At a recent roundtable event supported by Novartis, we discussed the future of community pharmacy with pharmacy, policy, voluntary, community, and social enterprise (VCSE) sector, and primary care leaders.
As the new arrangements for commissioning community pharmacy services become established, we explored how integrated care boards (ICBs) might develop their planning and commissioning and transform care pathways to deliver improved community pharmacy services. As we talked, four key themes developed.
Participants said conversations between chief officers, local pharmaceutical committees (local organizations that represent community pharmacies), and ICB representatives about capacity, workload, and access were essential and helped build a supportive local ‘pharmacy community.’ This includes developing close working relationships with the people working in local pharmacies and ensuring effective links between primary care network (PCN) pharmacists, community pharmacy clinical leads, and community pharmacists. Within these communities, it’s important to build a culture of collaboration rather than competition.
Participants also highlighted the unique insight that local pharmaceutical committees bring to discussions. These committees represent all pharmacies within a defined locality and, therefore, understand the facilities offered locally, including accessibility, capacity and workload, knowledge that is important when planning and commissioning services, and transforming community pharmacy pathways.
Involving the right people from inception is vital to generating appropriate ideas and solutions in addition to improving the dynamics of building relationships. Currently, in many areas, general practice tends to dominate primary care meetings, and there is often little or no representation from community pharmacies. Increasing representation of community pharmacy at this level may bring these experiences and opinions into focus. To deliver high-quality primary care services that meet the needs of the local populations, ICBs need to ensure there is a balanced representation and effective collaborative relationships between all four pillars of primary care, which include general practice, community pharmacy, dentistry, and optical services. Participants shared an example where this worked well by having weekly conversations between the ICB and community pharmacy, providing a consistent dialogue and frequent touchpoints.
Working with patients and the public
Involving patients – right from the beginning – is also important when designing services. Conversations about community pharmacy should involve local communities to gain insights into what works well, what is important to patients, potential improvements, the impact of the language used when talking to people outside the profession, and the wider needs of the local community.
Community pharmacy systems are complex, and not all pharmacies offer the same services, which can lead to variable experiences and be confusing for people. Supporting people and healthcare professionals to understand how community pharmacy works would improve understanding, expectations, and, hopefully, patient experience. National bodies and ICBs have a role to play here, sharing information to develop realistic expectations and an understanding of local variability.
Understanding the needs of the local area
There is a tension between providing a coherent national offer for community pharmacy – that’s easier for people to understand – and opportunities for local innovation. Many of the pharmacy leaders at our roundtable shared the role of regional innovation in providing services that match local community needs. One example mentioned was offering conversations with the community pharmacist about COVID-19 vaccination to improve uptake.
There was an appetite for innovation. But first, commissioners need to address the barriers, such as digital integration of patient records and workforce issues. Addressing these complexities to create capacity for innovation is key, as until then, the fundamentals of reliable access to medications will take priority over the ‘added-value’ services that community pharmacies could offer.
Evaluation and learning
There are opportunities to learn from and scale up innovative schemes. This culture of shared learning may help tackle disease prevention and inequalities and reduce hospital admissions. Participants highlighted the importance of detailed planning involving how to measure success, evaluate, and scale up before implementation. The process of innovation should be simple and added to the existing consistent, recognized community pharmacy national framework.
Academic evaluation of pilots requires funding and particular skills, and community pharmacy staff should have opportunities to train and develop research skills. The assessment may include cost-benefit effectiveness and patients’ experiences of services. Then, there’s a need to consider how and where to share this learning. Appropriate funding, planning, and evaluation are needed to expand successful pilots. Commissioners in ICBs have a role in supporting the development of infrastructure to enable assessment, innovation, and learning.
Community pharmacy systems will need to continue to adapt, evaluate and learn. The recent delivery plan for recovering access to primary care involves expanding the services offered by community pharmacies. Changes are already underway – by 2026, all newly registered pharmacists will be independent prescribers. The future of community pharmacy is exciting, with large developments happening nationally, and commissioners have an important role in supporting local systems to fully grasp these opportunities through developing relationships, working with patients and the public, understanding local needs, and evaluating and learning.