It is vital that the Community Pharmacist Consultation Service demonstrates that pharmacy wants to be better integrated into the NHS and can deliver quality clinical services, argues Michael Holden of Pharmacy Complete.

When it was launched in January 2019, the NHS Long Term Plan spoke of NHS 111 referring people on to community pharmacies. Here we are in the winter of the same year and the service is now live. Who knew the NHS and DHSC could actually move that fast?

The Community Pharmacist Consultation Service (CPCS) was launched on the back of the excellent results from the Digital Minor Illness Referral Service pilot in the North East and as part of the new contractual framework negotiations.

By incorporating the NUMSAS urgent supply service, the aim is to integrate community pharmacy into the NHS, manage the challenges related to urgent and emergency care, and underline the NHS’s desire to promote self-care and ownership of individuals’ health.

From recent conversations with pharmacists, I gather that the numbers being referred are still fairly small and that it will be a slow burn. While pharmacy cannot promote the NHS 111 option itself, the Help Us Help You campaign generally promotes NHS 111 and utilising pharmacy.

Also, the numbers of referrals from GP practices in the pilot areas are looking very promising. Certainly the GPs I speak to can’t wait for the opportunity to embrace the service.

Reflections

When the Healthy Living Pharmacy (HLP) initiative was developed 10 years ago, it was in anticipation that community pharmacy could and should play a bigger role in improving the health and wellbeing of our communities.

It was predictable then that a supply-based contract would not continue and that a shift to a quality-led, service-based contract would come. Hence the continued focus on organisational development.

One key aspect of the HLP model was evidencing outcomes for patients, the commissioner and pharmacy. Whilst completing the referral and consultation loop is the requirement for the CPCS, one could question what qualitative and quantitative outcomes are sought from this service.

What we do not want is a repeat of the MUR situation where the Government said there was insufficient evidence of benefits from the service and decommissioned it. So having the right culture and skills in place to deliver a great experience for patients is critical for a sustainable future.

Why is this service so important?

For community pharmacy the CPCS is, in essence, what pharmacists already do, but within a digitally supported and funded service framework that drives traffic to pharmacy, rather than away, whilst retaining the triaging and referral approach for red flags.

Yes, the revenue as it stands will not replace all the funding lost from the demise of establishment payments and MURs, but it is what we’ve got – so we must embrace it and demonstrate quality outcomes.

It is also an opportunity to grow OTC medicines business, particularly P medicines, by delivering a great clinical experience for patients.

Getting it right

As consultation numbers are still relatively low, albeit growing, there is an opportunity to perfect the in-pharmacy process. However, pharmacy cannot afford to have the slow uptake there was with MURs and NMS.

As with any new service, planning is key. This requires all team members to under-stand why the service is important; how it will be delivered; and what the benefits will be to patients, the pharmacy and the NHS. The service specification¹ is a starting point and explains the ‘how’, but it needs effective leadership and communication to drive full engagement.

An engaged and informed team that understands where you are going and why, wants to go with you, feels connected and safe to be involved, and feels valued, will always deliver more, as the Engage for Success infographic shows.²

Once the team is onboard, there are some practical enablers to make the service efficient and effective:

Service specification
Read and fully understand the requirements and processes.

Learning needs analysis
Identify and address any clinical knowledge and communication skill gaps:
• For pharmacists (and locums), including red flags
• For the pharmacy team.

Delegation and teamwork
• Who is going to monitor referrals through PharmOutcomes or Sonar Informatics and how?
• Who is going to act on them?
• How will the team react when a patient makes contact or presents at the pharmacy?
• Develop a SOP based on the templates provided
• How do you create the time for the pharmacist to deliver a quality experience by approp-riately delegating tasks that he/she does not need to do?

Premises and technology
• Notify NHS England that you intend to provide the service through the MYS platform
• Ensure the information on your DoS is up to date so your pharmacy can be offered as an option to patients
• Let the local GP practices know that you are providing the service and agree the best way to refer red flag patients
• Ensure the consultation room reflects a healthcare environment and that everything is in place (including IT connectivity with access to the SCR and shared NHSmail) to deliver an efficient service and great patient experience.

What could it lead to?

This is a service the NHS wants to ‘buy’ from pharmacy to meet its needs, so it is important that pharmacists embrace and deliver it. In doing so, the sector will demonstrate that it wishes to better integrate within the NHS and is able to deliver quality clinical services. It will also make it more likely that a GP and A&E referral service will be added to the current specification in future which, with potentially much larger numbers, should increase the funding.

Some of the testbed clinical services that have started and are planned will create further opportunities to utilise the accessibility of community pharmacy and the unallocated funding in the contract sum, currently around £250m, from 2021 onwards. The proof of the pudding, and all that…

<sup>References
1. england.nhs.uk/wp-content/uploads/2019/10/advanced-service-specification-nhs-pharmacist-consultation-service.pdf
2. engageforsuccess.org</sup>

^{This is a service the NHS wants to ‘buy’ from pharmacy to meet its needs}