The public health white paper recognises the value of community pharmacy, but what slice of the cake will the sector get? Zoe Smeaton looks at the best and worst case scenarios
As a “valuable and trusted public health resource” with a key role to play in smoking cessation campaigns and a chief pharmaceutical officer working closely with the public health community, pharmacy seems to have done pretty well out of the government’s public health white paper. Healthy Lives, Healthy People highlights pharmacy as a valuable profession, with the potential to do much more. And as Alastair Buxton, head of NHS services at PSNC, says: “Securing such a positive endorsement is a huge win and a testament to what’s been happening in pharmacy.”
Best case scenario
Experts agree that in a best case scenario, pharmacy could stand to gain considerably from this white paper. The ability of Public Health England to direct the NHS Commissioning Board could open the door for nationally agreed pharmacy services, Mr Buxton says.
Alternatively the reforms could lead to service templates, Boots UK says, which could enable more consistent commissioning at a local level. Or local commissioners could even be told they have to consider pharmacy as a provider, in DH community pharmacy tsar Jonathan Mason’s best case world.
The services in question could include smoking cessation, weight management and sexual health services, and as Georgina Craig, commissioning community pharmacy network lead at NHS Alliance, says, even some services currently in the GP contract could be up for grabs.
However, rosy as this all sounds, pharmacists would be right to have reservations. “I am concerned that the Department of Health has a track record of praise and promises for community pharmacy, but nothing actually changes. Will it be different this time?” asks James Lindsay, head of corporate relations at AAH.
Worst case scenario
If it isn’t, experts agree the worst case scenario would not make a happy ending for community pharmacy. They warn if pharmacy doesn’t make its case to commissioners, other providers could step in and secure all the public health funding for their own services. As Ms Craig puts it: “GPs [could] make a more compelling case than pharmacy and corner the market in public health services through their inclusion in GMS in areas where pharmacy is starting to grow its evidence base.” There could be no new services for pharmacy, alongside decommissioning of existing services, Mr Mason fears.
John Nuttall, managing director of the Co-operative Pharmacy, says: “A worst case scenario would see nothing concrete happening and huge local variability in terms of accessibility to services and health outcomes.”
Hemant Patel, secretary at North East London LPC, goes a step further, suggesting: “The worst case is that pharmacy is left with very little other than dispensing, then [we see] a reduced number of pharmacies because it will be more efficient to have 20 pharmacies doing 15,000 items a month than 40 doing 5,000.”
Pharmacy can avoid this fate, experts agree, but not without some effort. Andy Murdock, pharmacy director at Lloydspharmacy, says to achieve a best outcome, “pharmacy must step up to the plate and not expect it to be delivered as a matter of right”.
And whether the white paper is a threat or an opportunity “depends on how active pharmacists are in promoting the case for community pharmacy”, Mr Lindsay agrees.
Making the case
Making that case and ensuring commissioners understand the benefits pharmacy services can bring are the keys to success. As Ms Craig says: “How big a slice of the cake pharmacy gets will depend on the quality of its sales pitch to commissioners and the general public.”
But the work must be done at all levels, right down to individual pharmacists promoting their services to GPs and local directors of public health. Boots UK says it will be “essential” for contractors to engage with GP consortia and directors of public health in the future, for example. And pharmacists need to be collecting data on their services and interventions, Mr Mason advises. As Mr Murdock warns: “Pharmacy will need to record data far more rigorously than ever before in order to demonstrate our value.”
Quite whether pharmacy is up to this challenge remains to be seen: a C+D poll last week showed 88 per cent of readers were not talking to GP consortia yet and had no plans to do so. But experts have been quick to condemn those not making the effort and are clear that pharmacy has no choice but to start doing so quickly. Education and guidance from the national bodies and employers may well be needed, but as Mimi Lau, Numark’s director of professional services, concludes: “Pharmacy needs to wake up and act now.”
Five ways to help get the best from the white paper
- “Get to know who’s who in your area – who are the directors of public health? – and put yourself in front of them.”
Jeremy Main, managing director, Alliance Healthcare - “Take small steps: find out what is going on locally, talk to your practices, do some research, talk to others that can help and then develop an action plan.”
Mimi Lau, director of professional services, Numark - “Consider creating pharmacy-led consortia which could engage GP-led consortia. Pharmacies will need to think about collaborating.”
James Lindsay, head of corporate relations, AAH - “Individual pharmacists need to share their success stories with local commissioners.”
Liz Stafford, clinical commissioning lead, Rowlands Pharmacy - “Contractors should develop a clinical business development plan (if they have none) and decide what role they plan to have in delivery of public health services. “
Georgina Craig, commissioning community pharmacy network lead, NHS Alliance