The Government has revealed plans to significantly reform the NHS, by joining up existing services to support the delivery of care and to help tackle existing health inequalities, which have been further highlighted during the Covid-19 pandemic.

One of the key measures in the white paper for a new Health and Care Bill, published yesterday (11 February), is to legally join together the NHS and local government as part of Integrated Care Systems (ICSs) to enable them to respond to local health needs, including ‘moving services out of hospitals and into the community’, the Department of Health and Social Care (DHSC) said.

Under the plans, which ‘will start to be implemented in 2022’, clinical commissioning groups (CCGs) will ‘become part of’ ICSs, with ICSs to take on their ‘allocative functions’, the paper said.

In keeping with Matt Hancock’s vision for the future of the health service - which he spoke of when taking up the role of health secretary in 2018 - the proposals also seek to improve the use of technology within the NHS, so it can better support staff and improve patient care.

Drawing on the evidence from its bureaucracy consultation, the Government also hopes to reduce administrative pressures in the system so that local NHS services and their staff can spend more time with patients.

The proposals build on the NHS’ recommendations for legislative change in the NHS Long Term Plan and come a decade on from the last major piece of health and care legislation – the 2012 Health and Social Care Act.

The DHSC said that the pandemic has shown the impact of inequalities on public health outcomes, adding that there was a need for Government to act to ‘help level up health’ across the country.

‘Legislation will help to support the introduction of new requirements about calorie labelling on food and drink packaging and the advertising of junk food before the 9pm watershed,’ it added.

‘Pharmacies need fair funding’

Malcolm Harrison, chief executive of the Company Chemists’ Association (CCA), said he hoped the proposed changes will create an environment that allows the community pharmacy sector to do more ‘to help relieve pressure within the rest of the NHS’.

‘With waiting times for hospital treatment at their highest for ten years, community pharmacies are needed now more than ever to provide patients with clinical care, close to home,’ he said.

‘However, to deliver on this, pharmacies need fair funding for both the services they currently provide and for any additional workload they are ready and willing to deliver.’

He added: ‘It is not yet clear how the national and local commissioning of services will work in this new system. It is vital that everyone can access consistent care across the country, and that the good intentions of the white paper do not lead to a healthcare ‘postcode lottery’.

‘We also welcome the intention to improve data sharing. The ability for records to be easily accessed and shared by those providing patients with care could transform levels of safety and efficiency, helping to deliver the joined-up NHS that the white paper is calling for.’

Changes must ‘help not hinder’

Claire Anderson, chair of the Royal Pharmaceutical Society (RPS) welcomed ‘steps to facilitate more efficient ways of working’, but stressed that they ‘must be backed by investment and a comprehensive workforce strategy’.

She said: ‘These changes must help not hinder our health and care staff, who are focused on looking after patients during a global pandemic.

‘Staff are already under pressure and I’d urge the Government to ensure they get the help they need, supporting their wellbeing, boosting recruitment, and investing in education and training.Long-term reforms must also ensure we make the most of the whole of the pharmacy workforce to deliver patient care and reduce health inequalities.

She added: ‘The white paper includes a welcome focus on patient safety and we know pharmacists’ clinical leadership will be key to supporting this across the health service.

‘National plans must be backed by sufficient resources to support local delivery and it will be vitally important for the Government to engage with both patients and health professionals as the proposals move forward.

‘Positive opportunity’ for pharmacies

Simon Dukes, PSNC chief executive, said: ‘We understand that Ministers see this new white paper on health and care services as a really positive opportunity for community pharmacies.

‘They recognise the important contribution that pharmacies can make to the prevention agenda and the changes could provide a chance for pharmacies to deliver preventative healthcare in a way that could reduce overall costs for Integrated Care Systems (ICS).

‘We know too that community pharmacies, as the most accessible healthcare locations, can play a central role in helping to reduce health inequalities as per the ambitions of this white paper.’

He added: ‘But history tells us that it will not be easy for the sector to gain a foothold in newly reformed local healthcare systems, and we will continue to work closely with LPCs and contractors at a local level to ensure that this happens.

‘We had called for the Government to specify that community pharmacy must have a place in the new systems, with all primary care providers part of their governance, and we will continue to push policy makers and Parliamentarians to ensure that pharmacy is given a proper voice in all local systems.’

Mr Dukes also said that PSNC will work to protect contractors from any risks should the new proposals impact on the Community Pharmacy Contractual Framework.

‘Community pharmacies have been at the forefront of the NHS response to Covid-19 and this critical role must be built upon as we start to recover from the pandemic and look to the future of health and care services,’ he said.

Engage with pharmacy leaders

Leyla Hannbeck chief executive of the Association of Independent Multiple Pharmacies (AIMp) urged ICSs to engage with community pharmacy leaders ‘at a very early stage’.

‘We urge the NHS ICS statutory body responsible for commissioning functions to engage with community pharmacy leaders at a very early stage in any planning of commissioning services, so that we can help with forming relevant services that can be delivered efficiently for the benefit of patients in the communities that we serve,’ she said.

‘We also urge the new body to proactively work on breaking down the barriers and mis-understandings that currently exist between general practice and pharmacy and encourage effective collaboration.’

Ms Hannbeck also said she supported a move to reduce unnecessary NHS bureaucracy.