As a profession, we need to invest in transformation at a local level

Mukesh Lad, chairman of the LIPCO federated group, wonders where pharmacy fits into the Five Year Forward View

With the announcement of his Five Year Forward View earlier this year, NHS England’s chief executive Simon Stevens made a commitment to start joining up a number of NHS services, creating easier access to urgent help seven days a week. He also recognised this means a radical redesign of urgent and emergency healthcare services.

Inevitably, new strategy leads to innovative vocabulary such as ‘vanguards’, ‘primary care homes’ and ‘new models of care’. It’s something we’ve all come to expect from the NHS.

But where, amidst all the jargon, does community pharmacy fit in? At first glance and with barely a handful of pharmacy mentions in the strategy document (four ‘pharmacists’ in 39 pages), I initially felt somewhat indifferent to what I was reading.

However, the key point of the plan is to enable healthcare provision aligned to community need. So maybe there is a common denominator after all – the use of the word ‘community’ is what peeked my interest. Community pharmacy for community need? Surely it’s not that unreasonable … or is it?

An opportunity for pharmacy

Our profession already provides easily accessible care and services in the community. Therefore the NHS Five Year Forward View is surely an opportunity for pharmacy to put itself at the heart of the new models of care that Simon Stevens believe will unlock NHS change.

We should be grasping this opportunity to create a role for ourselves as part of the multispecialty community providers of the future. Much emphasis is constantly being placed on reducing unplanned hospital admissions. Supporting patients to achieve greater self-management of long-term conditions is another priority.

With high levels of medication adherence-related hospital admissions and their ideal positioning in the heart of every community, pharmacies have an incredible amount to offer Simon Stevens. Add to this our patient education skills and existing minor ailments services being successfully delivered and one would think that the NHS could no longer afford to overlook us.

With NHS investment of £200m into its Transformation Fund, more than 250 expressions of interest were submitted for 29 Vanguard Project opportunities. The aim is to move specialist care out of hospitals and into the community with the involvement of multispecialty teams to offer better, seamless care and rehabilitation services for more than 9 million people. Another aspect of the plan is to ensure no one is working isolated from expert advice 24 hours a day.

A lack of involvement

However, only six of the 29 vanguards have active pharmacy involvement. This underlines a disappointing lack of involvement and investment around our professions at a time of desperate need to change the way the nations’ healthcare is managed without bankrupting the NHS.

Despite the promise to invest more in primary care over the next five years and to build a better understanding of the role of pharmacy, waiting for central government to unleash our potential isn’t an option. The Forward View itself states: “We will build the public’s understanding that pharmacies and online resources can help them deal with coughs, colds and other minor ailments without the need for a GP appointment or A&E visit”. Is that really all we’re capable of with our five-plus years of study and training, Mr Stevens? As a profession, we need to invest in transformation at a local level. We have many strengths, albeit not yet recognised, not least of which is the fact we already have an infrastructure of established walk-in healthcare centres in the heart of the community. Our accessibility is second to none and we can often provide additional capacity and consultation areas for the benefit of other healthcare professionals.

So once again I find myself calling on my fellow professionals to work together now. Many independent pharmacists still don’t appreciate what an asset our profession can be if we organise ourselves effectively and efficiently to optimise our capabilities and avoid duplication with other healthcare colleagues.

The Primary Care Home

In the meantime, GPs are developing a new primary care provider model for a registered list size of up to 50,000 patients. The National Association of Primary Care is working with NHS England to create the ‘Primary Care Home’ under the Five Year Forward View. One of its aims is to bring together multidisciplinary services on one site, allowing patients to have more from less with generalists and specialists working together with access to diagnostics. This should enable community service integration with needs and priorities determined locally.

Community pharmacy must ensure it’s not left out of this equation either. Primary Care Homes will require pharmaceutical supplies as well as cost effective local healthcare services, many of which we can provide.

There has never been a more important time for independent pharmacies to federate into local provider organisations in order to exert influence for the benefit of its future. We urgently need to develop innovative local models of care that can be scaled up by working with partner federations. As a profession we have more than enough representative bodies and associations, but they’re simply not getting a clear enough message across to policy makers or commissioners. Reliance on national representation will put us at a disadvantage. We now need our own five year forward plan that will see us aligned with the rest of the primary care economy in a single, joined-up system for the benefit not only of greater patient outcomes but for our own existence.