Councillor Chris Peace visits local Community Pharmacy to hear how the sector is hoping for transformative change to contribute to the NHS Long Term Plan

Councillor Chris Peace visits local Community Pharmacy to hear how the sector is hoping for transformative change to contribute to the NHS Long Term Plan

March 13, 2019

Councillor Chris Peace – Labour Cabinet Member for Health and Social Care, who represents Gleadless Valley Ward, accompanied by her Cabinet Advisor – Councillor George Lindars-Hammond, visited Day Lewis Pharmacy in Gleadless Valley today to meet the Pharmacy Team and hear how despite increasing financial and workload pressures the sector is keen to see transformation in the scope of Community Pharmacy practice to help play a bigger role in the prevention and management of long term conditions and to help people in their local area improve their health and well being.

Current Funding Levels are Unsustainable

Community Pharmacies contribute huge value but are currently facing huge financial and workload pressures due to a combination of national funding cuts and extreme volatility in the medicines market.  There have already been 3 Pharmacy closures in Sheffield in the past year.

Closures are not the full picture; many pharmacies are having to find ways to reduce costs e.g. reducing staffing levels, stopping non-funded services (or implementing a charge for services) e.g. home deliveries and there are an increasing number of pharmacies that are reducing their opening hours.

Claire Thomas – Chief Officer for Community Pharmacy Sheffield, the Local Pharmaceutical Committee representing Sheffield Pharmacy Contractors said “We are concerned about what happens if more Community Pharmacies close.  Pharmacies are the safety net for the NHS, often the first port of call for minor conditions and advice.  Fewer Pharmacies and reduced opening hours could lead to increased pressure on GP practices and urgent and emergency care services.  We need to make more use of Community Pharmacies to keep people well and out of other services e.g. GP practices, A&E and hospitals.  To do this we need a new contractual framework.”

Councillor Peace was particularly concerned about where patients could go to access particular services provided through Community Pharmacies such as substance misuse services like the one provided by Day Lewis Pharmacy in Gleadless Valley.  There is a real risk that if the pharmacy providing this service closed then these patients may end up being lost to treatment or drop out of their treatment.

Community Pharmacies Contribute Huge Value

Community Pharmacies, like the team at Day Lewis in Gleadless Valley are continuing to work hard, providing services which include:

  • Dispensing medicines;
  • Smoking cessation support;
  • Medicines adjustments; and
  • Minor ailments advice

Community Pharmacies deliver substantially more in benefits than they receive in compensation, providing excellent value to the Department of Health and Social Care.

Dharmendra Mistry – Pharmacist Manager at Day Lewis, Gleadless Valley said “We have continued to offer a free blood pressure monitoring service, set up by the previous pharmacy owner that is very popular with our patients and customers.  We have a good working relationship with our local GP practice and if a patient is found to have uncontrolled high blood pressure we refer them to their GP, but as the GPs are struggling with workload and workforce issues of their own it is a real shame that we (Community Pharmacists) cannot be funded to work with GPs to optimise and improve medicine use by patients with long term conditions such as high blood pressure.  We have the knowledge and skills to do this kind of clinical work, we just need investment and integration in to Primary Care to be able to do it”.

Hopes for Transformation in Community Pharmacy

In January 2019, NHS England published the NHS Long Term Plan, setting out its priorities for healthcare over the next ten years and showing how the £20.5bn funding settlement will be used.  The plan was shortly followed by a five-year funding settlement for General Practitioners (GPs).  The NHS long term plan, envisages pharmacies doing more for the NHS e.g. blood pressure testing, and using clinical services.

It is recognised that for Community Pharmacy to make a meaningful contribution to the NHS Long Term Plan, transformative change is needed in the sector, shifting funding from a focus on the dispensing of medicines to patient care, and freeing up pharmacists’ time to offer more clinical services to patients.  The national negotiating body for Community Pharmacy – the Pharmaceutical Services Negotiating Committee (PSNC), has been pressing for reform of Community Pharmacy’s reimbursement arrangements for a number of years and are keen to begin discussions on this and on funding more generally.  It is hoped negotiations will begin before Easter.  For further information visit the PSNC website.

Claire Thomas informed Councillor Peace that in Sheffield, CPS are working with colleagues in the Accountable Care Partnership (ACP) to transform the scope of pharmacy practice, in particular Community Pharmacy practice (which is the biggest pharmacy workforce) to better utilise the clinical skills of the Community Pharmacist.  The aim is to have Community Pharmacists working collaboratively with GPs, in a new integrated care model, the Community Pharmacist becoming an extended member of the GP Practice Team with access to the GP clinical system from the Community Pharmacy.  This model of shared patient care and shared access to patients records will have the advantage of the Pharmacist being able to provide clinical services and support to GP practices whilst maintaining their accessibility by the public for face to face advice and services without an appointment.

Keeping People out of Hospital and Reducing Social Care Costs

Councillor Peace was particularly interested to hear how Community Pharmacists and their Teams could be doing more to help reduce the number of people admitted to hospital.  Two such examples include hypertension (high blood pressure) management and falls prevention.

According to figures from Public Health England 35% of patients currently being prescribed medication for high blood pressure do not have their blood pressure treated to target levels; remaining at an increased risk of heart attack and stroke.  Community Pharmacists working in collaboration with GPs could provide a Hypertension Management Service to see patients on a 4 weekly basis to discuss medicine use, compliance and lifestyle modification and make changes to prescribed medication to try and get their blood pressure reduced to target levels; reducing their risk of heart attacks and strokes and the associated costs of hospital admissions and social care required following a heart attack or stroke.

One in three people aged 65 and over fall at least once a year.  Risk factors for falling are multi-factorial, however there is evidence that taking four or more regular medicines increases the risk of falling.  Community Pharmacists are ideally placed to discuss falls risk with patients and conduct a multi-factorial Falls Risk Assessment, including a review of medication, to provide advice to patients on how to reduce their risk of falling as well as making recommendations for medication changes to reduce the number of medicines (particularly high-risk medicines that are associated with side effects that further increase the risk of falling).  The consequences of falling include: fractures, head injuries, social isolation/depression, disability, loss of independence, need for long term residential/nursing home care and even death.  Commissioning Community Pharmacists to provide a Falls Prevention Service could reduce the number of hospital admissions as the result of a fall and any social care costs as a result of the older person loosing their independence as a consequence of the fall.

Claire Thomas said “there is a lot of interest and enthusiasm locally by Community Pharmacists and some GPs to try and explore a more integrated care model where Community Pharmacists work more closely with GPs to share the care of patients, for example to improve the management of high blood pressure.  However, given the current financial pressures, Community Pharmacy Contractors are not in a position to try and pilot new models of care without the Pharmacists being appropriately remunerated for their time.  We need local Commissioners to consider investing in Community Pharmacy to help us begin this journey of transformation so that we can play a bigger role in improving the long term health of our patients”.

Vital Health and Prevention Services

Councillor Peace said “Sheffield Community Pharmacies provide vital health and prevention services in the heart of our communities but like other health and council services the Government is expecting Pharmacies to do a lot more for a lot less – and it’s completely unsustainable.  We need proper funding for Community Pharmacies to be playing a bigger role in community health care, but instead some are having to close down or reduce their service offer because of poor investment”.

I saw today what a vital role access to particular services provide to the community and thank the hard-working staff and Claire from Community Pharmacy Sheffield, for taking the time to speak with myself and Councillor Lindars-Hammond.  I have already written to the Secretary of State for Health asking that the Government looks again at their funding of Community Pharmacies and that they demonstrate that they value this vital service as much as the council and the people of Sheffield do”.

CPS would like to thank Councillor Peace and her Cabinet Advisor – Councillor George Lindars-Hammond – for giving up their time to visit Day Lewis Pharmacy in Gleadless Valley and listening to our ambitions for transforming the scope of Pharmacy Practice.

We would also like to thank the team at Day Lewis Pharmacy in Gleadless Valley for hosting the visit.

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