Opinion: Strategy needed for the bigger picture

We have never had a National Health Service. In 1948 Aneurin Bevan created a national illness service. Yet the NHS is now as close as we get to a national religion with politicians holding it in awe and its founding principles taken as gospel.

We are trapped in a psychology that does not measure the success or failure of the NHS on metrics of health (life expectancy, quality of life) but on disease treatment and investment in disease treatment (waiting lists and building programmes). Politicians continue to promote this narrative – Boris promised 40 new hospitals in 10 years and all mainstream political parties campaigned on the basis of more NHS investment. But the telescope is being held the wrong way round. 

As primary care clinicians, community pharmacists are crucial to not only delivering an expanded range of clinical services but also to championing wellness and delivering a broader health agenda. The funding of the NHS is at an all-time high, so why is morale and confidence plummeting? Sir Kier has rightly described the NHS as “broken”. Fixing things requires new thinking even if there is no new money. 

Despite the opportunities that have opened up for community pharmacy – Pharmacy First (a rushed scheme, which many GPs have yet to fully understand) and the vaccine programmes – with reduced financial and human resources the sector’s capacity to deliver and help with this fix is fundamentally diminished. The current contract places pharmacy in significant retreat – points of light in our communities are being extinguished at the rate of 10 a week.

Insolvable problem

Satisfying healthcare demand will remain an insolvable problem. Over decades the lion’s share of extra investment has gone into secondary care (delivering ever smaller benefits), while investment in primary care and public health has stagnated or, for community pharmacy, gone into reverse. Despite numerous pledges, no government has yet grasped the nettle of community care.

David Cameron established health and wellbeing boards (HWBs) under the leadership of local authorities, recognising that many key health determinants lay outside the healthcare sector. By helping to integrate primary and community care, they allow health to be discussed in a more rounded setting with, for instance, practical ways for public services to prevent falls in the elderly. These boards have never been fully developed and the pressures on local council budgets saw public health financial resources diverted to other services. An opportunity missed?

Medicine continues to advance but the by-product of this is that patients subcontract their health to clinicians. With a narrative focused on NHS targets, we have a system that all too easily treats disease but fails to promote wellness or personal responsibility. 

As pharmacists we can talk to patients about their polypharmacy – different tablets to treat related conditions – and blood pressure, high cholesterol, diabetes, depression. However, the most effective treatment, exercise, costs nothing. 

River of ill health

Little investment goes into stopping patients falling into the river of ill health. It is spent on the expensive rescue missions further downstream, which creates good news headlines but does not tackle the prevention issues – so the cycle continues. The system does not incentivise deprescribing, properly promote wellness or encourage personal ownership of health. 

It is investment in primary care services – particularly community pharmacies – anchored in our communities with a focus on wellness that can change this narrative. We see patients first and can intervene fastest.

After over 30 years I am delighted to at last be able to use my training and treat a range of conditions through the Pharmacy First scheme – impetigo, shingles, infected bites, UTIs and all the rest – but the real benefits to health will come when I and other primary care clinicians are empowered to help patients remain healthy and ‘own’ their own wellness.

Like many colleagues I took the NHS title “clinical pharmacist” for GP practice-based colleagues to be a careless insult to the majority of the profession. However, we own the word “community”, which gives us a powerful platform to promote community-based clinical and health services and play a fundamental role in the solution. 

We earned a huge amount of respect during Covid and recently all parties praised our work during the election campaign. We are ready to work with any government to deliver health and need a continuing two-way dialogue focused on community-based support, both practical and financial, to enable us to do this.

Graham was Leader of West Berkshire Council from 2005-12 and 2017-19 and chair of West Berkshire Health and Wellbeing Board between 2010-2012 and 2014-2017. He is a former member of the Public Health and Pharmacy Forum and has been a community pharmacy owner since 1986.