Dr Judith Smith, Director of Policy at the Nuffield Trust, on why pharmacy needs to act now to ensure that it doesn't miss out on delivering front-line care.

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Now more than ever – why pharmacy needs to act
Dr Judith Smith, Director of Policy, The Nuffield Trust
10 December 2014

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Agenda
Context of the one-year review
How we worked
What we found
What we concluded

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Context of the review

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Why a one-year review?
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Now or Never: Shaping Pharmacy for the Future (2013) set out a vision for pharmacy as a care-giving profession
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RPS was challenged to take responsibility for demonstrating progress toward that vision
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RPS fully embraced the ethos of the report and an independent one-year review was commissioned from The Nuffield Trust to explore progress since launch
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The review report is an independent assessment of progress primarily intended as feedback for RPS and its partner organisations in pharmacy

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Scope of the review
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An assessment of the extent to which progress is being made toward the ideas embodied by Now or Never
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Recognises that the report does not exist in isolation - lots of factors at play
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Picks up on wider policy developments since November 2014
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Need to be realistic about the timescale of the review - what could be achieved in a year
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In essence a reality check of progress and momentum primarily at a national level, and with a sense of emerging local developments

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How we worked

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How we worked
Two discrete stages
SIX MONTHS
TWELVE MONTHS
Assessed initial impact and helped refine scope of the 12 month review.
Overall assessment of progress made and the key themes emerging.
Telephone interviews with the Commission’s advisory group members; review of latest policy documents and press coverage; extended meeting of Commission advisory group and English Pharmacy Board.
Detailed analysis of media, social media, parliamentary and policy literature; around 40 interviews with stakeholders within and beyond pharmacy; an electronic survey of those who attended the parliamentary launch of Now or Never.

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What we found

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Policy context
Five Year Forward View. Sets out plans for radical new models of care across every part of the health service (2015-2020). Includes:
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urgent and emergency care networks
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a commitment to more funding and priority for new models of primary care, including ‘multispecialty community providers’ and ‘primary and acute care systems’ (ACOs)
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suggestion that all records could be shared at patient discretion Plus, the Better Care Fund and the Department of Health’s Transforming Primary Care plan

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Initial impact of the report
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At least initially, Now or Never seemed to have greater impact on practitioners and policy-makers beyond pharmacy than within the profession itself
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Now or Never got the ‘pharmacy message’ to a much wider audience
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Stakeholders outside pharmacy welcomed the opportunity to hear about the potential contribution of pharmacy to health and social care in the future
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Whilst the pharmacy world largely welcomed the report, the initial enthusiasm for the messages does not seem to have endured

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The pharmacy leaders’ response
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The RPS has taken on the goal of pharmacists becoming care- givers and has made significant advocacy efforts within pharmacy and the wider NHS
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The RPS campaigns, innovators’ forum, work with NAPC were all highlighted to our review
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The drive towards a broader role for pharmacists, however, has been undermined by the continuing divided leadership of the profession
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There is still a tendency for pharmacy to look inwards, missing vital opportunities to be part of wider NHS plans and priorities

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There has been progress
The care-giving role of pharmacy has gained particular traction the following areas over the last year:
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urgent and emergency care, and the potential for pharmacies and pharmacists within these networks;
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public health, including initiatives such as pharmacies delivering flu vaccination programmes;
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and pharmacists taking up roles within new general practice organisations and networks.

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Development of care-giving services
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Pharmacists at a local level continue to persuade some local commissioners to fund innovative services to support health and social care, but such progress remains patchy and lacks scale
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There has been disappointingly little progress over the last year in shifting the balance of funding and commissioning away from the dispensing and supply of medicines toward the delivery of direct patient services
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Does this reflect the complex and often fractured nature of pharmacy leadership in England, and hence a relative lack of influence on policy?

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What we concluded

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1. Consistent and ‘can-do’ messages are crucial
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The different professional, owner/employer and policy stakeholders in pharmacy must speak as one voice about the role that pharmacists can play in the new models of care advocated by NHS England
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There must be a consistent and ‘can-do’ message about how pharmacy is a crucial part of the answer to challenges such as urgent care, support for people with complex long-term conditions, public health, and treating common ailments

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2. Progress in attitude needs practical national backing
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There has been progress in the attitude of NHS policy-makers towards pharmacists providing care, for example for common ailments, within wider urgent care networks
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This needs to be backed by funding and coordination, through the national community pharmacy contract and/or new payment mechanisms being put in place to support the Five Year Forward View
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Pharmacists, GPs, and the wider NHS need a clear signal that the NHS means business about pharmacists assuming a wider care-giving role

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3. Local change and funding must gather pace
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National action will not suffice – change will continue to happen locally too
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Pharmacists must make the case locally for their vital contribution in the future, including support for frail older people, managing medicines to help avoid hospital admission, and supporting work on prevention and public health
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More guidance and support is needed from the RPS, employers and other national bodies about how to become part of local primary care federations and networks, and the new multi-specialty community providers and other care models set out in the Five Year Forward View

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4. Change offers opportunities for all of pharmacy
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The Five Year Forward View presents many opportunities for community, primary and secondary care pharmacy
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New provider organisations will form and roles develop as part of new models of care
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Pharmacy leaders must be at the centre of this national and local debate and planning
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If not, community pharmacy in particular risks being overtaken by the expansion of technology-driven dispensing and supply, and local pharmacy services being delivered by new NHS organisations

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5. It really is ‘Now more than ever’
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The financial context is tougher than ever. NHS England has set out a direction of travel that is about integrated local care providers, working in new networks that maximise the use of technology and new professional roles
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RPS was prescient in commissioning work on new models of care some 18 months ahead of the Five Year Forward View
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The challenge to pharmacy as a profession is to seize the opportunities on offer - if they fail to do this, their role in the community beyond 2020 looks bleak
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It really is now more than ever…

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