By Neil Trainis

A much-anticipated report by two leading health think-tanks which lays out a 10-year vision for community pharmacy, including proposals to get the government and NHS England to properly support the sector to play a bigger role in primary care and solutions to the barriers that have held pharmacies back down the years, has been published today.

The report by The King’s Fund and the Nuffield Trust, commissioned by Community Pharmacy England, makes wide-ranging recommendations to allow pharmacy teams the scope to provide clinical care for patients and help them live healthy lives with their medicines, as well as ensure pharmacies are an “integral part of a local integrated primary care offer” and can help prevent ill-health, a key tenet of the government’s community-based healthcare reforms.

As part of its work over 10 months in producing the report, the Nuffield Trust and The King’s Fund interviewed representatives from community pharmacy and the wider health and care system, including primary care, integrated care boards, local authorities, national bodies, representative organisations, education and academia and other stakeholders. Interviews with a small number of international pharmacy experts also informed the report.

It called for pharmacies across England to be better supported to help patients manage long-term conditions such as asthma and hypertension and refer them to hospitals and specialists for scans and blood tests. It also said pharmacies treating patients with minor conditions or delivering contraception services could expand their offering by diagnosing and treating chickenpox and UTIs and detect illnesses by using technologies such as wearable devices.

However, the report cautioned that any expansion of pharmacy services must be underpinned by an increase in funding and called on the government to put more into community pharmacy than the £645 million it recently promised to inject over the next two years.

The report, which highlighted “significant barriers” to the implementation of its recommendations such as a lack of investment in outdated buildings, equipment, digital infrastructure and training of staff as well as regulation and pharmacies’ integration with other primary care services, called for;

• greater investment in IT and data to ensure pharmacies offering enhanced services can access the national care records service and shared care records at ICB level.
• a change in law to allow pharmacies to dispense without a pharmacist on site so pharmacists can be freed up to offer clinical, face-to-face services.
• introduction of incentives to encourage collaboration between pharmacists and other local primary care services, including payments to free up pharmacists’ and GPs’ time when working together and investment to build up capacity.
• ICBs to have sufficient resources and time to support community pharmacies, particularly smaller independent pharmacies.
• changes to pharmacy’s contractual framework to allow the report’s recommendations to take effect and agreement at national level about how community pharmacy fits into the government’s primary care strategy.
• a national and local campaign to raise public awareness of the services available in pharmacies.

The report called on the government, NHS England and CPE to set out a timetable for the renegotiation of the community pharmacy contractual framework and urged the Department of Health and Social Care and General Pharmaceutical Council to produce clear guidance when it comes to commercial conflicts of interest that prescribing and dispensing roles might create.

However, the report said there was an opportunity to pilot new essential and advanced services in the coming years and independent prescribing will open new doors for community pharmacy in this area, allowing pharmacists to deprescribe and amend prescriptions as well as prescribe medicines.

When it came to workforce and training, the report said pharmacy workforce planning should be integrated into NHS England’s national workforce plan and community pharmacy must be included in integrated care boards’ strategies.

Workforce issues, the report added, should be considered by ICB pharmacy workforce boards that should be made up of community pharmacy, hospital pharmacy and general practice pharmacy representatives. It also said chief pharmacists on ICBs should provide strong leadership for pharmacy on the Board and local pharmaceutical committee leads on ICBs should be supported to contribute to discussions around the planning of services locally.

Nuffield Trust: Now is the time to overcome barriers 

Nuffield Trust director of strategy Helen Buckingham said the vision “illustrates the significant transformation we’ll see in pharmacy over the next decade.”

“Community pharmacies have an exciting and important role to play in supporting patients to live healthy lives, get effective treatments quickly and navigate their health care,” she said. “Many pharmacies are already doing this, but barriers exist at a national and local level to realising their full potential.

“Given significant pressures on primary care, difficulties faced by patients to access health services quickly, the creation of ICSs, and a growing awareness of the potential of community pharmacy, now is the time to overcome these barriers that could prevent the vision from being implemented.”

King’s Fund: Determination and commitment needed from pharmacy 

The King’s Fund’s chief executive Richard Murray said the vision outlined the “opportunity to invest in the future by maximising the potential of the experience and expertise held by community pharmacies.”

“Expanding their role would help pharmacies to keep more people well, for example by supporting them to manage common long-term conditions without always needing to visit a GP, or by diagnosing and treating a wider range of minor conditions,” he said.

He warned “determination and commitment” will be needed not only from the NHS but community pharmacy if the vision’s ambitions are to be realised.

“If community pharmacy steps up to seize these new opportunities, there will be benefits to their business and critically, they can provide better and more convenient access to health services for patients and the public,” he said.

CPE chief: Vision will encourage policymakers to think differently 

CPE chief executive Janet Morrison said the vision “lands at a pivotal moment” as it continues to iron out the details with the government about its £645 million investment and braces itself for negotiations on April 2024 and beyond.

“With community pharmacies in crisis, the sector needs to influence more effectively than ever before and working with a wide range of partners who also have influence in Government and the NHS, like these two leading think-tanks, is an absolute must,” she said.

“For some pharmacies this vision will not feel bold enough. For others, achieving the services set out will feel like a pipedream. Many of you will rightly wonder whether the many barriers and obstacles that Nuffield Trust and The King’s Fund have identified to achieving this future can be overcome.

“But in this vision, the think-tanks have sought to balance the full spectrum of pharmacy’s views, positioning the sector as the solution that it is, while also describing what needs to happen to help pharmacies thrive. Independent experts setting a clear direction like this will be a very powerful tool for us.”

Morrison insisted the vision will “encourage policymakers to think differently about what the pharmacies of tomorrow could look like and how we can make them a reality.”