Pharmacists could manage caseloads of patients at high risk of unplanned hospital admission, NHSE England (NHSE) has suggested, as part of guidance on easing pressure on services through ‘proactive personalised care’.

The document, published as parts of its winter resilience plans, suggest that pharmacists could support high frequency users – who use services more frequently than usual - to access care within the community to reduce growth in hospital demand.

Community pharmacies could refer patients at highest risk of unplanned admission who would benefit from ‘personalised care’ to ICBs and PCNs, while pharmacists could also manage caseloads of patients with significant clinical or pharmaceutical risk factors, it suggested.

It also said that ICBs and PCNs should consider additional recruitment to meet the need this winter.

The Pharmacist has approached NHS England to clarify whether caseload management would apply to PCN pharmacists only or if it would also apply to community pharmacists.

High-risk patients could include those who have had more than two unplanned hospital admissions and had been prescribed more than 10 medications within the last 12 months, and where additional support, including through community pharmacies, was judged to be required, it suggested.

However, NHS England stressed that ‘it is up to local areas to decide which cohorts they wish to focus on’.

Further support could then be provided through registered health professionals or partners such as pharmacists or Voluntary, Community and Social Enterprise (VCSE) services, or through social prescribing, health and wellbeing coaches, or continuing healthcare.

The guidance said that community pharmacies could play a role in identifying and referring patients, adding that ICBs ‘can provide business analyst support to support interoperability between systems and linking of system data based on population health management approaches’.

Once referred, caseloads of high-risk patients with significant clinical or pharmaceutical risk factors could be managed by a pharmacist, a GP, a nurse, an advanced nurse practitioner, or a physician associate.

The clinician would then invite a patient to a ‘What Matters to Me’ conversation about the issues they are experiencing and what type of support might be most beneficial to them. This would be followed up with regular check-ins.

Patients can be discharged or referred to relevant community support following conversations with the appropriate clinician or professional and on completion of interventions, but with the potential for re-entry to the list should a change in circumstance occur.

NHSE said it was supporting ICBs and PCNs ‘to boost capacity outside of acute trusts to support general practice, primary care networks and their teams through winter’, including by ‘scaling up of additional roles in primary care and increasing the flexibility for primary care networks (PCNs) to do this’.

In 2019, NHSE introduced the Additional Roles Reimbursement Scheme (ARRS), which granted specific funding for general practice to employ additional roles including pharmacists. Since then, the number of clinical pharmacists working in general practice in England has tripled.

NHSE said that ICSs that already have ‘proactive approaches’ to support patients at highest risk of unplanned admissions or those experiencing health inequalities should build on their existing approaches, while others ‘should start small and expand over time’.

NHSE encouraged ICBs and PCNs to use their current ARRS roles, including pharmacists, to meet increased pressure and demand during the winter months.

It also said that ICBs and PCNs should plan for the recruitment of additional roles through ARRS and/or System Development Funding (SDF).

This will help primary care ‘to strengthen their capacity to meet the needs of different patient groups’, to backfill roles ‘to allow current staff to prioritise more proactive work’, and to recruit for specific skills and experience ‘to provide targeted support for particular population health needs’, it said.