Spending on primary care now will ‘reap benefits’ down the line

Multi-year funding – rather than the pressure to deliver a balanced budget year-on-year – could provide a solution to primary care’s funding crisis, pharmacist and president of the National Association of Primary Care (NAPC) Ash Soni has told The Pharmacist.

He said that spending more on primary care would deliver savings for the health system overall.

But he also warned that the pressure on Integrated Care Boards (ICBs) to make savings could lead to a missed opportunity to invest in primary care services, including through community pharmacy.

ICBs, statutory bodies responsible for managing local NHS budgets to meet the health needs of a particular area, took on responsibility for commissioning local community pharmacy services in April this year.

This, alongside recent national funding announced for community pharmacy, should prompt ICBs to consider what the opportunities might be to enhance national services and commission community pharmacy at a local level, Mr Soni said.

But an inherited deficit and pressure to make savings and deliver balanced budgets might prevent ICBs from responding to the opportunity ahead, he warned.

‘A lot of the ICBs are so busy trying to get the numbers into the right place. They really don't have time to think about some of these things,’ Mr Soni said.

While ICBs might see an opportunity to commission primary care services, such as community pharmacy, dentistry and optometry, to avoid patients ending up in more costly settings, like A&E or hospital stays, they might hesitate to do so because ICB funding was already allocated to secondary care, Mr Soni said.

‘You've got no spare capacity,’ he explained, adding that secondary care was also struggling financially with increased demand and an inability to discharge patients because of a crisis in social care.

‘It's a vicious circle at the moment,’ the NACP president told The Pharmacist.

He added: ‘The solution, somehow, in all of this, is thinking about multi-year funding.

‘You have to pay more, often, to get the benefit further down the line.

‘If you think about a commercial business, you might make a loss at the beginning, because you're using the money to invest.

‘Because you know that in two, three years’ time, you'll be making a profit on that, because you've created greater efficiencies.’

He explained that moving away from a single-year funding model to one where NHS bodies would be allowed to potentially show a deficit initially, would enable them to invest in services now in order to reach system-level savings by the end of a several year period.

‘If you want to cut the costs further downstream, then what you have to do is spend more on prevention and detection,’ he said.

‘Of course, if you're doing that, the place that investment has to go is primary care in its broadest sense,’ he added, while noting that community pharmacy has ‘a fundamental role to play’.

He also called for a collaborative, place-based approach across the whole of primary care, suggesting that systems could embrace radical ideas like combined targets across community pharmacy and general practice at a neighbourhood level.

‘That's what we need to have happen. But again, that's quite radical thinking,’ he said.

He gave an example of one ICB which paid general practices for the total number of flu vaccinations given throughout their PCN area, rather than just those delivered by the practice. This incentive encouraged a collaborative approach between general practice and community pharmacy to deliver the vaccinations wherever the patient could most easily access them, rather than competing to deliver the service, Mr Soni said.

Each profession within primary care would have to accept that income from services would be shared between different professions, he noted.

‘But the benefit will be [that] if we can deliver more, the value of that whole basket becomes greater.

‘So, the challenge is about: how do we make sure the basket is big enough that you don't end up with people competing because they worry about what they've lost?’