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‘Whatever happened to the promise of more clinical services?’


By Isabel Shaw

27 May 2021

Pharmacist, Ashley Cohen, looks back at the five-year pharmacy contract and how far along clinical services have really come.

Almost two years ago, a five-year deal for community pharmacies was agreed between DHSC, NHSE&I and PSNC. The deal, agreed in July 2019, secured pharmacy funding and set out a clear vision for the expansion of clinical service delivery over the next five years, in line with the NHS long term plan. A flat funding of £2.52bn/year was proposed for the duration of the five-year period.

This financial settlement came after two previous years of significant cuts to the pharmacy sector, and although there was no financial uplift over the following five years, it at least provided some stability in terms of knowing the medium terms financial settlement rather than the historical annual contractual review. However, the settlement came against a backdrop of rising minimum wage, increased pension contributions, increased rent, and rates, along with other IT and premises upgrades, and it was going to be difficult to ‘sell’ this to those working in the sector.

The promise of moving away from volume-based prescription work to more clinical service delivery was certainly something that the sector has been crying out for, so two years on from the new contract and still in the depth of a global pandemic I thought it would be useful to review the contract and how it has been received at the coal face.

Community Pharmacist Consultation Service (CPCS)

The NHS Community Pharmacist Consultation Service was launched on 29 October 2019 as an Advanced Service.

Since 1 November 2020, general practices have been able to refer patients for a minor illness consultation via CPCS. This new service which was launched during the pandemic was a massive opportunity to shift minor illness from GP services to community pharmacy.

While GP practices were struggling to find capacity to see patients face to face, due to vaccination priorities and dealing with more complex caseloads, this new service should have fundamentally changed the way we are working, diverting consultations from general practice to community pharmacy teams. However, 18 months since the start of this service and six months since GP CPCS was launched, the volume coming through is barely registering.

To date across three of our pharmacies, we have yet to have a single referral via the GP CPCS, and only a dozen other CPCS referrals over the past six months. Its hardly the seismic shift in clinical services we were promised.

We are told that general practice has capacity issues and cannot manage the demand for its services, how come some of the workload is not being diverted to the pharmacy sector? Is it for fear that if general practice loses this work, then their funding will also be top sliced and shifted to accommodate this shift in provision?

MURs

MURs were phased out over the first two years of the five-year deal, to free up capacity and funding for the CPCS, and in recognition that NHSE&I did not consider them to offer good value for money. The service was finally decommissioned on 31 March 2021. This hardly was the right time to end a service just at the promise of a paradigm shift towards more clinical services.

So, pharmacy teams have had to stop a service that was paying circa £11,200/annum and replace it with a new service that, at current uptake, is paying about a tenth of that income.

NHSE&I have now commissioned Structured Medication Reviews (SMRs) back with general practice.

Why was our network of community pharmacies not better utilised to support these services?

New Medicines Service

Having the time to talk to patients on new medicines is extremely important and the NMS is often under utilised in practice. A formal framework exists that will remunerate pharmacies for engaging with patients taking certain category of medicines. Reassuring patients of side affects and compliance issues within the first few weeks of taking a new medicine provides better long-term adherence to medication and improved health outcomes. The service also confirms to patients that pharmacists are best qualified to talk about medication issues.

Pharmacy teams – look at your PMR and find ways of flagging up new medication, as the potential for improved clinical service and increased revenue can be substantial and rewarding.

From my experience, patients are pleased that a healthcare professional calls them to check how they are getting on with a new medicine.

Discharge Medicines Service

The Discharge Medicines Service (DMS) became a new Essential service within the Community Pharmacy Contractual Framework (CPCF) on 15 February 2021.

From 15 February 2021, NHS Trusts were able to refer patients who would benefit from extra guidance around new prescribed medicines for provision of the DMS at their community pharmacy. The service has been identified by NHS England and NHS Improvement’s (NHSE&I) Medicines Safety Improvement Programme to be a significant contributor to the safety of patients at transitions of care, by reducing readmissions to hospital.

Some three months on from launch, the uptake is patchy at best, and the number of referrals again are in single figures for our small group.

Although pharmacies had to be compliant in the service from February, hospital trusts are only rolling this service out slowing over the coming months. A huge amount of time was invested in staff training; SOPs; understanding the service, yet many pharmacies have yet to receive a referral.

Why the hesitation?

It’s great to be told about the shift from volume-based prescription workload to clinical services, but words need to be followed by actions.

Launching a few new NHS services that drip feed the occasional referral is hardly a paradigm shift. These need to be part of our day-to-day routine, not the odd one popping through every second month.

The new services I have described above barely register 0.75% of our monthly income – so it is hardly surprising contractors still feel the need to chase after prescriptions.

I am aware of pharmacies looking for ways of generating additional income to help support them through these difficult financial times. Setting up travel vaccination clinics, and private PGDs for certain services are a welcome addition, but these are all outside the NHS income stream. If our paymasters think we can undertake more clinical services: why the hesitation?

We have a network of clinically competent professionals ready willing and able!


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