Public awareness of pharmacy services is lacking, and outward-looking leadership is required at local and national levels to address this, claims a Royal Pharmaceutical Society report published today (5 November 2013). It also recommends that NHS England should use its national commissioning role to continue changing the balance of funding from dispensing and supply to delivery of services focused around patient care. NHS England should also be open to pharmacists holding contracts as professionals rather than through their employers.

The Commission on Future Models of Care was set up in spring (2013) by the RPS English Pharmacy Board and independently chaired by Judith Smith, director of policy at the Nuffield Trust. The commission’s report, entitled “Now or never: shaping pharmacy for the future”, provides examples of best practice and innovation and describes how pharmacy can help the NHS make the shift from acute to integrated care in the reformed NHS in England.

“Pharmacists and their employers must recognise the imperative to shift their focus away from dispensing and supply of medicines towards providing a broader range of services,” the commission suggests. However, it says that pharmacy is seen by external stakeholders as “a rather insular profession” that is often left out of key decisions around health policy.

“Pharmacists, particularly community pharmacists, are often quite marginalised in the NHS — nationally and locally,” Dr Smith commented. “It is the third largest healthcare profession, and I don’t think that pharmacy at the moment punches its weight.” She said that there has been more than enough analysis of what pharmacy can deliver and the profession now needs to act as an advocate for its own future.

The report says that the RPS must work to raise the profile of pharmacy among the public and within the NHS and social care, and should consider “drawing together a leaders’ forum made up of those committed to reshaping pharmacy as a care-giving profession”.

RPS needs to establish cohesive message about the profession

English Pharmacy Board vice-chairman Ash Soni said that the RPS has endorsed the commission’s recommendations formally. “There are some real elements that we need to take up, and there is a challenge for us, on behalf of the profession, around the leadership forum.” He added that the Society would need to work with stakeholders to establish a cohesive message about the profession for the public and organisations.

Chief pharmaceutical officer for England Keith Ridge said that NHS England welcomes the report and is looking forward to working with the RPS and other groups as it develops the forthcoming community pharmacy “call to action”.

“We also recognise that community pharmacy’s capacity with respect to urgent and emergency care needs to be utilised and that’s being considered as part of the [Government’s] urgent and emergency care review,” Dr Ridge said.

Health minster Lord Howe commented: “As this report highlights, there is potential for pharmacists and their teams to play an even greater role in the future, particularly in keeping people healthy, supporting those with long-term conditions and helping make sure patients and the NHS get the best use from medicines.”

Referring to the examples of innovation submitted to the commission, Dr Smith said: “The future is here, but it is just not very well distributed.

“Why are these models still considered innovative?” She added: “We had over 100 different models of care reported to us through the online submission process… . It was incredibly impressive.”

Stephen Dorrell MP, chairman of the House of Commons Health Committee, said that the RPS commission “addresses the right issues”.

“As often happens, the report’s argument is crystallised in a single sentence: ‘Pharmacists need to become first and foremost providers of patient care, rather than dispensers and suppliers of medicine.’ If we apply that thought consistently, as the report argues we should, we shall find ourselves in unfamiliar territory.”

Boots rejects many of the report’s recommendations

Peter Bainbridge, director of pharmacy for Boots UK, argued that it would not be in the best interests of patients to isolate the delivery of services from supply. “We believe this should remain a key part of the pharmacist’s role, allowing them to have a holistic view of the patient so they can understand the frequency and regularity [with which] patients are taking their medicines.”

He also rejected the idea of a leaders’ forum for the profession. “While we recognise that there is much we still need to do as a profession in order to realise the ambition of the report, we do not believe another pharmacy leadership body is needed to make this happen; rather we would like to see the existing bodies working together by supporting Pharmacy Voice in its aims.”

He acknowledged that changes are needed in the way that commissioning is structured. “However, we believe that contracts for individual pharmacists would further complicate the commissioning procedure … [and] will only work to slow down the rate at which pharmacy can offer the delivery of greater levels of clinical intervention.”

Independent Pharmacy Federation responds positively

Fin McCaul, chairman of the Independent Pharmacy Federation, said: “It is good to have an outsider, who is as respected as Dr Smith, recognise the value we can bring… . She has highlighted all areas that we need to work on. And also told us to [take action] rather than wait for national direction. It has highlighted that pharmacy is an undervalued resource and is also calling on local health authorities and clinical commissioning groups to be bold and commission services [from pharmacies].”

Regulator supportive of greater role for profession

Duncan Rudkin, chief executive of the General Pharmaceutical Council, said: “We want to play our part in enabling innovation and promoting improvement so that a greater role for pharmacy in supporting the health and well-being of patients can be realised.”

He pointed out that the GPhC has finalised a new strategic plan for 2014-17, which was laid before the UK and Scottish Parliaments last week. “This sets out our vision for the future of pharmacy regulation, with a regulatory framework that puts patients at its heart and is flexible enough to work well as pharmacy continues to change.”

Mr Rudkin continued: “We see a key part of our role as providing essential underpinning for public confidence in pharmacy as it takes on an increasingly wide and diverse clinical and public health role.”

What others are saying about the report

Royal College of Physicians president Sir Richard Thompson said: “We agree with the RPS that there is a greater need for joint working of professions, including pharmacists in multidisciplinary teams, in order to widen the provision of care for people in hospital and the community. The RPS is also right to note the need to control costs, and that therefore all professions working in or with the NHS will have to drive change using existing funding and innovation.”

Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “We would support wholeheartedly the expansion of both the minor ailments scheme and community pharmacy teams, as this would increase the capacity of the health service and allow better access for patients.”

He added that better use of community pharmacies could help to take some of the pressure off nurses by “dramatically reducing attendances at A&Es”.

Shirley Cramer, chief executive of the Royal Society for Public Health, said that pharmacy’s “unique position to help improve community health and well-being” is demonstrable in the emerging evidence base on the effectiveness of healthy living pharmacies. “We believe the role of health champions in pharmacies is a key aspect of enabling pharmacies to broaden their services and are keen to see the success of this scheme develop.” She added that education and partnership working were vital to ensure pharmacies are supported and have the resources they need.

NHS Confederation director of policy Johnny Marshall, who was a member of the commission’s expert advisory group, commented: “With the right services available in the right place, we can help many more people to manage long-term conditions and their overall health without needing to set foot in a hospital.”

NHS Alliance believes report’s recommendations should be followed

Mark Robinson, pharmacy, medicines and medicines optimisation adviser to the NHS Alliance, said: “This is a very important report for the profession, calling for better engagement within health, social care and public health. The report lays out several recommendations to commissioners, pharmacists and the professional body which should be acknowledged and followed”.

In a statement, the organisation said it had experienced examples of best practice delivered by pharmacists and pharmacies. “There is a challenge to us all to spread this best practice to ensure that good care is offered to everyone.”

Michael Dixon, chairman of the NHS Alliance, added: “I was pleased to see that our call for the employment or attachment of medicines optimisation pharmacists to all general practices was included in the [report’s] executive summary. Pharmacists are often the missing link to providing good care and are a valuable resource that should be better used.”

GPs less enthusiastic about the report’s recommendations

Andrew Green, chairman of the British Medical Association’s clinical and prescribing committee, said: “General practice recognises that pharmacists have a valuable role in working alongside GPs in the management of chronic disease, and good examples of joint working can be found in many parts of the country.” However, he argued that the number and severity of chronic illnesses in many patients makes them extremely difficult to manage. “The skills acquired in the years of GP training are vital if this is to be done safely. It is very easy to underestimate the challenges involved in providing care to these patients. Local commissioners are well placed to determine how GPs and pharmacists can best work together to provide seamless care, and will recognise that some groups of patients require innovative ways to be engaged.”

Dr Green also warned that multiple providers of care can lead to fragmentation of services, increased costs, division of responsibility and confusion for patients. “In particular, the management and monitoring of high-risk medications such as anticoagulation or disease-modifying antirheumatic drugs should remain with the prescriber,” he said.

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