In demand and On Demand: putting community pharmacy at the heart of a 21st Century NHS

The latest blueprint for the NHS in England vows to put community pharmacy at the heart of a new model of joined up care. The NHS Long Term Plan, published this January, 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. However, with opportunity comes challenge. Somehow, a profession that has for so long operated at the edges of primary care must be properly integrated 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.  

The 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 provide an accessible alternative to A&E for patients that don’t need hospital. In addition, retail pharmacy will become a ‘wellness destination’ where consumers can go for health checks for a range of high-risk conditions or education on the correct use of medicines. In time, as the NHS chases down a five-year target to give every patient the right to ‘digital’ GP consultations, pharmacists could themselves feature in the online interaction, providing virtual services as trusted professionals at the centre of connected care pathways. Healthcare in England is poised to move into the 21^st Century, with community pharmacy finally being given some much-deserved skin in the game.

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. But 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 have to 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.

The three Rs: rationale, roadblocks and roadmaps

The concept that pharmacy can play a greater role in primary care is built on irrefutable logic. As patients struggle to secure GP appointments and hospitals buckle beneath the weight of A&E demand, pharmacists remain the health service’s most accessible HCPs. In the Netflix era where consumers are accustomed to accessing services wherever and whenever they want them, community pharmacy are the closest thing we’ve got to Healthcare On Demand. They’re there when we need them. Yet despite being skilled, accessible and firmly embedded at the heart of local communities, their value is too often minimised, with their services disconnected from their partners in primary care. 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. 

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 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’. 

The plan also signals a political will to establish a culture of collaboration. Historically, GPs have appeared reluctant to build close relationships with community pharmacists, despite them serving the same patient populations. This approach has led to poor – and in many cases non-existent – data-sharing between GPs 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 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 mindset shift where collaboration becomes the default expectation. 

The 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 both general practice and acute care. Moreover, in the fullness of time, these platforms can be enhanced with new functionality that fuels On Demand models of virtual consultation.

NHS Near Me

This 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 and provide a better patient experience. 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 that 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 help the NHS deliver integrated care that’s fit for the 21^st Century. The capability and the technology is out there. It’s time to join up the dots.