough of Redbridge and are trying to roll it out.”
The pharmacy has also offered blood tests to people referred from their GP, saving the lives of at least three people who had extremely high blood pressure and needed instant referral. “At the time I thought it was a little unfair that pharmacies hadn’t been told about [these referrals],” she says. But it’s a service that needs to be picked up. So we decided to do a private blood pressure check service, again making protocols that safeguard both the patient and the pharmacist.”
“Perhaps this is a service that could continue, but we need structured pathways and integration with the GP contract for these kinds of services,” she added.
“We also need to look at the fact that because we have increased our [medicine] deliveries by about 80% we have reduced contact time with the pharmacist. We need to make up for that loss of contact time and intervention.”
She told NPA members: “I think I have learned more in this short period than maybe I’ve done in the past 10 years. I’m looking ahead at our profession with a lot of pride and positivity.”
Seek the limelight
Community pharmacists should “run towards the limelight and seek opportunities to engage”, rather than feel as if they don’t get invited to “the top table”, Jason Leitch, the Scottish Government’s national clinical director, told members.
“I have been an oral surgeon for many years but I still get accused of being ‘just a dentist’ when I’m at a podium with the First Minister giving health advice to the community,” he said. “The way to get engaged is to say:‘We can help you with that, we will do that, we have answers to that, we have prototypes for that’.”
He also highlighted the Near Me video-conferencing programme, started by community pharmacist Clare Morrison in the Highlands that has now been rolled out to outpatient departments and GP clinics across Scotland.
“This was piloted and prototyped inside pharmacies,” he said. “And [the way it is used by patients] illustrates the difference between embedding healthcare in people’s lives and making people travel to us, making healthcare some kind of special event.”
Leitch said the NHS in the four countries of the UK had “stepped up and responded remarkably well” to the “greatest public health crisis in history”, transforming the way they do business, but he told pharmacists: “COVID-19 isn’t going away any time soon. It’s probably coming back in the winter with an overlaid flu season. I fear that your work is not done.”