The Changing NHS and Public Health Landscape, is the second such landscape document produced by Pharmacy Voice, and will be followed by further editions. 

The purpose is to give pharmacy representative bodies at local, regional and national levels an increased understanding of current changes and also helps them make projections for the future. 

The document covers key architectural developments, progress of the Health and Social Care Bill, Local Professional Networks and public health. 

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“Our dispensing process is hindered by archaic rules. Our payment system is unreliable and inefficient. There are significant administrative barriers to developing new pharmacy services.  We must tackle this insidious problem. We can no longer tolerate the inefficient reimbursement system. The duplicative approach to service commissioning and accreditation must be reformed. Snipping medicine blisters as a common practice belongs to a bygone era.  With this report, we call on Government and other public agencies to take these matters seriously, so that pharmacists can be released to spend more time doing what they do best – delivering direct patient care”.

The Pharmacy Voice proposals include:

• Overhaul the NHS Business Services Authority Capacity Improvement Programme, so that procedures are transparent, accurate and efficient
• Introduce original pack dispensing and end the routine practice of ‘snipping’ medicines blister packs
• Develop national service frameworks for commissioned pharmacy services
• Less frequent Information Governance declarations
• Re-instate an annual renewal process for professional registration

The Department for Business Innovation and Skills and the Cabinet Office jointly lead the Government’s own ‘Red Tape Challenge’, which was launched in April 2011 and is scheduled to continue until 2013.

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The Prospectus, which builds on last year’s ‘Blueprint for Better Health’, consists of four linked strategic themes: medicines optimisation, public health and pharmacy, quality outcomes and reforming the pharmacy framework, and collaboration with commissioners and clinical leaders.

Rob Darracott, Chief Executive of Pharmacy Voice said:

“The unifying idea in our Prospectus is for community pharmacy to take its destiny into its own hands, by setting a clear direction and striding resolutely in that direction, not waiting for someone else to tell us what to do. Before the year is out we will have a research strategy, an IT strategy and a clear statement of purpose for the pharmacy contract.  These are matters that have in the past been done to the sector, not for the sector, and still less by the sector.

“There are some great ideas in pharmacy, and super developments like healthy living pharmacies. But there are too many shocks in the system and a gradual attrition in margin which is irreversible without profound changes to provide sustainability. Change is an absolute necessity, but it can’t be change for change’s sake.  Last year’s Blueprint started the process of defining where we as a sector need to get to. The Prospectus outlines what we need to do to get there.”

The next step will be to engage pharmacy stakeholders to take forward specific streams of activity.  

Pharmacy Voice chairman, Ian Facer, said:

“This is a call to action for pharmacy networks, representative associations and organisations at local, regional and national levels.  All of us need to take responsibility, to create the future our profession and our patients deserve.” 

• Community Pharmacy - Our prospectus for Better Health

Mike Holden, Chief Executive of the National Pharmacy Association, who was invited to the event said:

“If you look at the progress indicators that local authorities will be measured against – such as fewer falls and smokers – you can immediately see where community pharmacy fits in. Community pharmacy has an absolutely key role in improving the public’s health. During the Q&A, I pressed the Secretary of State on what assurances he can give that community pharmacy will be consistently and appropriately commissioned nationwide and locally in the future. This is important - the Healthy Living Pharmacy initiative demonstrates what can be achieved if the energy of pharmacists and pharmacy teams is backed by commissioners.”

In response to Mike Holden’s question, Mr Lansley stated that community pharmacy needs to work closely with local authorities, Health and Wellbeing Boards and GPs in the future and that the current pharmacy contract needs revisiting as it does not lend itself to this extended public health and wellbeing role.

The Secretary of State’s announcement included more information about the allocation of funding to local authorities to manage aspects of health improvement and illness prevention. Pharmacy Voice convened a round table to local authority representatives last September from which a number of actions are being taken forward.

The outcome indicators are categorised in the framework into four groups: improving the wider determinants of health, health improvement, health protection and healthcare public health and preventing premature mortality.

“The problems are now longstanding, and are damaging to relationships in the supply chain, as well as working against the interests of patients.   

“There are several factors feeding the problem.  Yet the fundamentals of a solution are obvious:  enough medicines need to go into the UK system, medicines distribution needs to be flexible enough to match patient need at pharmacy level, and all parties must observe law and ethics.  The Pharmacy Voice proposals to the parliamentary group address all of these fundamentals.

“The Department of Health, manufacturers and pharmacists signed up last year to the principle that pharmacies should receive medicines within 24 hours of ordering them.  This needs to be treated as a firm and enforceable commitment, not just a nice-to-do.  Meanwhile, some quotas are being applied bluntly.  Instead of mitigating supply problems, adding bureaucracy for all parties, creating inefficiencies for everyone in the chain, and delaying patients from getting the medicines they need.”

Pharmacy Voice is actively engaged in seeking a solution to the problem and encourages all parties to act within the established legal and ethical frameworks, with eyes fixed firmly on the needs of patients.

Rob Darracott, Chief Executive of Pharmacy Voice,said:

“Robust pharmaceutical needs assessment are an appropriate basis for market entry - robust being the operative word.  Unfortunately, PNAs published by Primary Care Trusts in the past 18 months have been, in many cases, substandard and defensive. We would like to see these concerns addressed as a matter of urgency, to underpin implementation of the new regulations.

“As regards market exit, it is an important principle that sanctions for poor quality provision are applied consistently and proportionately.”

“The Department of Health must ensure there are clear time lines for the transition to new arrangements to ensure that public and patients benefit from improved pharmaceutical care without unnecessary delay”.

Pharmacy Voice also calls in its submission for the distance selling exception to be scrapped.  Instead, the NHS Commissioning Board could in future decide on applications for distance selling pharmacies, based on need. 

“We had wide-ranging discussions about the health and well-being roles a of community pharmacy.  Peter was very positive about the clinical expertise and the  wide range of  services available to patients and the general public  in  their local pharmacy.  There’s clearly more that we can do together to improve patient care by helping people to make better use of their medicines and to help them more generally to lead healthier, happier and longer lives.”

Dr Peter Carter, Chief Executive & General Secretary of the RCN said: 

“Pharmacies have transformed in recent years and provide a vital service at the heart of communities.  We talked at length about getting better value from the drugs budget by optimising the use of medicines.  We also agreed that all health care professionals should coordinate their efforts around the needs of patients, both at a local level and across the UK.”    

Stephen Fishwick said:   

“This was a very positive discussion.  It’s great to have a senior representative of the nursing profession speaking in such warm terms about his pharmacy colleagues. 

“The MHRA proposals to repeal the legal clause that currently permits pharmacies to supply small quantities of medicines to GPs and to each other for use in their routine practice are troubling. We will be working closely with MHRA to make sure that useful current practice that is in the patient interest can continue.

“We don’t want tidier law if it means a total mess at pharmacy level.”

Section 10 (7) of the 1968 Medicines Act allows community pharmacies to supply medicines to GPs, dentists, chiropodists, opticians, veterinary practitioners, first aiders, charities and others for use with their patients. Pharmacists also use this clause in times of medicines shortages where a neighbouring pharmacy may require stock for a particular patient in need.

Rob Darracott, Chief Executive at Pharmacy Voice said:

“We welcome the guidance which recommends a greater role for pharmacies in assessing people’s risk of type-2 diabetes. There is no reason why all risk assessments need to be carried out by GPs or in GP surgeries, it makes sense to offer people ease of access through community pharmacy.  Through the New Medicine Service, pharmacists are making progress in improving medicines use amongst people with type-2 diabetes and a range of other pharmacy support is already on offer. We encourage commissioners and healthcare professionals to engage community pharmacy local networks as a significant partner in any service re-design.” 

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