The NHS should commission community pharmacies – and not just pharmacists employed by primary care networks – to provide structured medication reviews, the National Pharmacy Association has said as it published its ‘medium-term prospectus’ for the rest of the 2020s.

The ‘Making changes, meeting needs’ report, published today (July 13), makes a number of recommendations for how the community pharmacy sector can evolve to meet the changing needs of the NHS and patients, noting that previous ‘vision’ strategies have “tended to take as their starting point what the sector is good at and work outwards from there”.

Among the report’s recommendations is a “community pharmacy-based SMR offer with wraparound interventions enabled by independent prescribing,” with the pharmacist given full access to patient records and allowed to “send off for specific clinical indicators such as blood tests” so they can titrate medications as needed and identify adverse issues affecting the care of long-term conditions.

Criticising NHS England’s current approach, the NPA said: “Locating SMRs principally in GP practices means the opportunity has so far been missed to mobilise the community pharmacy network in this space.

“The community sector has huge potential to reduce harm from medicines and achieve better value for health systems by tackling waste.”

'Full prescription management role'

Other recommendations in the wide-ranging report include: rolling out pharmacogenetic testing capabilities to pharmacies; building on the New Medicine Service to create an ‘NMS+’ allowing independent prescribers to adjust prescriptions to tackle adherence issues; ‘reimagining’ pharmacy’s disease prevention offering and aligning it with the wider NHS; and giving pharmacists a “full prescription management role” with oversight of end-to-end supply.

The prospectus also calls for a greater role for pharmacy in managing long-term conditions like asthma, hypertension, heart failure and diabetes through measures such as the proposed NMS+ and an enhanced – and better funded – Discharge Medicines Service.

The NPA identifies several ‘enablers’ needed to meet these ambitions, including more Government investment in the sector and a “new deal” contractual framework that would give the sector “a degree of independent financial regulation” to address the power imbalance in funding negotiations, as well as a “fair deal” for independents with regard to medicine prices.

 'Challenging orthodoxies'

NPA chair Nick Kaye said: “Building out from the existing portfolio of services, there are some major opportunities within this decade, encompassing prevention, medicines optimisation, long term medical conditions and urgent care. 

“We are seeking to challenge orthodoxies that have limited the sector’s scope for too long.  At the same time, these ideas are firmly planted in reality because our start-point is what our paymasters in the NHS want, not what we can dream up. 

“Some of this is about redrawing the borders of pharmacy practice - for example applying pharmacogenomics to pharmacist prescribing.

“Other aspects are about re-imagining what is our domain as a sector; we are rightly based firmly in the community but our impact ought to be felt and formalised across the entire system, including hospitals.  We need to be ‘in the community but out of the box’.

“We are confident that the large majority of NPA members – by their nature innovators – are open to the idea of ambitious, transformative change.”  

In her foreword, Surrey Heartlands Integrated Care System chief executive Dr Claire Fuller welcomed NPA recommendations such as “building on hospital touchpoints” to address issues upon patients being discharged, and said: “I am delighted that the National Pharmacy Association is continuing to push a can-do agenda for the sector.”