The new networks have been the source of a lot of noise in the sector recently, but what part do contractors have to play in them? Costanza Pearce investigates
Under the new five-year GP contract announced in January, practices will be provided with extra funding to join local networks serving roughly 30-50,000 patients. While not all practices have to join one, all patients must be covered by a primary care network (PCN). The £4.5bn contract includes funding for practices working in these networks to employ additional staff, such as 70% of a practice pharmacist’s wage during the deal’s first 12 months.
NHS England and the British Medical Association (BMA) have made it clear that these networks will be led by general practices, but that they will also have to include other healthcare providers within the community such as pharmacies.
The impact of PCNs on community pharmacy doesn’t stop there, though. Networks will form a crucial part of the commissioning environment from 1 July – the deadline for their formation – onwards, not least because the Department of Health and Social Care (DHSC) continues to mention the GP and the upcoming pharmacy contracts in one breath.
There’s no doubt that the sector simply cannot afford not to engage with this new foundation to the primary care commissioning architecture. Here’s how to make sure you don’t miss out.
What is pharmacy’s role?
The sector’s role in networks is two-fold. First, there’s the inclusion of so-called ‘clinical’ pharmacists working from within network practices – you can find out more about what makes a ‘clinical’ pharmacist here – but pharmacists working outside of these practices are invited to the party too.
NHS England has stipulated that the inclusion of non-GP providers such as community pharmacies within networks will be a requirement from 2020, and it was clarified at the chief pharmaceutical officer’s (CPhO) conference on 1 May that PCNs will ‘typically comprise’ five to six general practices and nine to ten community pharmacies.
Community pharmacy ‘will need to have strong links with PCNs’, while so-called clinical pharmacists working in practices will be the ‘focal point for collaborative working across the different pharmacy sectors including hospital, mental health and community’, NHS England told The Pharmacist.
Perhaps surprisingly, NHS England’s vision is for community pharmacy to support the delivery of services in PCNs – in fact, guidance published in April states that non-GP providers will be ‘essential’ to this. Specifically, a community pharmacy within a PCN ‘will focus more on its clinical role managing the minor illness aspects of urgent care and supporting patients to prevent ill health’ and medicines optimisation, NHS England outlined at the CPhO conference.
Not only that, but an increased clinical role could see contractors delivering some parts of the GP contract service specifications, such as cardiovascular disease early detection and prevention and awareness of cancer symptoms, NHS England said.
Perhaps less surprisingly, PSNC indicated in March that these priorities are ‘likely to be reflected’ in the new 2019/20 community pharmacy contract it is currently in negotiating with NHS England.
What role can I take?
Of course, some contractors could apply to be recruited into practices as ‘clinical’ pharmacists following an 18-month training programme. In April, it was revealed that practice-based pharmacists will in theory be able to take on the leadership of their PCN as its clinical director, who is responsible for ensuring the network delivers local services and providing strategic and clinical leadership. NHS England clarified to The Pharmacist that while the clinical director of a PCN does not have to be a GP, they must be an appropriately qualified clinician who is currently working in a member practice of the network. Therefore, a practice pharmacist could take on this role.
Many contractors, however, will choose to remain in the community and engage with network practices from the outside, but this is less chartered territory. NHS England told The Pharmacist that contractors’ exact role in PCNs ‘will be for individual networks and community pharmacies to agree, including how community pharmacy can contribute to the delivery of network services to the local population’.
This role may be less well defined, but there are leadership opportunities here, too. In a briefing to Local Pharmaceutical Committees (LPCs), the PSNC said one local community pharmacy PCN lead – or ‘pharmacy lead’ – and if possible a deputy should be selected for each network. Both roles should be filled by volunteer contractors or a member of their team, who would attend every PCN meeting and send feedback to their LPC. For community pharmacy to have a voice in the newly-formed PCNs, it’s crucial that contractors step up to take on these roles – or risk being overlooked.
What are the next steps?
In January, PSNC chief Simon Dukes said contractors should take the GP contract as ‘a very clear indication’ of how the Government envisages the future of primary care. ‘Success will involve transforming the services that we offer and community pharmacies will need to be ready for radical changes, such as partnering with other contractors to jointly meet the needs of their local PCN’, he said.
The negotiator aims for community pharmacists to be ‘fully involved’ in PCNs, Mr Dukes added, and PSNC has been consistent in its messaging that contractors need to be proactive and coordinated as they seek to engage with the practices at the centre of PCNs. According to Nottinghamshire LPC chief officer Nick Hunter, some pharmacists are already working with local practices to some extent, perhaps even without realising it. Although LPCs will be able to ‘facilitate, guide and advise’, their working relationship will have to be between the PCN and the community pharmacies themselves, explains Mr Hunter. His hope is that with the advent of PCNs the need for pharmacies to be involved with parts of the old NHS structure such as CCGs will be less.
Other necessary adaptations will include making better use of technology and team members’ skills to free up pharmacists’ time for more clinical work, finding ways to interact with patients digitally and updating their skills to provide the services the NHS needs, according to PSNC. ‘If community pharmacies can show they’re ready and able to provide new services, new opportunities will follow’, said their animation outlining the future of pharmacy. ‘It will be up to everyone in community pharmacy to ensure that our sector is included in these important emerging structures’, it added.
For Mr Hunter too, action is vital. ‘Community pharmacists need to understand what that NHS community structure is, how they make best use of it and how they make sure that community pharmacy is made best use of to secure the future of the sector’, he tells The Pharmacist.
As the negotiator continues its discussions with the DHSC to determine the new community pharmacy contractual framework, we’re all waiting with bated breath to see how it enshrines the sector’s future relationship with the new PCNs.
For now, however, this much is clear – if community pharmacy is to have a seat at the table, it needs to show up.
For an example of how you might work with PCNs, take a look at the National Association of Primary Care’s (NAPC) guide on integrating community pharmacy within the primary care home – the NAPC’s model for PCNs.
PSNC recommends your first steps should be:
You can find PSNC’s ‘future of pharmacy’ animation and some resources to help you with these action points at psnc.org.uk/futureofpharmacy