Pharmacies and integrated healthcare in England

There has been a growing consensus over the last few years that better integration of pharmacies with general practitioners and the wider NHS presents an opportunity to improve patient care. Indeed, a Royal Pharmaceutical Society report from 2013 argued that studies of pharmacy dating back three decades have argued that pharmacists have the capacity and ability to expand their role from traditional medicine dispensing services to direct delivery of clinical and public health services.

A White Paper published in 2008 set out a future vision for pharmacy services that argued (among other things) for the pharmacy sector to have close involvement in the development of clinical pathways that support integrated care. The paper also called for pharmacies to take on a more active role in providing clinical and public health services.

Since the White Paper, community pharmacies have become increasingly involved in the provision of services outside traditional dispensing of medicine. Community pharmacies provide services including medicines use review, public health promotion and supporting self-care. However, there has arguably been slow progress on the integration of pharmacies with other parts of the NHS.

In 2013, the Royal Pharmaceutical Society (RPS) set up a Commission on future models of care, which published its report in November 2013, setting out findings and recommendations. The Commission found “widespread support” for the extension of the role of pharmacy in provision of services, in order to adapt to the changing needs of patients in the context of tightening budgets.

The NHS Five Year Forward View (FYFV), published in October 2014, set out a vision for the future of the NHS over the next five years, aimed at adapting the NHS to meet the changing needs of patients and the wider population. The FYFV proposed seven new models, aimed at removing barriers between providers of NHS care, and developing integrated services.

In July 2015, NHS England launched a pilot to increase the presence of clinical pharmacists in general practice. As of December 2016, there were more than 490 additional clinical pharmacists working in GP practices across England under this pilot. In April 2016, the General Practice Forward View (GPFV) was published, committing to extend this programme, by investing a further £112 million to support 1,500 more pharmacists in general practice by 2020.

In April 2016, in the context of the FYFV and GPFV, an independent review into community pharmacy clinical services was commissioned by the Chief Pharmaceutical Officer (“the Murray Review”) to identify the barriers preventing the best use of community pharmacy, and to make recommendations for new models of care and commissioning. The review, which was published in December 2016, found that poor integration with other parts of the NHS was one of three key barriers to unlocking this potential.

The review, by Richard Murray, the Director of Policy at the King’s Fund, was well-received by industry groups, including the RPS, which described it as “completely in line with our own vision for the profession”.

Current government policy towards community pharmacy is in support of stronger integration of community pharmacy with general practice and the wider NHS.

The government has pursued several policies which are intended to lead to better integration of community pharmacy, including the introduction of a Pharmacy Integration Fund (PhIF) as part of the 2016/17 community pharmacy funding settlement. While the government has not yet officially responded to the Murray review, in an answer to an oral question on 20th December 2016, David Mowat described the review as “an essential road map that sets out how we are going to move the community pharmacy network away from a remuneration model based just on dispensing and onto services as well”. According to Health Minister David Mowat, NHS England is intending to respond to the review soon.