Joining the pharmacy dots will save the NHS
NHS chief executive Simon Stephens published his NHS ‘Five year forward view’ in 2014 to almost unanimous acclaim. Now the general election is over, it will be full-steam ahead with the ‘Five year forward view’, and we must grasp the opportunity it presents.
Members are encouraged to read it and they should spot the numerous ways community pharmacy can contribute.
Historically, the NHS has not been a “health” service so much as an “illness” service. If the NHS is to survive the cash-strapped future, UK citizens cannot continue smoking, drinking excessively, eating all the wrong things and doing little or no exercise and assume that the NHS can put them back together again. It is this shift away from a paternalistic “bio-medical” model to a positive, proactive and person-centred approach to public health that is at the heart of the ‘Five year forward view’.
Many NHS costs are lifestyle related, including cancer, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, etc. Community pharmacy is a highly accessible and widely disseminated public health network. Given the millions of daily visits by both well and ill people, it is perfectly placed to deliver services. Yet the post-Lansley NHS has all but ignored the potential of healthy living pharmacies and is yet to commission a “no-brainer”, like a national pharmacy-led common ailments service. What is needed is national commissioning of important public health services (such as sexual health, smoking cessation, weight-management, alcohol, etc) to give the necessary pace and scale. Community pharmacy is generally locked out of local commissioning by GPs, so neither we nor the NHS can afford to wait decades for clinical commissioning group-led commissioning to deliver. Moreover, given the desperate and growing shortage of GPs and nurses, the NHS has finally recognised the potential for pharmacy.
For example, while smoking remains the number one killer, hypertension is number two. One in four adults is hypertensive, yet of every ten hypertensive patients, four remain undiagnosed, two are treated but not to target, and only four are treated effectively. Community pharmacists could easily identify these patients, and treat them appropriately by following evidence-based protocols. Read-write access to the patient care records means GPs would be kept informed and outcome data will be generated.
The ‘Five year forward view’ proposes federations of GP-practices working together within an area to provide and commission services, so we must federate the local community pharmacies that relate to each GP federation and offer pharmacy-led solutions.
Stephens wants another £8bn to fund the NHS, and Secretary of State for Health Jeremy Hunt has pledged to deliver it. While the Royal College of General Practitioners has successfully demanded a rebalancing of NHS funding towards primary care (i.e. GPs), the Royal Pharmaceutical Society (RPS) has failed thus far to make the equivalent case for community pharmacy.
I suggest the RPS should host a pharmacy ‘Five year forward view’ conference. The keynote speakers would be Stephens and Hunt. The audience would be patient groups, senior NHS England and Public Health England executives, GP leaders and a representative sample of community pharmacy innovators. There is nothing in the ‘Five year forward view’ that a community pharmacy somewhere is not delivering but we are all working in isolation with no one “joining the dots”. Surely this is a vital role for our professional body?
We need to sell Stephens and Hunt this message: pharmacy can save the NHS.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20068586
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