The perfect storm in which the NHS finds itself has created a huge opportunity for pharmacy, argues Graham Phillips, owner of the Manor Pharmacy Group in Hertfordshire

DESPITE ITS CURRENT PROBLEMS, we should never underestimate the love affair the British public has with the NHS. Nor should we forget that the NHS comes out top or near the top in virtually every available measure when compared with all other health systems around the world.

As a percentage of GDP, the UK spends less than either the EU or OECD averages, which makes the performance of the NHS simply stunning. However the NHS is much more than a health system: in the psyche of British citizens it is a social movement that enshrines some very British values – personal and political freedom, religious and social tolerance, the universal right to a decent education and, of course, universal free healthcare.

But is it sustainable? The long-term sustainability of the NHS was a question the Blair Government sought to answer. It commissioned Derek Wanless (a banker – don’t ask) to consider the issue and he concluded (in 2002) that the key was to involve citizens in a debate about their own health – in other words we could not expect to smoke, drink and over-eat our way through life and assume, like Humpty Dumpty, that the NHS would be able to put us back together again.

Wanless described how individuals should be “fully engaged” in looking after their own health and he even put money on it: a cool £20 billion a year. Wanless’ strategy was broadly ignored but it turns out that, in cash terms, he was bang on the money.

In 2008, Sir Michael Marmot, a leading public health specialist, published his seminal report on health inequality and the social determinants of health. It turns out that the key influencer on your health isn’t your GP after all – it’s your social circumstances and the parenting you receive in your early years.

Influencing the resulting “social gradient” was the key to tackling health inequality and would pay massive economic dividends as well as saving billions of pounds for the NHS. Sadly Marmot fell out with the current Government and his work, like Wanless before him, has not been fully progressed. The NHS has recently appointed a new CEO, Simon Stevens, who last year, to great fanfare, published his strategy for sustaining the NHS – the Five Year Forward View. Guess what? It’s all about Wanless and Marmot.

Paradigm shifts

So what has any of this got to do with pharmacy? Well, what’s needed are paradigm shifts, not small incremental changes, and community pharmacy sits at precisely that paradigm. There are more daily visits to UK pharmacies than the rest of the NHS put together. Statistically, patients visit their GP once a year, but visit their local pharmacy once a month – and not just when they’re ill. Pharmacists are perfectly placed at the intersection of health and social care to help people “mind the gap” between the two.

Spotting the early signs of dementia is just one example. Given the desperate shortage of GPs, the NHS financial crisis and the oft-mentioned potential contribution pharmacy could make, it would seem like a no-brainer but, as we all know, it’s simply not happening. So what is the solution?

Simply adding core services to the national pharmacy contract would deliver the pace and scale of change the NHS needs. In terms of public health we could use the healthy living pharmacy approach as a template for a pharmacy QOF. It just doesn’t make sense to have 150 different smoking cessation services, each with its own individual administration costs and procedures.

So for those public health services that are universally required, why not commission them nationally? I propose that smoking cessation, sexual health, alcohol services, obesity, weight management and common ailments become national services – there are probably others too. The service specifications would build in quality and outcomes as prerequisites. For other commonly needed services (e.g. drug misuse) there would be a series of templates (no more re-inventing wheels), but these would be commissioned locally as appropriate.

There would still be a need to develop new and innovative local services, but moving everyday services to a national level would free up local capacity to pioneer locally commissioned services. There could be a national pharmacy innovation fund to bid against. The pioneers could be networked. That way best practice would be identified and spread, and innovation would be implemented that much sooner. But all that will only happen if NHS England actually wants it to.

Political clout

If the Secretary of State for Health wanted to, he’d make it happen. But Jeremy Hunt is ignorant of pharmacy. All he can see are the doctors and the nurses. Every now and then he utters a few platitudes about pharmacy but, in truth, it is just meaningless political rhetoric. Is Jeremy Hunt’s ignorance his fault or ours?

We have to accept some share of the blame. Why? Because we haven’t done anything like enough to raise the profile of the profession. Nearly all the pharmacists I encounter proudly proclaim that they “don’t do politics”. Politics is, for some reason, a dirty word – and yet so much of our professional future is dependent upon the decisions of politicians.

By comparison, the other health professions are past masters at understanding the political process, pressing the buttons of professional aspiration and pulling the levers of financial success. They talk about patients and “tell the stories”, whereas we tend to talk rhetorically. We need to become much smarter at this if we are to compete effectively in the realpolitik of healthcare – for as long as pharmacists continue to fight shy of politics, we will continue to punch below our weight in terms of achieving our professional ambitions. Ignoring politics is professional suicide.

Pharmacy gets forgotten when health policy is developed and lazy politicians tend to use “doctors and nurses” as shorthand for the NHS. Why? Because we allow them to get away with it. And this rubs off on the public too. We need to find much more effective ways to address this. I have long argued that all the pharmacy bodies should work together to maximise their effectiveness and create a more visible presence for the profession.

We need to invest far more in activities that support and give a strong voice to the aspirations of the profession. When I talk to pharmacy audiences, I am often asked what the national pharmacy bodies are doing about a particular or contentious politic issue. My reply is often, “tell me what you are doing about it”.

We have one massive advantage that we must make more of: 12,000 pharmacies in England that could and should function as a living portal for the pharmacy message. Every time a member of the public goes into a pharmacy – and there are millions of ‘hits’ a day – we have the opportunity to make a good impression, communicate a message and demonstrate why we matter to an audience of more members of the public, patients, carers, politicians, medical professionals and journalists than the pharmacy bodies can ever hope to reach.

Pharmacies and pharmacists are our own best PR. Successful public affairs work is built upon sustained day-to-day contacts and briefings across all political parties, punctuated by ‘big bang’ campaigns.

Unite and campaign

So how about we all unite around a simple campaign – “How Pharmacy Can Save the NHS”. As part of the campaign we would need to keep stressing the following key themes:

• The shortage of GPs and the huge deficit means the NHS has to think differently

• Pharmacists want to support GPs and work with, not compete against them – so let’s align our contract with theirs

• Let’s have a national common ailments service. It would save 57 million GP visits a year and reduce unnecessary prescribing of precious antibiotics

• We need national commissioning, via the healthy living pharmacy model, of key public health services (obesity, sexual health, smoking, alcohol)

• Community pharmacists should take over repeat prescription management

• With individual patients’ consent, community pharmacists would have read-write access to their electronic health records

• If pharmacy is to be a sustainable profession, we need a cap on student numbers, just like the other health professions.

All we need is one poster, printed in various sizes, and displayed in every pharmacy window, and a leaflet which can be handed to each of the 2 million people who visit a pharmacy every day. Let’s leave no stone unturned. We can access every member of the public, every local and national politician, health colleagues and journalists.

We must lobby every MP and invite them to a local pharmacy in their constituency. Offer them a photo opportunity and do some pharmacy “show and tell”. Would it work? The strength of the pharmacy organisations working together from their different perspectives was demonstrated beyond doubt a few years ago when the Office of Fair Trading proposed a free-for-all market in community pharmacy.

The organisations – and, most importantly, individual pharmacists themselves – mounted a vigorous lobby to communicate our concerns to the public, who swamped politicians’ mailboxes with letters of support for our position. All of this was at the time of the Gulf war.

Besides pharmacy, the only issue mentioned more in the House of Commons was the war itself. In turn, politicians across all parties backed pharmacy’s cause – a highly unusual result, politically speaking. Scotland and Wales entirely rejected the plans and in England, the Government backed away from the OFT’s position with its so-called “balanced package of measures”. This was admittedly a fudge but we kept up the pressure and now no more 100-hour pharmacy contracts will be issued.

Perfect storm

The perfect storm in which the NHS finds itself creates a huge opportunity for pharmacy. The desperate lack of GPs and shortage of cash means politicians and commissioners are searching for answers. Tweaks won’t do it. There’s a growing realisation that pharmacy has many of the answers. However, as Dr Judith Smith of the Nuffield Trust said in response to the Five Year Forward View, although pharmacists could be the key to unlocking some of the intractable problems facing the NHS, until the profession finds the unity and clout to overcome the barriers, it may miss the opportunity to open the door to new models of care.

Outside the profession there is growing support from patient groups, the NHS Alliance and senior politicians. There is growing recognition of pharmacists’ potential from the BMA and RCGP. Will pharmacy be passive and once again snatch defeat from the jaws of victory? Only time will tell…but one thing’s for sure. Doing nothing will achieve nothing. Our future lies in our own hands.

Plan to save the NHS

• The NHS has to think differently and radically

• Align the pharmacy and GP contracts

• Introduce a national pharmacy common ailments service

• Nationally commission pharmacy public health services

• Pharmacy should manage repeat prescriptions

• Give pharmacists readwrite access to patient records

• Cap pharmacy student number