Heartbeats on the High Street: How Community Pharmacy can transform Britain’s Health, Wealth and Wellbeing
Even the most optimistic of its advocates now acknowledge the scale of the challenge facing the NHS. Rising demand for services is stretching the capacity of healthcare providers. The population of England is projected to grow by over 4 million between now and 2024. The fastest-growing age group is people aged 65 and over, and the level of long-term conditions is on the rise.
At the same time, pressure on budgets is restricting the ability to hire, train and retain enough doctors and nurses to meet our population’s health needs. NHS England’s target to deliver an additional 5,000 GPs by 2020 is looking increasingly unattainable, with the workforce showing signs of contraction rather than growth.2
In other words, a dangerous combination of increased demand and reduced supply is pushing the NHS to breaking point.
Since the Acheson Report of 1998, research has shown that it is our most deprived communities that are disproportionately impacted by healthcare inequality. So when public services fail, it is the disadvantaged among us who feel the pinch the most. The failure to resolve systemic challenges in the NHS has had a profound effect on these people, diminishing their access to preventative healthcare and health education.
The crisis is complex. There is no silver bullet. And yet, there exists a healthcare provider that could be transformative for our NHS: a provider that is embedded on high streets in almost every part of the country, including our most deprived neighbourhoods, that is staffed by a network of clinically-trained professionals, with a proven social value, who have the capacity to prevent illnesses which are costing the taxpayer billions of pounds each year.
This provider is Community Pharmacy.
In this report, we make the case for Community Pharmacy as the first port of call in primary care. We are not the first to say this. For years, healthcare leaders have talked about the “potential” of Community Pharmacy. In 2008 the Pharmaceutical Services Negotiating Committee argued that “pharmacists are undoubtedly the most accessible healthcare provider in the community at a time when NHS resources are increasingly under pressure”. Several recent reports have been published: NHS England launched the Murray Review of Community Pharmacy Clinical Services in 2016, at the same time as the national Community Pharmacy “Forward View” project and a PricewaterhouseCoopers report on the economic value of Community Pharmacy. This year, the Secretary of State for Health has acknowledged that the Government has not “exploited the tremendous skills that pharmacists have nearly as effectively as we might.”
Despite the evidence of these reports and the warm words of healthcare officials, the transformative potential and value of Community Pharmacy continues to be overlooked. Local commissioning structures like Clinical Commissioning Groups (CCGs) and Sustainability and Transformation Partnerships (STPs) rarely have a pharmacy representative making strategic decisions alongside GPs. There is a lack of parity in how the clinical role of Community Pharmacy is perceived. And in 2016, the Chancellor of the Exchequer announced a reduction in financial support to Community Pharmacy of £113m for the year – a figure that equates to a reduction of 4 per cent, rising to 7 per cent in the coming year when compared to previous levels.
There are even signs that the recommendations of the Murray Review will not be adopted by NHS England. In 2016, the Parliamentary Under Secretary of State for Health, David Mowat, said during a debate in the House of Commons that “we regard pharmacies as vitally important to the NHS. One of the proposals that we shall announce shortly is a proposal for an integration fund of £300m, which will be used entirely to provide services and pay for pharmacies to provide them. It will be informed by the review that is being conducted by David Murray”.5 But this year, NHS England has declined to publish a response to the Review, stating in an October All-Party Parliamentary Group (APPG) that “at present there is no need to have a formal response … because we do feel that it’s by and large been taken into account”.
The same month, Lloyds Pharmacy announced the closure of almost 200 stores across England, blaming “challenging market conditions” and government cuts.7
Community Pharmacy also struggles to communicate its own role, leading to a lack of recognition of its services and representation among policy makers. Too often, pharmacists are viewed as shop-keepers rather than qualified healthcare specialists. Too often, the social value of Community Pharmacy is poorly understood. Complex contracting structures and “establishment payments”, the fact that 95 per cent of their funding comes from the NHS, and a perception in Government that many pharmacies exist in inefficient “clusters”, have given rise to cuts and calls for reform.
Recognition needs to be earned, and it is clear that pharmacies themselves could do more to standardise their practice and scale up their offer. At present, there is an asymmetry in the way that different local pharmacy partnerships operate across the country. Organisations like the British Medical Association (BMA) have advocated pharmacists working with GPs, but note that training for pharmacists varies. And there is no formal programme of quality improvement in Community Pharmacy to match the Quality and Outcomes Framework for GPs.
In the following pages, we argue that the time has come to turn the potential of Community Pharmacy into practice. The NHS simply can no longer afford to overlook the role that Community Pharmacy might play in reducing the cost burden on taxpayers and the capacity burden on GPs.