Lack of pharmacy representation on ICBs 'staggering', says committee chair

Representation of community pharmacy within integrated care boards (ICBs) is critical to the success of the government’s primary care recovery plan, chair of Health and Social Care Committee (HSCC) Steve Brine suggested today.

Meanwhile leaders from NHS England and integrated care systems (ICSs) have highlighted the need to implement preventative healthcare, such as vaccination, amid ongoing challenges like hospital waiting lists and pressure on A&E.

In a panel discussing the government’s response to the Hewitt Review and HSCC report, Mr Brine said that ‘keeping the whole squad happy’ would be the biggest challenge for ICSs.

Integrated care systems (ICSs) were created as statutory bodies last year under the Health and Care Act 2022, and are intended to bring together local providers of health and social care, as well as local government and the voluntary sector, to deliver care that responds to local population needs.

Speaking at the NHS Confed Expo today, Mr Brine said that the decision-making boards attached to each ICS – integrated care boards, or ICBs – needed to be representative of every part of the system.

And he highlighted community pharmacy in particular given its major role in the government’s recent primary care recovery plan.

‘They talked about pharmacists, and how important community pharmacists are to that,’ said Mr Brine.

But he said that he was ‘staggered’ by lack of pharmacy representation on many ICBs.

And he said that creating and maintaining good relationships between different parts of ICSs would be critical to their success.

‘Those relationships are critical and how you keep everybody happy and everybody inside the tent is the devil's own job,’ he said.

The panel also highlighted the tension between the pressure to cut waiting lists and the need to invest in preventative healthcare.

Joe Rafferty, chief executive of the Mersey Care NHS Foundation Trust, said that many across the NHS and providers were ‘finding it difficult to lift our eyes from the fire’.

But he said that the solution to these crises was preventative care.

‘We all know we need to call the fire brigade, and I think we know what one looks like – it’s prevention-shaped,’ he said.

And he suggested that while prevention was a long-term aim, conversations needed to begin on creating short- and medium-term interventions, bringing together healthcare providers and local authorities to tackle social determinants of health.

In particular, he highlighted the need to work across different disciplines to help the most vulnerable.

‘What we think are different problems, frankly they’re the same problem,’ he said, giving the example of people with complex lives who are ‘super-users’ of services such as police, A&E and mental health services.

He said that breaking down barriers and allowing people to work across disciplines would not only deliver a better use of resources for the system but also better care for these individuals.

‘It’s not rocket science,’ he said.

And he added that planning for winter pressures was focussed on vaccination, saying that it was the ‘most vulnerable people who are unvaccinated’.

Meanwhile, Steve Russell, chief delivery officer and national director for vaccinations and screening at NHS England also highlighted the need to focus on vaccination and prevention more broadly.

‘What's the balance of time spent on electives and A&E in a conversation in the ICB / ICS, compared to vaccination and screening?’ he asked, noting that vaccination is one of the most powerful and effective public health interventions, second only to clean water.

And he said that partners within the integrated care system should concentrate their efforts on developing strong local relationships, trust and accountability.

Commitment to ICSs welcome but challenges remain

Patricia Hewitt, former health secretary and chair of Norfolk and Waveney Integrated Care Board, who led the review into ICSs, said that she welcomed the government’s commitment to support the newly-formed systems and approach to population health.

She said that the government’s response, which was released yesterday, was ‘more positive than I’d expected’ and said that it ‘would have been a complete miracle if they had accepted every recommendation’.

And she said that the government’s ‘thoughtful’ response showed an understanding that ICSs were about more than healthcare, but rather a multidisciplinary approach to the needs of a local area, including social care and local government.

She said that the cross-party support for ICSs meant that they were ‘here to stay’ and that those who had been hesitant about getting involved in their local system should ‘put aside all of those doubts’ and ‘get stuck in’.

But Mr Brine said that more clarity was still needed around how local ICSs and place-based partnerships would be expected to implement local and national targets, and how they would be supported and held accountable to do so.

He described ICSs as the government’s ‘arm of delivery’ in implementing national targets such as air quality, but said that the ‘jury was out’ about what the ‘balance between command and control and local leadership’ would be.

But Ms Hewitt said that ICSs were ‘not primarily a delivery arm for government’ but rather ‘there to respond to local population needs, and work with the benefit of national support, best practice, the right policy framework and the rest of it to get better health outcomes’.

And she said that NHSE was ‘owning the difficulties’ of simultaneously being expected to ‘radically restructure and downsize’ – which she said was happening ‘too much, too fast’ – alongside implementing the new ICSs, which have recently taken on local commissioning responsibility for community pharmacy.

Mr Rafferty also said that providers outside of the NHS, such as local government and social care providers, needed to have ‘skin in the game’, and that challenges around devolving budgets to place-based partnerships – a locally focused group of providers including health and social care – would need to be resolved in order for them to be a success.

Community pharmacy workforce response ‘lacklustre’

The Hewitt review had also highlighted the need to address issues of competition for the pharmacist workforce between community pharmacy and general practice and primary care networks.

But Janet Morrison, chief executive of Community Pharmacy England (formerly known as PSNC) criticised the government’s response for being ‘lacklustre’ on addressing the pharmacist workforce issues across primary care.

‘Whilst the Hewitt Review is clear that action should be taken to carefully consider the best use of the limited pharmacist workforce going forwards, the government continues to point to the long-awaited NHS workforce plan as the bringer of solutions,’ she said.

‘Their long-term plan must cover the entirety of the pharmacy workforce across the NHS, including community pharmacy.’

James Davies, Royal Pharmaceutical Society Director for England also called for the government to 'urgently publish the long-awaited NHS workforce plan', while Paul Day, director of the Pharmacists’ Defence Association said that 'all parts of the health system need to make best use of pharmacists'.