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Speaking up for community pharmacy
Issue 98, 23rd December 2016
The future: Rob Darracott looks ahead to 2017 and asks, 'what next for community pharmacy?'
Over the course of the last year, when I have been asked to talk about the state of community pharmacy, and how, at a time when the NHS is crying out for pharmacists’ skills (and putting them into urgent care hubs, A&E departments, and another 1500 GP practices in an announcement this week), the Government is implementing a swingeing pay cut to community pharmacy budgets. 

My answer has always been to start with context.

Last week saw the publication of Richard Murray’s Clinical Services Review (CSR), as important a document as there can be in terms of what happens next after such a difficult 2016.  His start point?  Page 1.  Context. 

Changing patient and population needs for healthcare.  An ageing population with multiple long term conditions.  Emerging models of pharmaceutical care provision in the UK and internationally.  Evidenced sub-optimal outcomes from medicines in primary care settings.  The need to improve value through integration into patient pathways, and service redesign of all aspects of care.  Not just doing things better, but doing better things to get anywhere close to a financially sustainable NHS.

We might have read it all before, but have we taken it in?  How does our response so far measure up against the context which Richard Murray sets his review, and which is, whether we like it or not, the context in which community pharmacy must operate?

The Five Year Forward View is the system vision for health and care in England.  Its approach, through five new care models and Vanguards, moves us towards greater NHS localism.  And while the 44 Sustainability and Transformation Plans (STPs) may not be quite as local as they look, these “place-based plans” show how local services are to evolve to deliver the 5YFV vision of better health, better care and improved efficiency. 

The Murray Review, and the accompanying evidence paper, point the way forward.  Its recommendations to NHS England are developmental:  ongoing monitoring within care pathways for long term conditions, case finding, and independent prescribing underpinning community pharmacy-based clinical services.  All these elements reflect strongly the way forward described in the Community Pharmacy Forward View (CPFV), although if anything, the ambition set out by the pharmacy bodies went a lot further. 

The context provides the “why”.  Murray and the CPFV are aligned on “what’s next”.  And NHS England have £282m sitting in an Integration Fund to explore doing things differently, to test and evaluate new ways of working over the next four and a half years.  So, for community pharmacy, the immediate future must shift to “how”. 

Richard Murray recognised some of the barriers to change.  But there are things we need to fix too if we are to respond to the 2016 context – sub-optimal outcomes, isolation from the rest of primary care, a cash strapped NHS tasked to do more with less, the importance of local. 

Pharmacy Voice’s ambition for the future, as outlined in the CPFV, is clear: we want to get to the point where people choose the community pharmacy services outlined in the CPFV/CSR because they are aware of what’s available, trust its quality and feel confident it will deliver what they need.  And commissioners are convinced of the value of community pharmacy services, and the contribution pharmacy teams make to health improvement. 

Setting out a vision for the future is easy; turning it into reality is not.  The roadmap for achieving it needs to be similarly ambitious, while running to a realistic timetable.  Above all, it needs to recognise that we must do better, at working with patients and the public, at building partnerships across the health and care system, and at empowering the workforce with new skills while harnessing technology to create the capability and capacity to deliver.  Most importantly, it needs to recognise that change does not happen by accident.  If we are to be ready, and look and sound like we are, then for change we need a strategy, momentum, resources and support. 

The national representative bodies have worked together over 2016 on the Support Your Local Pharmacy campaign and to develop the Community Pharmacy Forward View.  Whatever 2017 brings for Pharmacy Voice, the 11,500+ pharmacy teams across the country deserve effective leadership, committed to creating an environment that enables community pharmacy to take a place around every table, while ensuring our representatives have something constructive to say and the confidence to commit to delivery when they get there.
 
As I said at the beginning, this year I’ve started many a conversation with context.  I’ve usually finished with change.  I can’t see the context changing, so if we want something different in 2017, then we need to change our context.  Are we ready?  Because, if we are, then 2017 is the year we all need to get fired up. 
Read the CPFV
More news & views
NHS England publishes guidance on gateway criteria for new Quality Payments Scheme
NHS England has, today, published guidance on the qualifying criteria for its recently announced Quality Payment Scheme.
 
The scheme was announced in the pharmacy settlement in October and represents the first time that performance will have a direct determining factor in community pharmacy remuneration.
 
Funded from the reduced overall global sum imposed by the Government, up to £75 million will be made available to community pharmacies that meet certain requirements.
The guidance covers the gateway criteria, the four criteria that must be met to qualify for any payments under the quality criteria themselves, which are:
  • the contractor must be offering at the pharmacy Medicines Use Review (MUR) or New Medicine Service (NMS); or must be registered for NHS Urgent Medicine Supply Advanced Service Pilot; and
  • the NHS Choices entry for the pharmacy must be up to date; and
  • pharmacy staff at the pharmacy must be able to send and receive NHS mail
  • the pharmacy contractor must be able to demonstrate ongoing utilisation of the Electronic Prescription Service at the pharmacy premises.
Qualifying pharmacies will be eligible to receive payments, should they accrue sufficient points, in April and November 2017.
 
The guidance details the support pharmacies can expect in return, including the further development of the NHS Choices website to make it easier and clearer for pharmacies to update their NHS Choices entry and making NHS.net email accounts more accessible.  Further guidance on the quality criteria themselves is promised for next month.
 
In response to the publication, Rob Darracott remarked:
 
'It’s essential that community pharmacies embrace the scheme – significant amounts of money are on offer for following and demonstrating good practice and, in the context of the reduced funding overall, there is an opportunity to recoup at least a portion of what is being lost. And while this is vital for contractors, who will want to engage as a means of mitigating the cuts, which will be much greater without, I hope that most also do this because continuous quality improvement is a fundamental element of the context in which all NHS professionals operate. 

'I am sure the majority of colleagues will be able to qualify for these significant payments, many with only minor adjustments or by keeping more detailed records, and LPCs up and down the country are, I know, already putting in place programmes to support achievement of the criteria. 

'Both gateway and quality criteria are important in demonstrating that pharmacy is ready and able to deliver the kind of services recommended by Richard Murray’s Clinical Services Review and our own cross-sector Community Pharmacy Forward View”.
Read the new guidance
Seasons greetings from everyone at the PV team!
Its been a very busy year for everyone involved in community pharmacy and we've all faced some pretty daunting challenges. And while not everything has gone as well as we might have liked, the team at PV remains the sector's biggest fans!

We continue to rely on your hard-work and ingenuity as we work to promote the sector's emerging vision for the future - the Community Pharmacy Forward View - throughout 2017.

Oh, and a big thank you for the amazing cards and presents we have received in the office - while we're grateful for the chocolate, some of us have had to start working on our New Year's resolutions a little earlier than planned...
One of the many presents received at PV towers (other brands of chocolate are available!)
Thank you all for your support in 2016 and Happy Holidays from everyone in the team

Please note that the office is now closed until 3 January - see you in 2017!
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