More should be done to ‘support collaboration’ rather than ‘fostering competition’ between different parts of the primary care system, a new report released this week by The King’s Fund and the Nuffield Trust has said.

‘Frontline’ clinical staff working in primary care such as in community pharmacies and general practice should instead be seen as part of a multi-disciplinary neighbourhood health team.

And workforce strategies set out by integrated care boards (ICBs) should explicitly include community pharmacy alongside the primary care workforce and the wider pharmacy sector workforce, the report recommended.

The report was commissioned by Community Pharmacy England (CPE) to set out a long-term vision for the community pharmacy sector that would form the basis of the negotiator’s discussions with policymakers and commissioners.

In a survey of the sector, the report described how many of its interviewees had said the development of primary care networks, especially the ‘rapid expansion’ of pharmacists working in general practice through the Additional Roles Reimbursement Scheme (ARRS), had  ‘impacted local relationships across primary care and community pharmacy’.

‘Rather than supporting joint working, we heard that these developments had created competition for funding and staff,’ the authors wrote.

The report suggested that each ICB should establish a pharmacy workforce board to consider workforce issues across the community, hospitals and general practice.

And it said that commissioners should ‘take account of primary care services in the round when making commissioning decisions’, with ‘financial incentives to support collaboration rather than to foster competition between elements of the primary care system’.

The report also highlighted a need for ‘multi-professional working’.

‘This includes community pharmacists being able to work collaboratively with colleagues in general practice and other community-based services as part of multidisciplinary neighbourhood teams, and to work closely with pharmacists in other settings, including in hospitals and elsewhere in primary care,’ the report added.

It added that interdisciplinary training from undergraduate studies onwards was suggested as a way of enabling this.

‘Any integration of community pharmacy will also require better joint working across frontline clinical staff, particularly between community pharmacists and GPs,’ the report added.

To help with this, the report highlighted the need for community pharmacists to be able to access clinical records, as well other suggestions from interviewees including:

  • Community pharmacy access to safeguarding systems and ability to refer patients or directly book them into other services
  • Better communication routes and digital tools to support real-time discussion and information sharing between primary care clinicians
  • Targeted local development work to help build trust and relationships
  • Integrated workforce development, including joint training and portfolio or rotational roles
  • Work to resolve disincentives to collaboration such as competition for services, funding and staff.

Consideration should be given to ‘applying the same model for NHS funding of GP premises to community pharmacies, for the space required to deliver clinical services’, the report recommended.

It also mooted the idea of more pharmacies to be co-located with general practice, which some interviewees said ‘could bring benefits in terms of strengthening joint working’.

However, ‘others strongly disagreed with moving towards greater co-location, citing concerns around the loss of community pharmacies from accessible high-street locations’ and ‘high costs associated with leases linked to GP practices’, the report said.

And it emphasised that ‘additional spending in community pharmacy should be seen alongside spending in primary care as a whole’ and did not mean ‘attempting to extract from general practice any spending on services now being provided in community pharmacy’.

‘Primary care in England is experiencing a deep access crisis and for the foreseeable future, there is more than enough patient demand to keep both general practice and community pharmacy busy (indeed, too busy),’ the report added.

At a local level, several interviewees said that different sectors and professionals, including community pharmacists and GPs, should come together to develop and redesign patient pathways in the community.

And the report set out several ways that community pharmacy could deliver clinical services over the next five and 10 years, including cancer referrals and managing long-term conditions like asthma, hypertension, atrial fibrillation and menopause and HRT.

And in addition to offering walk-in services, the report also suggested that community pharmacies could offer some longer consultations on an appointment basis, including remotely.

Helen Buckingham, director of strategy at the Nuffield Trust and one of the report’s authors told the press this week that she thought it ‘unlikely that we'll end up with big pharmacies with big receptions in the way that you have GP practices’, but rather that ‘part of the working in partnership between pharmacies and GP practices might be might be sharing receptions’, or technology could be used to manage booking and check-in systems.

The Department of Health and Social Care and NHS England were contacted for comment.