Community Pharmacy Liverpool was named Best Supporting Local Representative Group at the Independent Pharmacy Awards for its pioneering work across the city. Saša Janković reports…

With few areas of Liverpool that are not socially deprived, Community Pharmacy Liverpool represents 122 community pharmacies across the city that face daily challenges.

During 2022 the LPC work tirelessly to expand services offered through local pharmacies to help increase public access to healthcare that had been hampered by the Covid pandemic – not least through a successful roll-out of the Community Pharmacy Consultation Service (CPCS).

“We were given some funding from NHS England’s regional team to engage and project manage the roll-out of CPCS in general practice,” explains Matt Harvey, chief officer for Community Pharmacy Liverpool, “so our engagement officer David Barker was seconded to that as ‘LPC project lead GP CPCS implementation’, and worked on drumming up interest beforehand and then training practices.

“Luckily the CCG primary care team was very supportive, introducing him to practice managers, clinical directors of PCNs and also the managers of the PCNs, who encouraged practice managers and teams to get on board with the referring.”

As a result, the LPC helped recruit 79 out of 84 GP practices in the city to refer patients for pharmacy consultations through CPCS, with over 6,500 patients referred in 2021-22.

To support GP referrals the LPC also launched a ‘Pharmacy First’ service through the city’s pharmacies in May 2021, allowing pharmacists to provide medicines for a range of medical conditions that would otherwise need to be treated by a doctor. Numbers grew steadily from a standing start in April 2021 and reached over 600 provisions a month by mid-2022.

“Based on David’s hard work our latest CPCS report from October 2022 showed we only had five unengaged practices with CPCS,” says Harvey, “so our work going forward is focused on getting those signed up to increase their referrals.” As of December 2022 only 4 out of 84 practices were not engaged with Pharmacy First.

And there are other tasks for the year ahead. “Something else we found recently was some practices had started dropping off CPCS because of staff churn, which is interesting as we hadn’t foreseen this,” adds Harvey, “so David is now focusing on what support they need for retraining new staff, what the barriers are and how to overcome them.”

Barker says the PGD service, Pharmacy First, which was commissioned by Liverpool CCG, has been “well accepted and made a significant difference” for patients.

“As we rolled out the service the challenge was connecting with GP practices under lockdown conditions and closed doors,” he says, “especially since back in 2020/21 we had no established relationships with practice stakeholders.

“We worked in collaboration with the CCG comms team, gaining their support in rolling this service out to the practices across the city. GP practices slowly came on board but they wanted assurance that their patients would be managed successfully by community pharmacies.”

Future of Pharmacy First

With new stakeholders emerging as CPCS became an Investment and Impact Fund (IIF) target as part of the NHS England DES, the LPC developed key relationships with PCN non-clinical managers to support them in reaching the targets set by NHSE, with Barker describing this as “a game changer, particularly with slow moving practices in the PCNs”.

The key to the success of this project, according to Barker, has been delivering training and providing appropriate resources for reception staff in general practice. “Every practice has its own way of doing things, so it was about a tailored approach, giving confidence to admin and reception staff on how to create a referral in EMIS, and what language to use to persuade patients to accept the offer of a consultation in a pharmacy setting for their minor ailment,” he says.

“I also ran Q&A sessions on how to manage ‘reluctant patients’ and developed a simple referral guide to help the practice identify suitable patients, and this has made a huge difference in the quality of referrals to CP.

“Building trust and rapport with the practices has been a big step in helping troubleshoot problems, for example, where patients have been incorrectly referred to a community pharmacy and need to be signposted back to the GP as they did not fulfil the correct criteria, such as a UTI in a patient over the age of 65 years.”

Hopes for the future

In 2022 over 10,000 patients were referred to community pharmacy in Liverpool, with Barker suggesting official figures by year end could be in excess of 15,000 with winter pressures.

Indeed, Harvey calls Pharmacy First and CPCS “a brilliant double whammy” and believes Liverpool’s learnings from the service could feed into a national roll out. “For example, at the moment the PGDs used have different specifications across Cheshire & Merseyside so work is being done to harmonise them across all areas, which will make things a lot easier,” he says.

Building on these successes, a local enhanced contraception service (tier two) is about to launch in Liverpool commissioned by the local sexual health service, which will run until the national service planned as part of the CPCF takes over in October 2023.

Harvey says: “I also hope we manage to expand Pharmacy First not just by conditions but in other areas. A harmonised service would be very useful across Cheshire & Merseyside, but it is a balancing act between pushing for more and not over stretching already stretched pharmacies.”

As for his national wish list, he says: “A national Pharmacy First service would be great but it must be commissioned in a way that takes into account the local services that are out there – and, of course, it needs to be funded outside the current global contract as we can’t do this in our existing funding envelope.”

Whichever way that goes, commissioners would do well to look to Liverpool for great examples of a service that works well.