In demand and on demand: improving primary care with community pharmacy

The NHS Long Term Plan outlines a vision for ‘fully integrated, community-based healthcare’ where pharmacists play a prominent role in multidisciplinary teams aligned with new primary care networks. It’s an ambitious framework that, finally, gives community pharmacists a seat at the top table of NHS care says Steve Bradley, group managing director, at Cegedim UK.

Somehow, a network that has for so long operated with pharmacists at the edge of primary care must now properly integrate them into the wider ecosystem to provide added value for patients. Getting there will require a system-wide shift in culture and connective technologies to fuel collaboration. The former may take time. The latter is readily available, he argues

The NHS Long Term Plan promises to ‘make greater use of community pharmacists’ skills and engagement with patients’, empowering them to support urgent care, promote self-care and reduce prescribing costs. As a result, the expectations on GPs will be significantly reduced and, in turn, practice managers can ensure their practices are running as smoothly as possible. Additionally, as the NHS chases down a five-year target to give every patient the right to ‘digital’ GP consultations, in time, pharmacists could themselves feature in the online interaction, providing virtual services as trusted professionals at the centre of connected care pathways.  Practice managers can be assured that their practices will stay ahead of the game to provide the service that so many patients desire in this new era of technology.

The proposals are as exciting as they are familiar. Across the world, community pharmacy is undergoing a paradigm shift as health systems seek to enhance the profession’s role as primary care interventionists. The NHS has – for many years – talked up the need to maximise pharmacy’s expertise with the introduction of new services to support medicines usage, disease management and public health programmes. There is no question that pharmacists who are trained to prescribe can play a crucial role, providing an extra pair of knowledgeable hands to review patients with long-term conditions – hands that will allow GPs to focus more of their time on diagnosing and treating patients with more complex conditions.

However, the reality has never lived up to the rhetoric. So, as policymakers, once again, attempt to unlock the value of community pharmacy, how can we prevent their good intentions falling short at the crucial point of delivery? It won’t be easy, but we must make it work. Because, as demand for healthcare increases, the NHS can no longer rely on traditional models of care. Community pharmacy is part of the solution. Fortunately, the tools to integrate them are well within grasp.

So, as policymakers, once again, attempt to unlock the value of community pharmacy, how can we prevent their good intentions falling short at the crucial point of delivery?

The three Rs: rationale, roadblocks and roadmaps

The concept that pharmacy can play a greater role in primary care is built on irrefutable logic. The demands on GP practices are considerable, with just under a fifth of patients waiting longer than a fortnight for a routine appointment with a GP or practice nurse. As practices try their hardest to maximise appointments, pharmacists remain the health service’s most accessible healthcare profesionals (HCPs) and a welcome form of support.

In the Netflix era where consumers are accustomed to accessing services wherever and whenever they want, community pharmacies are the closest thing we’ve got to ‘healthcare on demand’; they’re there when we need them.  Plans to integrate them with the wider health ecosystem – as part of multidisciplinary teams – should be welcomed and actively pursued. But we must learn the lessons from the past.

In the Netflix era where consumers are accustomed to accessing services wherever and whenever they want, community pharmacies are the closest thing we’ve got to ‘healthcare on demand’.

Previous attempts to maximise community pharmacy have been thwarted by cultural, technological and financial barriers. Lack of reimbursement is a common obstacle to expanding pharmacy services. For example, although pharmacies are incentivised to conduct medicine use reviews (MURs), the financial rewards are capped, meaning that busy pharmacists often carry out additional work without financial gain. This is, at best, counterproductive. However, there are encouraging signs of change. The Long Term Plan earmarks £4.5 billion of new investment to fund expanded community teams. This includes a ‘shared savings’ scheme for primary care networks so that they can benefit from their efforts to ‘reduce A&E attendances, streamline patient pathways and reduce over-medication through pharmacist review’.

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Culture and collaboration

The plan also signals a political will to establish a culture of collaboration. Historically, there has been a lack of data-sharing between GP practices and retail pharmacy. If community pharmacists are to deliver enhanced patient services that relieve the pressure on general practice, they must have access to GP records to help deliver timely, efficient care. The NHS Long Term Plan underlines the importance of data-sharing as part of digitally-enabled integrated care. Alongside it, the steady increase in digital native GPs will likely stimulate a mind-set shift where collaboration becomes the default expectation. Encouraging this collaboration will help practice managers to ensure their records are accurately kept, paving the way for practices that are well-organised and benefitting both staff and patients.

Technological barriers to integration do not exist. In the age of interoperability and cloud technologies, data from familiar, well-established systems can simply (and securely) be connected to empower HCPs with real-time information at the point of clinical care. These integrated solutions can power pharmacy-led services that help ease the burden on general practices and their managers. Moreover, in the fullness of time, these platforms can be enhanced with new functionality which fuels ‘on demand’ models of virtual consultation – a key factor for the future of primary care.

In the age of interoperability and cloud technologies, data from familiar, well-established systems can simply (and securely) be connected to empower HCPs with real-time information at the point of clinical care.

NHS Near Me
It may sound futuristic, but in other parts of the UK these innovations already exist. In Scotland, progressive health organisations have piloted collaborative models that give pharmacies full access to GP records, allowing them to deliver services that reduce physicians’ workloads, save vital time, provide a better patient experience and improve the running of the practice. In 2017, for example, 19 community pharmacies in Inverclyde signed up to a minor ailment service that allows pharmacists to assess and provide treatment for uncomplicated conditions that normally require a GP prescription. More recently, NHS Highland piloted ‘Pharmacy Anywhere’, a scheme to improve pharmaceutical care in three remote, rural areas. The programme used telehealth to give patients access to pharmacy-led medication reviews without the need for either party to travel. The scheme, which saved the three practices £8,448 a year, is now integrated into NHS Highland’s pharmacy service and has led to the creation of NHS Near Me, which aims to deliver telehealth at scale.

These pilots, and many more, highlight the transformative benefits of collaboration and data sharing. It’s why, as primary care organisations adapt to the Long Term Plan and build the infrastructure to deliver its ambitions, the most progressive will be those who draw inspiration from successful pilots and open themselves up to collaboration. Primary care in England may be some way away from services like NHS Near Me but, with innovative thinking, creative collaboration and simple technology, community pharmacy could maximise the level of care practices already provide and enhance their capacity to deliver care to an ever-expanding patient base.  The capability and the technology is out there. It’s time to join up the dots.

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