New community pharmacy vision ‘a powerful tool’ for negotiator

A new vision for community pharmacy which centres on a clinical future will help form the basis of the sector’s discussions with the government and policymakers going forward.

Published today by independent experts the King’s Fund and Nuffield Trust, A Vision for Community Pharmacy sets out national and local services that community pharmacy could provide within five and 10 years.

Janet Morrison, chief executive of Community Pharmacy England (CPE), which commissioned the report, said the vision was intended to help the negotiator encourage policymakers to ‘think differently about what the pharmacies of tomorrow could look like’.

She added that it would be a ‘very powerful tool’ for the negotiator and that CPE had already begun discussions about how to build on the vision set out in the report.

The vision, which follows almost a year’s worth of research and consultation with the sector, explores how the role of community pharmacy can be expanded over the next decade, while recognising the ongoing challenges.

Over the next five years, all community pharmacies could be using independent prescribing to deprescribe and amend prescriptions, as well as a walk-in consultation service and a common conditions service, it suggested.

And they could choose to provide additional advanced services, such as prescribing long-acting-reversible-contraceptives (LARC) and emergency contraception, cancer detection and referrals, as well as flu and Covid-19 vaccinations, hypertension case-finding and atrial fibrillation detection, and smoking cessation.

The report also suggested that community pharmacies could be locally commissioned to manage long-term conditions such as hypertension, lipid control and asthma.

And within 10 years, the hypertension and atrial fibrillation case-finding service, flu and Covid-19 vaccination service and cancer detection and referrals could become essential services which all community pharmacies would be expected to provide, the report proposed.

Distance selling pharmacies would need to make arrangements with other partners in order to fulfil all aspects of the core contract for essential services, rather than having a separate contractual arrangement, it added.

In addition to independent prescribing, the report envisions community pharmacists making the most of new advances within the profession, including the option to use pharmacogenomics as part of medicines optimisation services.

The vision also explores how pharmacies could provide even more patient support, such as managing minor injuries, menopause advice and HRT reviews, diabetes checks, dermatology, pain, and depression and anxiety management.

Commenting on its launch, CPE chief executive Ms Morrison said the report ‘provides yet more powerful evidence as we work to persuade policymakers to help us to ensure the sustainability and success of community pharmacy’.

She added: ‘The blueprint will help us to encourage policymakers to think differently about what the pharmacies of tomorrow could look like and how we can make them a reality.’

And speaking to the press this week, Ms Morrison emphasised that the report sets out a long-term vision for the sector to form the basis of discussions with decision makers.

‘Nothing will change overnight. But we're not trying to change the minds of contractors overnight,’ she said.

‘We're trying to change the minds of commissioners to see us in a different way – as a professional, clinically competent workforce, as people who can be a vital part of primary care and in both of the neighbourhood and within the regions and systems.’

But Helen Buckingham, director of strategy at the Nuffield Trust, who co-authored the report, said there were some things that contractors could be doing now ‘to get ready for change’.

‘If I'm going to be delivering a different range of services in two or three years’ time, what is that going to mean for my premises, are my premises suitable for that? What does that mean for my own skills as a clinician, what am I going to need to get skilled up in? What does it mean for me as an employer, actually, how am I going to need to build our teams?’ she said.

She added that while these were ‘not instant actions’, they were prompts to start thinking ‘differently and strategically about the future’.

‘You have to start somewhere and tomorrow is as good as any day,’ added Ms Buckingham.

The report also recognised wider challenges around implementing the vision, highlighting in particular the need to reform the sector’s funding model and the importance of community pharmacy involvement in integrated care boards (ICBs).

Investment in IT systems and supporting collaboration rather than competition with GPs and other primary care providers was also highlighted as critically important.

In particular, the report suggested that: ‘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.’

It also mooted the idea of community pharmacies being funded per registered patient, akin to GPs, although it acknowledged the value of patients being able to access any community pharmacy.

And the report recommended that the law be changed to allow dispensing without a pharmacist on site.

A cross-sector group on supervision recently agreed on the importance of having a pharmacist physically present in a community pharmacy, although members disagreed about whether this should be embedded in primary legislation or specified elsewhere.

But Ms Buckingham told press this week that she stood by the vision’s recommendation, saying that the much-debated issue was not going to go away.

‘I think it will come back up again, because it was such a fundamental barrier to being able to make the best use of the skills across the team,’ she said.

And she said that technological advances could help maintain patient safety even in the scenario of a pharmacist’s absence.