Back in July, we held a webinar with some of our members to explore how the NHS can continue to build on the role of community pharmacists in Integrated Neighbourhood Teams and what could be done imminently to improve local health services for citizens.
Community Pharmacists are ideally positioned to address a growing number of health needs within a local population and can encourage person activation and self-care. Addressing these health needs, in particular around prevention but also around acute and long term conditions, within community pharmacy, would reduce the demand for reactive healthcare services, including GP appointments.
Pharmacy First was launched earlier this year by NHS England to free up GP appointments by enabling Community Pharmacists to see patients and prescribe for seven common illnesses. During our engagement webinar it was discussed that the first step to improving the uptake of Pharmacy First would be to ensure it is advertised and promoted so that both citizens and healthcare staff can fully utilise the services on offer at pharmacies.
We know that patients sometimes need guidance and support to move around a complicated healthcare system, so there needs to be clear and consistent messaging, with simple language and communications. People generally use the services they are most familiar with so anything requiring them to take a new action needs to be clearly communicated several times in a number of different ways to encourage people to shift their behaviour to trying something different. It’s important that patients and the public have a positive experience of the new pathway and get what they need from community pharmacy first time to ensure they use it again and recommend it to others too.
Many people don’t have a good understanding of what the alternative options are for support other than their general practice. They might regularly walk past the door of the community pharmacy when attending general practice for something that could be resolved at the pharmacy. It’s about supporting people to access the right services, in the right place, at the right time.
This will require targeted campaigns/education/activation/nudge, and the planning of care and support based on population health need and partnership between community and primary care partners. Trained care navigators within GP surgeries can support with this as they direct patients to the professional best suited to their needs.
Capacity within community pharmacy remains a challenge and for some providing additional services on top of business as usual simply isn’t possible. There have been a number of community pharmacies closing in recent years which has increased the pressure on those that remain.
It was highlighted by NAPC members that the relationships within primary care and particularly between GPs and local community pharmacists are key to improving services. Dialogue between practice and community pharmacy needs to be two-way with continuity of messaging within GP and pharmacy with consistent shared messages. Although there is no substitute for personal relationships there is a need for systems to be in place that enable and support collaborative working rather than just relying on the strength (or lack of) existing relationships across organisations and individuals.
There is currently no reliable system to record the referrals from GP to Community Pharmacy and to know if these are resolved or bounce back to the GP. Joined up IT systems would improve the service for health professionals and patients/citizens. This would require shared clinical records to provide the knowledge of what has been resolved and what action is required. At present, there is a lot of duplication of effort between partners in primary care which adds cost for no additional value, so joined up systems would also help to reduce this..
With pharmacists qualifying as independent prescribers from 2026, work needs to start now in primary care to plan how to make the most of this important new skill. Primary care workforce planning is currently undertaken through individual primary care partners with independent commissioning processes and often based on a transactional approach which is payment by activity rather than longitudinal capitated budget responsibility – a more joined up approach could start to address some of the issues our members have highlighted.
By increasing support for patients within community pharmacy it would enable GPs to focus on those people who have the more complex health needs.
How could we make things even better?
When thinking about the longer-term investment into integrated neighbourhood teams, joined up IT systems would provide improved patient experience and would add insights for healthcare professionals to improve patient care. This is particularly the case for GP and pharmacy as it would enable each caregiver to know if a patient issue was resolved and what medication/advice a person might have previously received.
Workforce planning should be coordinated across primary care partners based on population health and well-being need, with the care and support provision identified to deliver for those local needs, and then the skills identified for the service.
When a local population health need such as hypertension is identified the redesign of the care and support offer ranging from healthy behaviours through to management of complex disease would assist in putting this into practice.
There is currently inadequate funding for the prevention of disease and promotion of healthy lifestyles within primary care, which can result in unnecessary costs elsewhere within the system. One of our members who joined the discussion suggested that the investment of just 1% of the current A+E budget redirected into prevention in primary care would start to see a shift across the system.
