Community pharmacy should be an ‘anchor’ in neighbourhood health

Community pharmacy should be central to planning urgent care within neighbourhood models, delegates heard at a primary care conference yesterday.

Speaking at the Westminster Health Forum on the next steps for general practice and primary care in England, primary care leaders raised concerns about the role of PCNs and the potential impact on general practice of shifting to neighbourhood care.

They said that moving additional roles and PCN funds into neighbourhoods would be ‘destabilising’.

But Hampshire and Isle of Wight ICB, primary and local care director, James Roach, said that neighbourhood working was ‘a real opportunity for local clinical management’ if integrated neighbourhood teams were given the freedom to change the delivery model.

And he said that community pharmacy should be ‘fully involved as a neighbourhood anchor’, particularly in deprived areas where pharmacies are often the first point of access for patients and should be central to planning urgent care within a community model.

Mr Roach added that it was ‘critical’ neighbourhood working was seen as a ‘whole system endeavour’ involving general practices, community pharmacists, advanced nurse practitioners, community matrons and district nurses.

‘They play a key role in supporting people with long term conditions. There's clearly a huge opportunity in that interface between primary, secondary community and social care to ensure that we're wrapping specialist care around the patient, that we're able to ensure a proactive model that supports conditions differently,’ he said.

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Company Chemists’ Association (CCA) chief executive, Malcolm Harrison said Pharmacy First demonstrated the potential for pharmacy playing a larger role in providing urgent care.

He said that the NHS had ‘dipped its toe in the water of pharmacy providing urgent care services, and we think they found that to be a good temperature, and we need, even now, to dive in and get on with expanding and enhancing what it can offer the patients and the system’.

However, he raised concerns that only one in 12 Pharmacy First consultations currently come from GP referrals, despite all practices being able to refer.

‘We need to understand more about why this is. We know that if all ICBs delivered at the rate of the highest performing ICB, then we'd have an additional 1 million GP appointments released,’ he said.

He added that  94% of consultations end in a complete episode of care without onward referrals and, under the current system, this could be expanded from 5 million appointments to about 9 million.

‘If we were to add new conditions and expand the criteria for delivery in the current conditions, there's opportunity of up to 30 million consultations a year being delivered. And just imagine what capacity that could release from the rest of primary care if 30 million people who currently go to GPs were able to go straight to their pharmacy and receive the care they need,’ he said.

Chief executive of Community Pharmacy London, Conor Price, said that the barrier to working collaboratively in primary care is the way commissioning is carried out.

‘We are commissioned competitively, and we are commissioned in a way that pushes us against each other and to work against other.

‘Take vaccinations as an example, where it becomes pretty much a fight of who gets the most jobs done, whereas realistically, if we did that together in a neighbourhood approach, then we'd be looking at improving patient outcomes,’ he said.

Concerns that ARRS staff might be shifted into neighbourhood were also raised at the event as speakers speculated on the forthcoming neighbourhood contracts first announced in the 10 year plan in July last year.

The Health Foundation senior policy fellow, Dr Luisa Pettigrew, said: ‘The big question for me is, what will happen with the new neighbourhood contracts when they come out? Will there be proposals to take some of those roles out because they were coming through PCN funding …then redirected to neighbourhoods?

‘I think if that was to happen, that would really destabilise the progress that general practice has made in becoming more multi professional over the past few years,’ she said.

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She added that significant uncertainty remained about the content and funding of the new contracts.

‘One thing is really important - that funding channelled through PCNs for those roles is not removed or rechannelled elsewhere,’ said Dr Pettigrew.

Executive lead at Herefordshire General Practice, Dr Lauren Parry, warned that pooling budgets or moving discretionary funding from practices could threaten their viability.

‘With the shift from hospital to community… if we're not really careful and really mindful, then actually you can undo a lot of the good work.

‘Additional roles were brought in to address the GP shortfall in terms of the number of people in those posts… if we move them into other work in the neighbourhoods or prevention, we need to make sure that we've got the workforce in general practice. It needs to be considered as the whole and not just moving those roles into a different way of working,’ said Dr Parry.

British Medical Association chair of the General Practice Committee for England, Dr Katie Bramall, said there was a ‘complete paucity’ of information on the new neighbourhood contracts.

‘It's very clear we're not going to these contracts this year.

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‘If there's any appetite for trying to gather up locally commissioned services, they will require at least six months’ notice on those contracts. I don't think that's a goer personally,’ she said.

Dr Bramall added that expectations of rapid transformation were unrealistic, renewing calls for some PCN DES funding to be ‘repatriated’ to the core GP contract to provide stability and support recruitment.

The two new contracts, yet to be published, are the single neighbourhood provider (SNP) contract which, according to the 10 year plan, will deliver enhanced services for groups with similar needs over a single neighbourhood of around 50,000 people and a multi neighbourhood provider (MNP) contract which will cover 250,000 or more people for care that requires a scaled-up approach.