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Pharmacy and GPs must form a ‘single voice for primary care’ in ICSs

ICS

By Isabel Shaw
Reporter

28 Sep 2021

Community pharmacy and general practice must work towards changing their relationship as competitors to a more collaborative ‘single voice for primary care’ if pharmacies are going to be fully utilised in ICSs, according to a new report.  

This suggestion comes along with other recommendations in a document published yesterday (27 September) by NHS Confederation’s PCN Network, Primary Care Federation Network, National Pharmacy Association and Primary Care Pharmacy Association.  

The findings — which will be distributed to primary care networks, primary care federations and other stakeholders in local systems — explore how the ‘opportunities and benefits’ of involving community pharmacy in ICSs can be fully reached at a local level.  

One of the key recommendations published in the report which came from the roundtable discussion in July was that pharmacies and GPs should work together more collaboratively.  

‘Community pharmacy and general practice need to work through the historical perceptions of their relationship as providers, moving from a position of competition to one of collaboration and a single voice for primary care,’ it said in the report.  

A participant at the discussion suggested that the shift to commissioning local services through ICSs could help by better aligning GP and community pharmacy contracts. 

NHS England and NHS Improvement confirmed in July that the commissioning of pharmaceutical services in England will be transferred to Integrated Care Systems (ICS) from April 2022.

Until now, all commissioning decisions for primary care services, including pharmaceutical services, have been in the hands of NHSE&I

Meanwhile, the roundtable also came to the conclusion that community pharmacists must be appointed the ‘time and space’ to get involved in working through the development of local services with their primary care colleagues. 

According to the report, the need for primary care providers to integrate with each other,as well as with other sectors, was a ‘constant theme’.

‘This was seen as a key mechanism for gaining a voice for primary care within the ICS and ensuring that, as stated in the ICS Design Framework, it is embedded in decision-making at all levels of the system,’ the report explained.  

Another recommendation was that nationally specified pharmacy services should be ‘properly resourced’. It also said that ‘commercial viability is a valid request by contractors in the NHS’. 

There was also ‘strong support’ for using the ‘broader clinical skills of community pharmacists’. 

The report added: ‘It was felt that medicines optimisation should be a golden thread running through the community pharmacy offer, particularly given the high level of NHS spend on medicines and the impact that community pharmacy can have on improving patient outcome.’  

‘Navigate emerging NHS structures’ 

Commenting on the recommendations, Dr Graham Jackson, GP and senior clinical advisor at the NHS Confederation,  said: ‘It is critical that all available clinical capacity is used effectively. Our report examines the opportunities of collaboration with community pharmacy and identifies key enablers available to local systems, as well as addressing barriers.’” 

‘We urge PCN clinical directors, primary care federation leaders and others locally to support community pharmacists to navigate the emerging NHS structures and thoroughly consider what pharmacies can bring to the table in terms of urgent care, public health, medicines optimisation and more.’ 

Andrew Lane, chair of the National Pharmacy Association, said: ‘The Covid-19 pandemic has shone a bright light on the value of working collaboratively across systems. Community pharmacy can deliver most as an integral part of the system rather than being seen as an adjunct to the main action.  The sector has an important role to play as a full partner within PCNs, with primary care federations and ICSs. 

‘Medicines safety and optimisation is widely recognised as part of pharmacy’s unique skill set but increasingly community pharmacy will collaborate with partners in primary care to deliver integrated clinical services to the population.’ 

He added: ‘This report shows that community pharmacists are not a voice in the wilderness within the NHS. It is fantastic to have the NHS Confederation weighing in with their encouragement.’ 

Other recomednations from the report include: 

  • Service developments must be translated into a national contract specification for local adoption with the ability for some local flexibility to be applied to meet the specific needs of a local population.
  •  ICSs must support the implementation of nationally specified services, locally ensuring there is project management, IT deployment and system-level governance and oversight for implementation. This should be backed up with appropriate mechanisms to involve community pharmacy in decision-making at all levels and resources available to enable this.
  • An appropriate information technology and information governance framework is needed to support data sharing and facilitate the development of local services and the implementation of national services.
  • An appropriate medico/legal framework is needed which recognises the role of pharmacists as independent prescribers and resolves issues relating to conflicts of interest.

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