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Indispensable progress

Public pharmacy partnership is designed to support communities to take more control and influence over their health

North-East London LPC’s High Street Clinic model of pharmacy care has been well received, and signals local movement from transactions towards relationships and care packages

North-East London LPC has had an “amazingly positive” response from pharmacists, LPCs, and commissioners, to its High Street Clinic model of pharmacy care, says its secretary Hemant Patel. The model was outlined to the government and other stakeholders in the LPC’s ‘Indispensable’ document.

In the HSC model, federated groups of pharmacies operate within a public pharmacy partnership (PPP) that links them to voluntary organisations as part
of a holistic strategy to improve patient care. “We are now engaging with the commissioners to develop the work described and already getting traction at workforce development level and when considering Sustainable and Transformation Plans (STPs) in NE London,” says Mr Patel.

High Street Clinics are NE London’s version of the retail clinics that have been successful in the US over the past five years, adapted specifically for local needs.

Five pillars of care

The HSC model is based around five pillars of person-centred care:

  1. Getting the best out of medicines and nutrition by delivering safe, effective, patient-friendly outcomes through pharmacist prescribing.
  2. Getting the best out of life through public health and behaviour change measures. Health champions and pharmacists trained as health coaches in community pharmacies can help individuals improve their health quality and longevity.
  3. Getting the best out of communities by leveraging community assets. PPP is designed to support communities to take more control and influence over their health, and develop community assets through integration and mutual support.
  4. Getting the best out of the workforce using new employee stakeholder models with performance incentives and profit sharing.
  5. Getting the best out of the healthcare system by making every contact count, and delivering the right care at the right time and in the right place. 

HSCs are working with local GPs to redesign local care pathways for patients with long-term conditions, and with hospital trusts to support transfer of care and reablement. Pharmacists work closely with care homes to improve medicines use and visit patients in their homes as part of a multidisciplinary team to draw up care action plans.

They also work with mental health trusts to support the physical health of patients with psychosis. And they encourage healthy lifestyles in the young by working closely with local schools, and visit workplaces to promote mental wellbeing.

HSCs grew out of the SelfCare Pharmacy concept, developed previously by NE London LPC. SelfCare Pharmacy involves managing long-term conditions and co-morbidities in community pharmacy and ensures parity between mental and physical health.

The five strands of SelfCare Pharmacy tie in closely to the five pillars of HSC, and aim to empower patients and improve care efficiency. Its five strands are:

  1. Maintenance of healthy behaviours and prevention of illness
  2. Facilitating early diagnosis of preventable disease
  3. Getting the best out of prescribed medicines
  4. Facilitating independent living
  5. Preparing patients for managing predictable emergencies.

For the next five years, Newham CCG is investing in getting patients with stable long-term conditions and co-morbidities out of GP services and into community pharmacies, using pharmacy care plans with a strong emphasis on self care. Local pharmacists are specially trained to provide the broader HSC range of services, including support for mental health, diabetes, cardiovascular disease, and respiratory diseases such as asthma and COPD.

In Redbridge, a new system of GP referrals triggering biopsychosocial needs assessments by pharmacists is ready to enhance support to patients with stable long-term conditions, improving medicines compliance while identifying low-level mental health problems early before they escalate into more serious conditions.

Key developments

STPs around the country are going to be important local vehicles for commissioning services such as HSC pharmacy in line with population needs and the NHS Five Year Forward View, says Mr Patel. “With the cuts in global sum coming we are preparing for new locally designed income streams.”

Mr Patel suggests that pharmacists should be looking out for, and starting to engage with, the following key developments:

  • Greater emphasis on self care and community engagement
  • Patient-owned care plans
  • Workforce integrated across community and primary care
  • Weighted capitation contracts (including primary care services)
  • Sophisticated use of IT and digital technologies.

The SelfCare Pharmacy practice model has already been commissioned in Newham and Waltham Forest, and in Barking and Dagenham a mental health trust is working with the LPC to enable community pharmacists to provide care for discharged patients. The Integrated Winter Self-Care and Support Scheme will be piloted in three pharmacies and will work in partnership with GPs and community nurses.

“Community pharmacy in NE London is moving from transactions to relationships and care packages,” says Mr Patel.

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