NPA sets out 10-year vision for community pharmacy

The National Pharmacy Association (NPA) has released its 10-year vision for community pharmacy, setting out what the sector can do to meet NHS and patient needs over the next decade.

It said that clinical services should be developed that help to cut GP waiting times, improve access to urgent care, prevent poor health, provide integrated care for major conditions such as cardiovascular disease, diabetes, respiratory disease and mental health, and deliver value for money for the taxpayer and accessibility for patients.

Dr Claire Fuller, chief executive of the Surrey Heartlands Integrated Care System (ICS) commented that the plan is based on an understanding of what commissioners need, which she described as the kind of thinking ‘that makes people like me sit up and take notice’.

The NPA said that it would be sharing its vision for community pharmacy in England with the King’s Fund and the Nuffield Trust, which are developing a vision for the sector on behalf of Community Pharmacy England (CPE).

Other organisations, such as the Royal Pharmaceutical Society (RPS) and the Company Chemists’ Association (CCA), have also recently set out their visions for the future of the sector.

The NPA said that ‘by and large we are all agreed on the need for community pharmacy to take a clinically focused journey, building on the medicines supply function, integrated with the NHS and adequately resourced’.

But it added that: ‘National Pharmacy Association members by their nature – as natural innovators and agile, skilled health care professionals – are particularly open to the idea of ambitious, transformative change.’

In its prospectus, it suggested a range of ideas for new and expanded services that fit into a ‘strategic service development sweet-spot’, where the three driving forces of ‘community pharmacy aspirations, patient needs and services that commissioners value’ align.

This includes the proposal of a national travel vaccinations service through community pharmacy, commissioning of community pharmacy to support medicines adherence in care home settings and allowing pharmacist independent prescribers to adjust prescriptions as part of an expanded new medicines service.

But to support this, the NPA said that ‘urgent action’ on funding was needed ‘to maintain current services and lay the ground for an improved service offer’.

It said that the current Community Pharmacy Contractual Framework (CPCF) was failing NPA members, the wider sector, the NHS, government and patients, and was adversely affecting independent pharmacy contractors in particular.

It set out 10 principles which it said any new deal should take into account, including creating a ‘level playing field’ for independents that do not benefit from ‘averaging’; paying pharmacies ‘in a timely fashion’ rather than relying on backdated ‘clawbacks’; stopping ‘dispensing at a loss’ and paying pharmacies for services in addition to dispensing.

It also said that a multi-year deal should guarantee uplifts in line with inflation ‘as a minimum’ and that any excess margin should be re-invested into the development of pharmacy services, as it is in Wales.

And it called for independent financial regulation that mitigates the risks of a single purchaser [the government] ‘using its power to achieve short-term gain at the cost of sustainability’.

To address workforce shortages, the NPA said that more pharmacists were needed across the sector ‘to match increasing patient demand and the development of clinical services’.

And it proposed that community pharmacies be able to access Additional Roles Reimbursement Scheme (ARRS) funding to deliver services in the community, and that local NHS managers conduct an impact assessment prior to any further recruitment into GP or Primary Care Network sites under ARRS.

Community pharmacy should be better integrated at a local level, the NPA added, as service development and commissioning moves to local Integrated Care Boards (ICBS). And it said that ‘national leadership needs to be embedded into the 42 ICS ‘laboratories’ and recognise the scalable winners’.

In addition, the NPA also said that digital advances, such as artificial intelligence (AI) could be used to support face-to-face access to care.

And it said that private services delivered by community pharmacies should continue as they were key to developing innovative new services and benefiting patients.

NPA chair, Nick Kaye, said that ‘building out from the existing portfolio of services’, there were ‘some major opportunities within this decade, encompassing prevention, medicines optimisation, long term medical conditions and urgent care’.

He added: ‘We are seeking to challenge orthodoxies that have limited the sector’s scope for too long. At the same time, these ideas are firmly planted in reality because our start-point is what our paymasters in the NHS want, not what we can dream up.

‘Some of this is about redrawing the borders of pharmacy practice - for example applying pharmacogenomics to pharmacist prescribing.

‘Other aspects are about re-imagining what is our domain as a sector; we are rightly based firmly in the community but our impact ought to be felt and formalised across the entire system, including hospitals. We need to be “in the community but out of the box”.’

He added: ‘We are confident that the large majority of NPA members – by their nature innovators – are open to the idea of ambitious, transformative change.’

What does the NPA want to see?

Prevention

The NPA said that ‘as health and wellbeing hubs, pharmacies already have a significant role to play in keeping people well, in addition to treating people when they are poorly’.

And it suggested that ‘properly supported’ community pharmacy could:

Help to reverse health inequalities by expanding existing services, potentially through a ‘public health service bundle’ that could be adopted by each ICS
Re-imagine its ‘Healthy Living’ offering to become more proactive, making community pharmacy the ‘one-stop-shop for all health and social care patient needs through to vaccination services’, with access to the rest of the health and social care system
Take advantage of its high footfall by making every contact count, by offering on the spot services such as testing for infections or taking regular bloods to help manage long-term conditions. ‘Our core role of safe medicines supply is the basis upon which community pharmacists can regularly review and manage long-term conditions, with the application of diagnostics and laboratory tests where appropriate,’ the NPA report said.
Support digitally excluded patients to ‘get health-active online’, if that is how they want to access healthcare

Travel vaccination

In particular, the NPA proposed a national travel vaccination service through community pharmacy, which it said would not only make vaccination more accessible to the wider population, but also help tackle vaccine hesitancy by building on pharmacists’ ability ‘to provide advice and support to those who are still wary of any vaccination service’.

Tackling health inequalities

The report highlighted that community pharmacy accessibility, particularly in areas of highest deprivation, ‘means that investment in community pharmacy has great potential for reducing health inequalities – by locating care where it is needed most’.

And it suggested that a focus on women’s health could help reduce health inequalities, given that ‘while women in the UK on average live longer than men, women spend a significantly greater proportion of their lives in ill health,’ according to the Women’s Health Strategy for England.

‘Community pharmacists and their teams are well placed to provide support with medicines, as well as wider health advice and support to women at all stages of their lives – a fact underpinning the recently announced roll out of an NHS contraception service through community pharmacy,’ the NPA said.

Medicines Optimisation

The NPA proposed that community pharmacies should be able to deliver structured medication reviews (SMR), with the possibility to prescribe within competence enabled by independent prescribing.

In addition to full access to patient records, it said that the pharmacist should be able to send off for specific clinical indicators such as blood tests – ‘enabling the pharmacist to titrate any medication as required as well identify any issues adversely affecting recovery and management of long-term conditions’.

It added that community pharmacists should be allowed and incentivised to deprescribe medicines where appropriate, supported by advances such as genetic testing for personalised medicines (pharmacogenomics).

The NPA also suggested community pharmacy could be used more to provide medicines optimisation services in nursing, residential and supported domiciliary care settings. It gave the example of the Medicines Adherence Service in Northern Ireland, which sees community pharmacies dispensing prescribed medications at set intervals and providing compliance support solutions ranging from large print labels to monitored dosage systems (MDS). The NPA report described this as ‘a new and sensible way to fix a very pressing issue in the England pharmacy network’.

Managing long-term conditions

The NPA also proposed a ‘New Medicines Service Plus’ (NMS+), which would see community pharmacists with pharmacist independent prescribers being able to amend a patient’s prescription – ‘from a change in formulation through to a change in dosage and ultimately a change in medication’ – where necessary and appropriate to improve adherence.

And the organisation called for separate funding for the Discharge Medicines Service (DMS) outside of the current global sum, saying that ‘health and social care package support services, with vulnerable case-load of patients, get much closer attention from pharmacy teams’.

It added that community pharmacy could help prepare patients going into hospital for elective treatment by contributing to their pre-admission preparation around medicines as well as after discharge. ‘By building on our touch points we can give people a soft landing back into the community, reduce readmissions and help address bed-blocking,’ the report said.

In addition to the expected role of prescribing in managing cardiovascular disease, the NPA said that ‘the pharmacy sector should continue to be progressive and working towards a recognised prescribing role in other high prevalence long-term conditions too’.

And it said that there should be a ‘national dialogue’ around how community pharmacy could be integrated into patient care plans.

Access and urgent care

The NPA called for the incoming Pharmacy First Service, as well as the NHS Community Pharmacist Consultation Service (CPCS), which the NPA says is operating ‘under-volume’, and CPCS referrals from A&E, to be ‘optimised’, adding that this would ‘give same day urgent care a huge boost’.