The NHS and social care are under greater pressure than ever before. This was true even before COVID-19 but the pandemic has forced health leaders to rethink the delivery of care to make better use of all services at their disposal. Priorities include shifting as much of the burden of care away from hospitals and into the community, while also lightening the load on GPs.
This mission to maintain or even improve access to care has put increased focus on the role of pharmacies. Located at the heart of communities and enjoying a high degree of trust, pharmacies have long been seen as an under-utilised service, with poor connectivity to other health and care services. Until now, they have felt side-lined by clinical commissioning groups and primary care networks, who drive the delivery of care in England.
This has been a cause of frustration for pharmacists for many years. They are highly-skilled health professionals. They also have regular contact with some of the most vulnerable people in our communities, who are less likely to consult medical professionals in other settings. Yet their primary role within the NHS is dispensing medicines prescribed by GPs and selling over-the-counter medicines.
The failure of the health service to make the most of this resource for the benefit of patients is at least partly recognised in NHS England’s Five Year Forward View, a blueprint for the future of health and care. Published before the pandemic, the plan envisaged an enhanced role for community pharmacy, particularly in the delivery of care outside hospitals and supporting more people in later life to remain in their own homes for longer.
In practice, this would take the form of helping people to manage long-term conditions, for example. The aim is to improve the effectiveness of NHS Health Check, give people greater opportunity to be tested for high-risk conditions like cardiovascular disease and diabetes, and improve access to preventative treatments. A pharmacist can help a person with asthma reduce or avoid asthma attacks by improving their inhaler technique, and carry out some of the tests that are critical to help a person with diabetes live a fuller life.
Another area where pharmacists can make an important contribution is with medicine reviews. Increasingly, patients live with multiple long-term conditions and their medication is prescribed by different specialists. Incorrect use can contribute to poorer health outcomes or exacerbate symptoms, and even cause admission to hospital. As well as helping patients, medicine reviews can save the NHS money but cutting down on the use of drugs and treatments that are not effective and identifying alternatives that are more cost effective.
Making better use of community pharmacies appears to be a win-win for all parties concerned. However, many barriers need to be overcome before this can be made a reality. Funding is a concern. The current system is complex and mainly focussed on reimbursement for dispensing drugs, rather than on patient outcomes. Digital connectivity between pharmacies and other parts of the NHS is generally poor; contact with GPs and hospitals still relies on paper records sent by post. We also need more pharmacists and with broader medical training. Last, but not least, many community pharmacies currently lack the facilities they need for patient consultations, so significant investment is needed in buildings.
By Martin Barrow.
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