Listening to reaction to the chancellor’s Autumn Statement on 3 December, anyone would think that Simon Stevens’ NHS Five Year Forward View was no more than a clearly made case for more money for the NHS.
But the cornerstone of the forward view is the new models of care that will unlock change in the NHS: from GP networks becoming large scale community services providers, to district general hospitals as hubs of new accountable care organisations.
Outside Westminster, the report has opened up a much needed conversation among practitioners and the health policy community about how the NHS can adopt these models of care and make them work in different localities.
Buried within the alphabet soup outlining the various models is something that has not gone unnoticed by seasoned primary care researchers such as myself: pharmacists are vital to many of these new care models.
They feature in the report’s description of multispecialty community providers, urgent and emergency networks, and in how NHS England envisions the future of primary care. If we are to make reducing emergency admissions of frail older people a priority, pharmacists are needed to help address the unacceptable level of medication related hospitalisation in the NHS.
Generations of commentators have highlighted the potential for pharmacy to help the NHS become a more efficient and community based system that is better equipped to help people manage long term conditions.
Pharmacies are located in almost all communities and typically open for long hours. On any one day pharmacies have the highest number of contacts with the public of any part of the NHS.
In some areas, such as Bromley-by-Bow, pharmacists are already treating patients for minor ailments within a local primary care network. In others such as Enfield, they are working with care homes and older people’s teams to help people manage their conditions.
But despite this potential, pharmacy has historically been overlooked in NHS policy by management. Fragmented leadership, arcane funding arrangements and difficulty gaining access to policy debates have obscured just how much pharmacists could contribute to solving many of the NHS’s most pressing problems.
The profession is, of course, encouraged by the forward view. After years of NHS policy with barely a mention, a vital strategy document puts pharmacists at the heart of the health service’s most interesting proposals.
So, now that the case for pharmacists moving beyond their traditional role as suppliers and dispensers of medicines, to one more focused on direct care is made at the highest level, can pharmacy rise to the challenge? If only it were that simple.
Now or never
A year ago I chaired an independent Royal Pharmaceutical Society Commission on Future Models of Care. The innovative ways I saw many pharmacists working convinced me that their time had come. Our report, Now or Never: Shaping Pharmacy for the Future, urged pharmacists to seize the opportunity to move into care giving.
We issued a rallying cry for the leadership of the profession to unite and help pharmacists overcome barriers that had prevented their full involvement in the future shape of health and social care.
But a year on, many barriers remain. The Nuffield Trust has been asked by the Royal Pharmaceutical Society to examine progress made in the first year since the commission. It draws on interviews with senior local and national healthcare leaders, and a survey of pharmacy stakeholders.
At a local level pharmacists continue to develop innovative models of care, but these lack scale. The leadership of the profession is still struggling to get its message across to funders, commissioners and policy makers. The fragmented range of representative bodies within pharmacy makes it harder for the profession to articulate the role it can play in Mr Stevens’ NHS.
Despite the encouraging place that pharmacy occupies in the forward view’s vision for regional urgent care networks, there has been little progress nationally in shifting the focus of the community pharmacy contract towards service delivery. This is needed if pharmacists are to be convinced that policy makers are serious about supporting their wider care giving role.
The Royal Pharmaceutical Society was prescient in commissioning work on new models of care in early 2013. Back then it seemed unlikely that pharmacists would be included in a policy document that would set out the future direction for all sectors of the NHS.
Pharmacists could be the key to unlocking some of the intractable problems facing the NHS, but 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.
A version of this blog also appeared in the HSJ.
Smith J (2014) 'Pharmacists as care givers can make the forward view come true' Nuffield Trust comment, 17 December 2014. https://www.nuffieldtrust.org.uk/news-item/pharmacists-as-care-givers-can-make-the-forward-view-come-true