The Pharmacy Integration Programme/Fund (PhIF)
The Pharmacy Integration Programme/Fund (PhIF)
In the Government’s letter from 17th December 2015 entitled ‘Community pharmacy in 2016/17 and beyond’, the Department of Health and Social Care (DHSC) announced that it would consult on a Pharmacy Integration Fund (PhIF) to help transform how pharmacists and community pharmacy will operate in the NHS.
The Fund is the responsibility of NHS England and is separate to any negotiations related to the Community Pharmacy Contractual Framework (CPCF).
The stated aim of the PhIF is to support the development of clinical pharmacy practice in a wider range of primary care settings, resulting in a more integrated and effective NHS primary care patient pathway. In particular, the PhIF is intended to drive the greater use of community pharmacy, pharmacists and pharmacy technicians in new, integrated local care models.
The initial stated priorities for the fund in 2016-18 are:
- deployment of clinical pharmacists and pharmacy services in community and primary care including groups of general practices, care homes and urgent care settings such as NHS 111; and
- development of ‘infrastructure’ through the pharmacy professional workforce, accelerating digital integration and establishing the principles of medicines optimisation for patient-centred care.
Click on a heading below for more information.
What is the focus of the PhIF?
NHS England has stated that the key areas for the operational delivery of the Five Year Forward View will be used as the guiding principles for deployment of the Fund i.e.:
- Improving care and quality;
- Improving health and wellbeing; and
- Closing the finance and efficiency gap.
The fund will be used to integrate and support the development of clinical pharmacy practice in a wider range of primary care settings, to create a more effective NHS primary care patient pathway. In particular, the fund will drive the greater use of pharmacists and pharmacy technicians in new, integrated local care models.
The stated intention is to free up pharmacists and their teams to: spend more time delivering safe and effective clinical services and health improvement for their patients; work in a variety of NHS settings, as part of an integrated local primary team; and be supported by improved technology.
NHS England also stated that the findings of the Chief Pharmaceutical Officer’s Independent Review of Community Pharmacy Clinical Services (the Murray Review) would inform how the Fund would be used to invest in shaping the integration of community pharmacy clinical services.
Governance of the Fund
The governance of the fund is overseen by an NHS England Pharmacy Integration Oversight Group including representation from Clinical Commissioning Groups, NHS England regions, general practice, patients and carers, DHSC, Health Education England (HEE) and Public Health England. This group does not include representation from the community pharmacy sector.
In October 2016, NHS England said a pharmacy integration stakeholder reference group would be established in 2017 to ensure engagement with a wide range of stakeholders. An event for stakeholders was held in November 2017, but to date, a stakeholder reference group has not been established.
Two task and finish groups have been established for work on care homes and integrated urgent care. The work on urgent care is also reported through to the Pharmacy Reference Group for the Hospital to Home work stream of the NHS England Urgent Care programme.
How much is the Fund worth?
In December 2015, the DHSC letter stated that in 2016/17 £20m would be available for the PhIF, which would rise to £100m by 2020/21 so that over the course of 5 years £300m would be distributed through the Fund. NHS England subsequently announced that following a review of planned spending, for 2016/17, they would allocate £2m to the fund and for 2017/18, £40m would be available. There will be further business planning carried out within NHS England for 2018 onwards and more funding will be made available.
There is also a commitment to use up to 5% of the PhIF for evaluation of any programmes of work supported by the Fund.
What are the current work programmes?
Integrating NHS pharmacy and medicines optimisation into STPs and ICSs
In August 2018, NHS England and NHS Improvement announced a new programme, supported by PhiF, to test how NHS pharmacy and medicines optimisation/safety can be integrated into Sustainability and Transformation Partnerships and Integrated Care Systems (ICSs).
The Integrating NHS Pharmacy and Medicines Optimisation (IPMO) programme aims to develop a framework which will set out how to systematically tackle the medicines optimisation priorities for the local population in an STP/ICS footprint and use the expertise of pharmacy professionals in the strategic transformation of systems in order to deliver the best patient outcomes from medicines and value to the taxpayer.
Workforce education and development
With investment from the Fund, NHS England is working with Health Education England (HEE) to further clinical education and development:
- Modular access to post-registration training and development for community pharmacists. Total provision is likely to be up to 2,000 postgraduate certificates a year, initially through to March 2019. It involves a range of standalone modules or accumulated to obtained a Postgraduate Certificate at Masters’ level;
- Independent prescribing qualifications for up 2,000 pharmacists in general practice, NHS 111/Integrated Urgent Care centres and care homes;
- A new training pathway for pharmacists and pharmacy technicians who work in care homes and NHS 111/Integrated Urgent Care centres;
- Clinical and professional leadership development for 600 pharmacists (Mary Seacole programme);
- Piloting a support programme for pharmacy technicians;
- Accredited checking pharmacy technician training in community pharmacy, starting in London and the South East before rolling out nationally; and
- The first ever England-wide community pharmacy workforce survey.
The PhIF care homes task and finish group, jointly chaired by the Royal Pharmaceutical Society and NHS England, has developed integrated clinical pharmacy models to support care home residents.
In March 2018, NHS England announced the launch of The Medicines Optimisation in Care Homes programme which focuses on care home residents, across all types of care home settings and aims to deploy dedicated clinical pharmacy teams that will:
- Provide care home residents with equity of access to a clinical pharmacist prescriber 4 as a member of the multidisciplinary team, with the supporting infrastructure for achieving medicines optimisation according to need; and
- Provide care homes with access to pharmacy technicians who will ensure the efficient supply and management of medicines within the care home, supporting care home staff and residents to achieve the best outcomes from medicines.
Integrated Urgent Care
The Integrated Urgent Care (IUC) / NHS 111 / NHS England / HEE Workforce Development Programme has undertaken some initial pilot studies to evaluate the role of the clinical pharmacist working within the NHS 111 contact centre. This pilot work and the NHS 111 Phase 2 Learning and Development programme have shown that pharmacists can add value to the clinical skill mix working within the Clinical IUC hub, completing calls and providing self-care advice across a range of calls that involve the use of medicines.
The PhIF IUC clinical hub task and finish group is now overseeing the deployment of pharmacists into IUC Clinical hubs, a programme of education and development and evaluation of the role within the hub as part of the multi-disciplinary teams (MDT) to identify the impact on the referral rates and patient outcomes.
NHS Urgent Medicine Supply Advanced Service (NUMSAS)
The NUMSAS pilot is being funded by the Fund.
Digital Minor Illness Pharmacy Referral Service (DMIRS)
The DMIRS enables NHS 111 call handlers to refer patients requiring advice and/or treatment for low acuity conditions to community pharmacies across the North East of England.
The service covers the geographical area of Durham, Darlington, Tees, Northumberland and Tyne and Wear which is covered by ten Clinical Commissioning Groups and contains a population of approximately 2.6 million. Up to 618 pharmacies are eligible to sign up to provide the service across the region.
The service is intended to increase capacity and relieve pressure on existing urgent care services, deliver care closer to home in the community and potentially result in cash releasing savings. The service will be evaluated in order to inform the potential roll out of this approach to other areas of the country.
The Fund has been used to support the following work which is being led by NHS Digital:
- Developing the adoption of messaging and transfer of care data to community pharmacy from NHS 111 and hospital care settings, and the sending of a post event message from community pharmacy to other care settings;
- Supporting the uptake of NHSmail by community pharmacies; and
- Supporting the roll out of the Electronic Prescription Service tracker by NHS 111 and IUC clinical hubs
Pharmacists in general practice
The roll out of pharmacists in general practice, funded by NHS England, commenced prior to the establishment of the PhIF, but it has been used to fund subsequent waves of the programme, education and development for the pharmacists and an evaluation of the programme.
What has been spent so far?
The following information on spending was provided by Steve Brine MP, Parliamentary Under Secretary of State for Health, in a letter to Sir Kevin Barron MP, the Chair of the All-Party Pharmacy Group.
|Minor Ailments Survey||£14,556|
|Set up and supply of NHSmail (NHS Digital)||£185,396|
|Support staff costs||£5,456|
|Expenses payments for patients and public volunteers||£956|
|Travel and accommodation and other expenses||£341|
|Budget item||Actual Spend||Estimated additional spend|
|Regional and national staff||£157,673||£305,531|
|Public and patient volunteer payments||£1,444||£4,404|
|GP pharmacist programme||£5,000,000|
|IUC Pharmacist programme||£517,860|
|Education and development programme||£5,100,100|
|Community Pharmacy Referral Scheme||£250,000|
|Pharmacy system leadership development||£3,000,000|
|Total estimated spend 2017/18||£18,200,370|
Further information on the Fund
Further information on the Fund can be found on the NHS England website.