Turning a vision into a reality.

The Royal Pharmaceutical Society has recently published “A vision for pharmacy professional practice in England”. The report sets out the 10 year vision for pharmacy transformation but does it go far enough to make the bold step change we need to make this vision a reality? Louise Laban, Sales and Marketing Director at Centred Solutions explains more.

Describing a vision for future of pharmacy is challenging, but the RPS document published in partnership with the Kings Fund is a promising start. “A vision for pharmacy professional practice in England” quite rightly states that, if supported to succeed, “pharmacy teams over the next ten years can transform the way that they provide care to every community in England”.

The vision outlines how patients and the public could experience pharmacy professional practice in the future using three person-centred themes to bring this to life:

• Integration of pharmacy teams across health and care systems, enabling them to support people to improve health and stay well.
• Delivery of person-centred care and shared decision making that enable all people to live well with the medicines they take.
• Pharmacy teams that enhance patient experience and access to care.

The vision explains that transforming pharmacy professional practice cannot be done by pharmacy teams in isolation. It requires support, collaboration and co-ordination across the whole healthcare system and other organisations and workstreams both within and outside the NHS. With this in mind the vision highlights three enabling themes to help pharmacy achieve the person-centred themes it has set out:

• Allowing pharmacy people to work at the top of their ability to deliver increasingly integrated care to patients and the public and provide expertise to the wider healthcare system.
• Data, innovation, science and research which can be used by pharmacy teams to personalise care and medicines use.
• Pharmacy professional practice across the healthcare system transformed by leadership, collaboration and integration.

The document rightly points out that the newly created Integrated Care Systems offer the opportunity to integrate pharmacy teams into the wider healthcare systems “in a way and at a scale previously not achieved, resulting in improved access to care for patients”. Nobody can argue with the vision. It is no secret that pharmacy is massively under-utilised for providing patient care and clinical support. The Covid-19 pandemic succeeded in highlighting just how valuable pharmacy can be, with the sector keeping their doors open and providing crucial care and support when it was needed most. But this has been a double-edged sword. Expectations of pharmacy are far greater now than ever before and pharmacy are increasingly being asked to deliver more and more for less. This increased demand for services, coupled with years of flat-funding and high inflation, has left many pharmacies at breaking point. So the question is are the “enabling themes” highlighted in the RPS vision enough to support pharmacy to deliver more person-centred care both now and in the future?

Pharmacy People Working at the Top of Their Ability

The RPS vision says the aim for the future is to have a pharmacy workforce that is motivated and has the capability to advance the delivery of care to patients regardless of setting. Short term goals to achieving this include the development of a comprehensive workforce strategy to provide the right number of people with the right knowledge and skills across the pharmacy workforce. It says pharmacy team workforce planning needs to be part of integrated care board people plan. Yet there is no detail on how this will be brought to life. For those working in community pharmacy a more detailed plan is needed urgently to address the workforce challenges currently being faced. We have seen pharmacies temporarily closing their doors as they don’t have enough staff with others saying they are paying hugely inflated costs for a locum pharmacist simply to keep their doors open. It’s impossible to see how community pharmacies can be asked to deliver more without a detailed workforce plan to address these shortages.

Other short term goals include protected and structured time for learning and research. However if we look at community pharmacy alone I struggle to see how this can be achieved without a real plan around how we free up the pharmacy professionals from back office and administrative tasks. It is absolutely right that the pharmacy workforce has the opportunity to develop their learning – it not only benefits themselves and their organisation, it benefits the patients too. But where is the capacity in community pharmacy to do this currently and how do we find it in the future?

Longer term goals including supporting health and wellbeing, workforce planning and a structured post-registration career roadmap for pharmacist and pharmacy technicians.

Data, Innovation, Science and Research

It’s great to see data and information highlighted as a way of personalising care including medicines usage, driving service improvements and meeting population health needs. Equally the report recognises the need for innovation, science and technology. However for me the focus on innovation also needs to be on how we can support pharmacies to have more capacity to deliver patient facing services as well as innovation for the patient-facing services themselves.

Short term goals talk about having a pharmacy workforce with digital skills to take advantage of the digital revolution that will provide opportunities for targeted patient interventions, a large scale roll out of pharmacogenomic testing and personalised prescribing and a quality improvement and clinical audit culture. Longer term it talks about population based decisions informed by data, single patient electronic records across healthcare settings and using technology to prevent ill health and optimise medicine use.

Nowhere in the report does it mention how technology can be used to free up capacity to deliver these new innovations and services and to make the shift they really need to make from dispensers of medicines to frontline healthcare professionals. Without technology, pharmacy teams time will continue to be taken up by back office and logistical tasks. Technology already exists to automate these tasks and to free up the capacity that community pharmacy teams so badly need right now.

It's a model we know that works. We have customers who have used our FLOWRx Hub and Spoke technology to move to a centralised pharmacy dispensing process. The results have been more time in store to deliver NHS and private services so that these pharmacies aren’t just keeping their head above water – they are growing and thriving.

Leadership, collaboration and integration

The vision for the future sets out an aim where collaboration enables pharmacy teams to integrate in local systems in local teams and across systems. Short term it talks about ICS strategies for planning and commissioning of pharmacy services and shared pharmacy team roles working across ICS. Yet we know that one of the reasons for a shortage of pharmacists in community pharmacy has been the incentive for many pharmacists to move into primary care settings. It is absolutely right that all pharmacists need to be an integral part of health and care teams working from a range of settings but the workforce challenges currently facing community pharmacy needs to be addressed first. Without this we face the closure of many more community pharmacies from our high street.

Final thought

The implementation goals outlined in this vision highlight what needs to be done to allow pharmacy teams to acquire the capacity, knowledge and skills to enable them to deliver personalised care in a more integrated healthcare system. This is a great start however they don’t go far enough and there are some areas which simply have not been addressed in the document.

The report states that “community pharmacy will continue to become increasingly important at neighbourhood level, supported by direct commissioning of local services to meet local need which can be used to unlock the full potential of community pharmacies as anchor organisations in their local communities.”

What the vision doesn’t do is outline how capacity will be created in our over-burdened, over-stretched and under-funded community pharmacies to deliver increased patient facing and clinical services.

The amount of time currently spent by pharmacy on dispensing is considerable and is arguably an inefficient use of the pharmacy team’s valuable clinical skills. Such reform will only be possible if the right resource and support is made available to change this.

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.

The importance of automation for pharmacies has never been greater. Using technology allows pharmacists to optimise staff efficiency and mitigate workforce shortages. There is technology that is scalable and available right now that would free up vital staff time from back office, manual tasks so time can be better spent on patient care and helping achieve the vision set out by the RPS.