The Opportunity for Community Pharmacy in Primary Care Networks :: C+D
A PCN is a network of medical practices covering approximately 30,000 to 50,000 patients each. First announced as part of the NHS’s long-term plan, around 1,000 PCNs will be in place by Monday (July 1) when the new contract takes effect. NHS England says it will be “responsible for providing integrated health and social services through multi-professional teams to patients in the community”.
NHS England has predicted that within four years a typical PCN of 50,000 patients could employ around six full-time ‘clinical’ pharmacists. They will be among the 20,000 staff NCPs recruit in total across the country, mostly funded under the GP contract. By 2023-24, the cost is expected to equate to £1.79 billion, or £1.47 million for an average network.
But how does community pharmacy fit into all of this?
Although GPs will play a ‘leading role’ in NCPs, they should collaborate with a ‘wider’ group of healthcare providers which will ‘include community pharmacy’, says NHS England in its advice for local pharmaceutical committees (LPC). He expects each PCN to have 10 or 11 community pharmacies in its catchment area.
“The community pharmacy team can be part of PCNs as delivery partners, being an active member of the multidisciplinary PCN team and meeting regularly with other PCN clinicians,” continues NHS England. The sector “will become an integral part of these new networks” thanks to local engagement, he insists.
Although its plans do not include direct funding for community pharmacy, NHS England is committed to expanding PCNs beyond general practice. “Collaboration with non-generalist providers, such as community pharmacies, will be a requirement for NCPs from April 2020,” it says.
NCPs are responsible for providing seven “national service specifications” which have been defined in the General contract:
- Structured Reviews and Medication Optimization
- Improving health in nursing homes
- Long-term conditions
- Personalized care
- Support early diagnosis of cancer
- Prevention and diagnosis of cardiovascular diseases
- Fight against neighborhood inequalities.
There is a clear overlap with pharmacy offerings, and industry leaders were quick to point out the potential of getting NCP-commissioned services.
Community pharmacy will be “crucial”
Ravi Sharma, director of England’s Royal Pharmaceutical Society (RPS), says community pharmacies should play a ‘crucial’ role.
The RPS envisions the pharmacy building on existing relationships with primary care providers through NCPs, he explains. “For many years, pharmacists and their teams have worked in collaboration with healthcare professionals in all primary care settings. We want this to grow with the NCPs.
He points out that pharmacists will not be limited to working in the networks’ medical offices. “While general medicine will be at the center of the NCPs, the NHS long term plan makes it clear that pharmacists do not need to be employed directly by GP practices or NCPs. It opens the door to new ways of delivering care that involve pharmacists from across the NHS, including community and hospital colleagues,” says Mr Sharma (pictured below, left).
“I personally believe that NCPs provide a new opportunity for community pharmacies to explore how they can be involved in helping NCPs deliver new and innovative services. I don’t think the community pharmacy will be forgotten.
But how can community pharmacies make the most of this “opportunity”? Leyla Hannbeck, director of pharmacy for the National Pharmacy Association (NPA) (pictured below), says they need to be proactive and start making connections now. “The NHS long term plan and GP contract made it clear that community pharmacy has a role to play. Contractors should work with LPCs to ensure they are ready. »
His advice reflects NHS England advice for pharmacy teams, which says community pharmacies will need to “find a way to work more closely with each other at the local level, to enable NCPs to engage effectively with the sector”. The Commissioner sets out a four-step process for LPCs to engage with NCPs (see below).
Ms. Hannbeck continues, “At the moment, it’s about demonstrating the value of community pharmacy. It’s not just about letting things happen. Mr Sharma agrees, saying pharmacies need to work “in collaboration” with NCPs. “The exact role that community pharmacies will play in PCNs will be up to the PCNs and community pharmacies to work together and agree.
“Strong local pharmacy leadership is essential to ensure the full integration of pharmacy. »
“A once-in-a-generation opportunity”
General Pharmacist Graham Stretch takes on a leadership role in the networks as Clinical Director of Brentwood PCN. He says he has been encouraged by the level of commitment he has seen from community pharmacy teams. “A refreshing spirit of optimism and collaboration is emerging,” he says.
“This is a unique opportunity to engage our profession in the delivery of pharmaceutical patient care both in practice and in community pharmacy,” says Stretch (pictured below), who is also president of primary care pharmacy. Association.
It’s an exciting time for pharmacy, but the industry shouldn’t wait for an invitation, he says. “The profession needs to make sure its feet are under the table and its voice is heard. Community pharmacy has enormous potential to contribute to public health in areas such as smoking cessation, sexual health, lifestyle counseling and long-term management of conditions.
“Pharmacies with longer opening hours provide an opportunity to grow as extended access sites. I would love to see NCPs develop pharmacy roles as frontline healthcare professionals.
“Pharmacy will be critical”
Fin McCaul, the Pharmaceutical Services Negotiating Committee (PSNC) regional representative for the North West of England, agrees that community pharmacy should play an important role in NCPs. However, they may not be the focus at first.
“It has been indicated that next year this will be rolled out more widely, and community pharmacy should be a critical part of this network at this stage,” McCaul says (pictured below).
“The networks are just getting started,” he explains. “The initial aim is to try to bring GPs together, which historically few people have done. They also aim to enable the region’s clinical network to develop multidisciplinary teams, reduce the burden on practices and integrating social prescription into networks.
Pharmacies must anticipate. “To prepare for the next step, it will be important to develop your relationships with the local health and social care sectors, so that community pharmacists in the region can understand what ‘working together’ will mean.”
A head start in Yorkshire
In West Yorkshire, community pharmacy has already started to prove what it can do in PCNs. Amanda Smith, pharmacy representative for the Central Halifax NCP, says about two-thirds of county networks already have community pharmacy representatives.
Bradford has had a PCN for two years, while Leeds has already set up an inhaler verification service through one of its PCNs, says Ms Smith (pictured below), who is also vice-president of Community Pharmacy West Yorkshire. But “in central Halifax, we got settled in December 2018, so we’re just getting started.”
“It seems a bit more focused on GPs, because of the way the funding has been put together. Meetings are primarily made up of people from a generalist background, but seek to utilize other resources in the area.
One of Ms Smith’s top priorities has been to create local networks of community pharmacies, as they have traditionally “tended to be quite isolated”, she says. “We didn’t work together [before]. It’s one of the things we’re trying to get people to do more of. She did this by creating a Telegram messaging group and hosting events.
Ms Smith points out that it is not easy for community pharmacies to engage with NCPs, with funding cuts leading to staffing issues and a new contract remaining woefully out of reach. “The ability to do additional services is not great.”
“Ahead of the Game”
Raj Radia, chairman of City and Hackney LPC, says his region has also prepared – through primary care ‘neighborhoods’.
“In some ways we were ahead of the game. We have funds and we use them to fund the pharmacists responsible for each area,” says Mr Radia, owner of Spring Pharmacy in Hackney. “Community pharmacy needs to be represented at NCP meetings because you can be sidelined,” he says.
The sector clearly has the opportunity to integrate into the center of primary care with NCPs and has already started to play a role in parts of England. But although networks should engage with organizations other than GPs and expect pharmacies to help them achieve their goals, it is up to each pharmacy to decide how important the role is. that she will play locally. The sector must act now to ensure it is not left behind.