Securing a place on STP boards is achievable for local pharmaceutical committees although it is hit and miss across the country. Richard Brown explains…

In April 2013 Primary Care Trusts, which held the responsibility for public health along with primary and secondary care, were replaced by Clinical Commissioning Groups (CCGs) while NHS England (NHSE), alongside local authorities (LAs), become accountable for public health.

This restructure of the system saw LAs suddenly required to spend their budget on health promotion but the beneficiary of this spend was the CCG or NHSE.

This was because for each smoker who quit, they were less likely to develop respiratory diseases in later life and less likely to be admitted to hospital. Ultimately the separation of these organisations led to some poor commissioning decisions across a disparate system because one organisation’s budget was being used to support improved outcomes for another organisation.

This situation was further compounded by the removal of the ring-fence around public health spend, with the simultaneous reduction in LAs’ budgets by central government as part of the austerity drive.

In recognition of this risk, the government, in December 2015, produced the Five Year Forward View (2016-2021) which will provide an £8.4 billion real term increase by 2021 to deliver three key improvements to the health system:

·      Close the health and wellbeing gap.

·      Close the care and quality gap.

·      Close the finance and efficiency gap.

This was the birth of Sustainability and Transformation Partnerships (STPs) and in January 2016, the government announced 44 STP ‘footprints’ across England to ensure:

·      An increased focus on the prevention of ill-health rather than treatment to improve outcomes.

·      The patient is at the centre of their care.

·      Greater efficiency in the system.

·      An improvement in the sharing of best practice across a wider number of people and organisations.

STPs range in population size from approximately 300,000 to over 3 million and bring together all organisations responsible for the delivery of health services.

This collective, therefore, develops the overarching strategic intent for a much wider population and ensures CCGs, LAs along with NHSE, acute trusts, mental health partnerships, community interest groups, ambulance trusts and primary care providers come together to improve patient outcomes. However, the STP itself has no commissioning accountability - that still resides with the local bodies (CCG/LA, etc).

STPs have also been challenged to provide system leadership as the creation of a plan must be integrated into the local health economy that it serves. It would not be acceptable to create a plan without the engagement of the private, public and voluntary systems involved in its delivery.

This local planning process will be supported for the first time by central funds to support local transformational projects.

What does this mean for community pharmacy?

As a positive it means that the strategic plan encompasses all sections of primary and secondary care and, more importantly, looks at where the patients or customers access health.

Obtaining places on various STP boards is now more achievable for local pharmaceutical committees (LPCs), although this is still hit and miss across the whole country.

As always, it’s the strength of the relationship held by the LPC with various commissioners in CCGs and LAs that ensures representation, as these people are often the gateway to getting pharmacy recognised as an integral party to the delivery of the plan.

The downside is there are now far more players in the market place and community pharmacy could be left on the side-lines if it doesn’t adapt to this new way of commissioning and delivery.

The NHS, however, needs to continue to change and evolve. It cannot keep driving people into hospital for treatment and needs to look at alternatives and more cost-effective and efficient ways to care for the population.

Supporting patients in their own home with packages of social care, treating people remotely via homecare organisations and liaising closely with primary care partners all enable hospitals to prioritise the patients requiring more specialist treatment.

The health system also needs to increase the focus on prevention of ill health. Yet LA budget constraints mean this doesn’t always flow into improved accessibility of services through innovative commissioning.

Things need to evolve beyond STPs and we are now seeing the emergence of Integrated Care Systems (ICS). In 14 pilot sites STPs have become ICSs where even greater collaboration will be achieved and the NHS, along with other system leaders, will collectively take responsibility for managing resources and delivering outcomes to the local population.

If successful, it will undoubtedly lead to ICSs commissioning services across their ‘footprint’ and therefore decreasing the need for commissioning at CCG and LA level.

What does the future hold?

Should community pharmacy be wary or embrace STPs and ICSs? The change in the system is allowing commissioners to think outside of the normal historic commissioning of services into GP surgeries.

There is now a real awareness of the value other providers can bring with alternative accessibility and cost bases. Slowly, services are now beginning to be delivered by willing providers - for example, a stop smoking service run at a local community centre.

This changing landscape means community pharmacy must continue to engage with commissioners and most importantly deliver when these services are offered.

To accept a service and fail to achieve targets is less likely to be acceptable but, far more importantly, will reduce the chance of future services being commissioned.

ICSs will have a large range of providers of which community pharmacy is one small, yet important cog. Whether we succeed will be down to the hard work of LPCs along with delivery by the pharmacy.

Avon LPC’s progress

In Avon LPC we have been invited to sit on various groups that feed into the main STP board. This has materialised from having a strong working relationship, developed over many years, with key stakeholders in the CCG.

The LPC is now focused on ensuring that pharmacies are delivering against new projects and are now seen as a key partner in the healthcare system.

This has taken a number of years worth of investment from the committee, with resources ploughed into implementation and project management support.

We are now in a fortunate position that the system is now being realised to the benefit of community pharmacy and it is the hope of the LPC that this will lead to additional CCG commissioning.

Richard Brown is chief officer of Avon local pharmaceutical committee and director of Virtual Outcomes.

(Picture: andrewmedina - iStock)