Suggested Learning

A state secret?

The one thing that’s conspicuous by its absence is a coherent community pharmacy strategy

Withering discovers that NHS England has a head of pharmacy strategy and is left wondering what purpose it serves

I wonder how many of us knew that NHS England has a head of community pharmacy strategy. Her name is Anne Joshua; however, in her biography I can’t find any mention of experience of working in or with community pharmacy, or even primary care. Previously, she worked for 10 years as the associate director of pharmacy leading the Health and Medicines Information Service at NHS Direct, before becoming the NHS England pharmacist lead for the NHS 111 Digital Urgent Care programme.

I wouldn’t hold any of that against her, and I have no reason to believe that she did anything other than a first-class job in these roles, but ... a head of strategy with no experience of the sector for which she’s supposed to create the strategy? Seriously?

Not privy

Of course, jobbing pharmacists generally don’t get to hear about the people behind the scenes at NHS England, or the Department of Health; we aren’t privy to the conversations they have with our representatives from PSNC or Pharmacy Voice – all we get are the soundbites afterwards. But the one thing that’s conspicuous by its absence from NHS England or the DH is a coherent community pharmacy strategy. Or – if they have got one – they are keeping it so close to their chests that it might as well be a state secret.

And yet ... over the summer we’ve seen the publication of two strategy documents for community pharmacy. The first is the grandly titled, ‘Supporting the Development of Community Pharmacy Practice within Primary Care’ from the New NHS Alliance. It says that action is needed on four fronts: tackling the root causes of ill health; patient self-care; meeting the changing needs of an aging population; and delivering new models of care. Blimey!

It could have been written for us, but it wasn’t – it’s all taken from the NHS Five Year Forward View. They are “disappointed that ... the NHS has failed to fully utilise the expertise of the community pharmacist within their locations in the heart of many communities”. Disappointed? How do you think we feel?

It goes on to say: “We must recognise community pharmacy ... as an integral member of the primary care team. We must also recognise the pharmacy’s unique position within the community and their ability to reduce demand within general practice as part of the solution to the crisis within general practice.”

They make eight specific recommendations, including “commissioning a community- pharmacy-led new model of care looking to fully utilise the pharmacist’s expertise within the heart of communities”. If this had been written by one of our pharmacy organisations I would have thought: “Bravo, chaps. Good effort.” But to see these words coming from the New NHS Alliance is enough to set my personal ‘clapometer’ to maximum.

The second document is, ‘Community Pharmacy Forward View’ from Pharmacy Voice, PSNC and the English Pharmacy Board. We might expect a whole lot of partisan huffing and puffing, but what we find are restrained, practical, and evidence- based suggestions on how pharmacy can – and should – evolve to meet health needs. Community pharmacy becomes the “facilitator of personalised care for people with long-term conditions”, the “trusted, convenient first port of call for episodic healthcare advice and treatment”, and “the neighbourhood health and wellbeing hub”. Bravo, chaps! Good effort!

No: I really mean it. On first reading, the degree of consensus between these documents seems remarkable. If it were an exam, an accusation of cheating, or plagiarism, might follow. But actually it’s not remarkable at all. If you take the NHS Five Year Forward View as your starting point, and think logically about how community pharmacy could evolve to meet those needs, then, what would really be remarkable would be to come up with something that didn’t look like either of these documents.

What’s the thinking?

Which brings me back to Ms Joshua. It may be presumptuous of me to think that she is leading the development of a strategic vision for community pharmacy and has a key role informing and advising ministers on these issues. I can’t know for certain, because (obviously) it’s a state secret. What I would like to know is her opinion of these two documents. How far are they away from her thinking? How far away are they from the thinking of the new pharmacy minister David Mowat?

Mr Mowat recently went to a pharmacy for his flu jab. It makes a good ‘photo opportunity’, I suppose. But like too much of politics today it has no substance behind it. But, with the announcement of our new funding package a month off as I write, it would be helpful to have some indication of whether we should look to the future with optimism or with apprehension.

An acceptance of the principles behind these two strategies could be the prelude to a partnership to take them forward – a prelude to optimism and confidence. Sadly, I’m not hopeful because I don’t think this government really has got a strategy for us, unless Ms Joshua is able to tell us otherwise.

Withering is the pen name of a practising independent community pharmacist. Withering’s views are not necessarily those of ICP.

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