A ‘more active role' for community pharmacy in urgent care and prevention is outlined in a report into the next steps for integrating primary care, published today (26 May).
'At the heart of the new vision for integrating primary care is bringing together previously siloed teams and professionals to do things differently to improve patient care for whole populations,' the ’Next steps for integrating primary care: fuller stocktake report’ says, ahead of ICSs becoming statutory bodies from July.
The report, commissioned by NHSEI and led by Dr Claire Fuller, chief executive-designate of Surrey Heartlands ICS, highlights two issues that have ‘dominated debate’ - the need for people to access same-day urgent care and the need for GPs to be able to provide continuity of care to those patients who need it most.
It says the wider primary care team 'could be much more effectively harnessed,' specifically the potential to increase the role of community pharmacy, dentistry, optometry and audiology in prevention, 'working together to hardwire the principles of "making every contact count" into more services.'
For example, the report highlighted Sutton community pharmacist and NPA member Reena Barai, who attended a director of public health presentation on local health and social demographics, where she learned of the higher than average rates of mental health problems and suicide among young people and males in Sutton compared to the rest of London.
In response her pharmacy team 'immediately enacted a simple but crucial change' in their dispensing behaviour, the report says. 'They endeavoured to check that any young person prescribed anti-depressants was asked how they were feeling and whether they felt the medication was helping.
'This opportunity to ask for help allowed many people to feel they could talk to a pharmacist about their mental health and the pharmacy team were able to refer patients back to their GP if they felt they or the patient had concerns.’
Ms Barai, who served on two of the Fuller working groups, said: 'This report will form the blueprint for partnership working as a ‘must do’ rather than a ‘nice-to-do’. In the last two years, I’ve seen a growing desire for collaborative working, driven by the pandemic, but there’s a way to go yet.'
She pointed to the NHS Community Pharmacist Consultation Service and the Hypertension Case-Finding Service as examples of services requiring close collaborative working focused around the needs of patients.
'To get there, we are going to need to look beyond a traditional definition of primary care and understand that NHS urgent care is what patients access first in their community - typically from their home or high street,' the report says. ‘That might be online advice on symptoms and self-care or going to a community pharmacy.’
It says: 'We should start by recognising the current system is not fit for purpose – it is fragmented and causing frustration among patients and staff. In the face of rising demand, we need to move to a streamlined and integrated urgent care system – and primary care has an essential role in achieving this.
'Critically, we need to create the conditions by which they can connect up the wider urgent care system, supporting them to take currently separate and siloed services – for example, general practice in-hours and extended hours, urgent treatment centres, out-of-hours, urgent community response services, home visiting, community pharmacy, 111 call handling, 111 clinical assessment – and organise them as a single integrated urgent care pathway in the community that is reliable, streamlined and easier for patients to navigate.'
The report highlights 'a more active role' for community pharmacy in urgent care and prevention, including early diagnosis of cancers.
In terms of workforce, the report says 'addressing the shortfall in GPs is essential and urgent,' but acknowledges there are also 'recruitment and retention challenges across the wider primary care workforce, particularly NHS dentistry and community pharmacy.'
However, it points to PCNS having been 'more successful than we all hoped in hiring extra staff in new roles,' with over 18,000 FTEs in post by the end of March 2022 - 'significantly ahead of the trajectory towards the 26,000 March 2024 target' - and said 'progress must not stall'.
Dr Fuller said: 'We are weeks away from the inception of the new ICSs and, with it, the biggest opportunity in a generation for the most radical overhaul in the way health and social care services are designed and delivered.
'Primary care must be at the heart of each of our new systems – all of which face different challenges and will require the freedom and support to find different solutions.'
She called for 'action at every level,' as 'these new systems alone can’t fix all the problems.'
NPA chief executive, Mark Lyonette, said: 'This document is a clear signal to ICSs to break through silos in primary care and to engage community pharmacy in a multidisciplinary push on prevention, urgent care and long-term conditions.
'This is an invitation to be active partners in integrated care and that means investing time and energy in building relationships to improve local services.'
The Fuller Stocktake considered six themes during the spring of this year: Creating the right environment (for working together), people (workforce), access (physical and non-physical), working with communities, governance, and data (for improving population health).
'At the heart of this report is a new vision for integrating primary care, improving the access, experience and outcomes for our communities,' the report says, which centres around three essential offers:
- streamlining access to care and advice for people who get ill but only use health services infrequently: providing them with much more choice about how they access care and ensuring care is always available in their community when they need it.
- providing more proactive, personalised care with support from a multidisciplinary team of professionals to people with more complex needs, including, but not limited to, those with multiple long-term conditions.
- helping people to stay well for longer as part of a more ambitious and joined-up approach to prevention.
In March, Sajid Javid said pharmacists and other providers in primary care will be expected to play a large role in preventive care under new health reforms set out by the Government.
A report by NHS Confederation's PCN Network, Primary Care Federation Network, National Pharmacy Association and Primary Care Pharmacy Association calls for community pharmacy and general practice towards 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.
In November last year, NHS leaders urged the government that the pharmacy sector should be better integrated into the healthcare system in England.