Invest in Pharmacy to Transform Primary Care

Centred Solutions Head of Marketing, Shelley Dyer, takes a closer look at the Fuller Stocktake Report and what it might mean for community pharmacy.

A report into the future of primary care services in England has stressed that pharmacy needs to play an integral role in the newly established Integrated Care Systems (ICS).

Led by experienced GP Claire Fuller, the stocktake report, commissioned by NHS England, says that left as it is the primary care system will become unsustainable in a relatively short period of time. It states the current system is not for purpose, is fragmented and is causing frustration for both staff and patients.

The document calls for previously siloed teams to be brought together and for professionals to look at doing things differently so they can improve care for whole populations. It says ICS provides the opportunity for a radical overhaul of the way that health and care services are designed and delivered, and that primary care should be at the heart of these systems and be built as locally as possible to respond to the specific needs of that community.

Pharmacy is singled out for the role it could play in this future model of service delivery.

“It came across clearly that the wider primary care team could be more effectively harnessed, specifically the potential to increase the role of community pharmacy….For example, on cancer diagnosis community pharmacy could play a more active role in signposting people to screening to support early diagnosis building on a successful pilot form the Accelerate, Co-ordinate, Evaluate programme.”

Improving access, experience and outcomes for communities should be centred around three essential offers it says. And when you look at each of these closely it’s easy to see the value involving community pharmacy would bring – yet it remains vague when it comes to the detail of how this might work. If the NHS trust puts its trust in community pharmacy and provides the right support and resources it could be transformative.

The three essential offers

Streamlining access to care and advice for those who get ill but use health services infrequently, providing them with more choice around how they access care and ensuring that care is available in their community when they need it. Introducing a “pharmacy first” model would be an obvious choice and it is one that is already working well across the border in Scotland.

Providing more proactive personalised care with support from a multi-disciplinary team of professionals to those with more complex needs. Pharmacy could play a key role here as they are easily accessible and best placed to support with medicines optimisation schemes or a role out of additional therapy areas under the new medicines review service. Another great example is the latest announcement that community pharmacy teams will proactively identify patients with potential cancer symptoms and refer them for further checks as part of a new pilot.

Helping people stay well longer with a joined-up approach to prevention. Pharmacy have already started to move to this model and are well placed to grow this area further. Take for example hypertension checks. High blood pressure accounts for 12% of all GP appointments in England (PHE, New opportunities to tackle high blood pressure). A simple high blood pressure check in community pharmacy doesn’t just highlight undiagnosed cases, it can prevent potentially fatal outcomes.

The golden thread running through the report is that system change alone is not enough. Such reform will only be possible if the right resource and support is made available. It explicitly says that some of the recommended changes cited in the report requires the overall growth of primary care capacity. As well as highlighting a shortfall of current GPs it also acknowledges the recruitment challenges faced by community pharmacy, yet it appears to suggest no solution to this.

And it’s not just resource in terms of manpower, if such an approach is to be realised then time and funding models will also be key. The amount of time currently spent by pharmacy on dispensing is considerable and is arguably an inefficient use of pharmacist’s valuable clinical skills. I know of pharmacy group owners who were seeing 90% of their pharmacists’ time being spent simply on dispensing. If all that time and energy is spent on dispensing then where does the time come from to deliver additional services and collaborate with other healthcare providers?

Technology could be one solution. Technology isn’t about replacing people, it is about freeing up valuable staff time from administrative and back office tasks so that it can be redirected into patient care and clinical services. But technology of course comes with a cost, so the right funding models and support needs to be in place to enable pharmacy to go down this route.

It is refreshing to see the report acknowledge technology as a key area for driving these reforms across primary care. It says digital technology can help transform the way services are delivered but often the underlying infrastructure to enable transformation is lacking. As such, it calls for a more coherent approach to digital transformation in primary care and also says NHS England should consider combining and simplifying central and transformation budgets for primary care.

Will it work?

Primary care is busier than it’s ever been yet public satisfaction rates are at an all time low. Pharmacy can play a key role in transforming the way care is delivered in communities across England and it’s great to see that acknowledged. However, without action to fill the existing capacity gaps there is a real risk that this reform will be unsuccessful.

Reforming the way the NHS works isn’t new. I was working at a Primary Care Trust when it was announced they were to be replaced with Clinical Commissioning Groups and I was also working at NHS England at its inception in 2013. Now as we move forward to a model of Integrated Care Systems it can only be hoped that, from experience, we learn reform alone isn’t enough. The UK spends significantly less per capita on healthcare and its administration than most countries in western Europe and it has done for decades. For these changes to have real impact what is needed is a system wide change and significant investment across all aspects of the health and care service. Without this those on the frontline, including community pharmacy, will continue to be overstretched and underfunded and won’t be able to make the transformational changes required to turn this vision into a reality.

It’s my hope that NHS England and other policy making organisations acknowledge the recommendations in the report and put in place the right resources, support and enablement tools to create thriving primary care systems that draw on the insights of those who live and work there, with pharmacists at the very heart of this change and well placed to deliver it.