Date of prep: December 2020
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The ‘Pharmacy First’ concept, first coined in Scotland, has been taken forward by the Health and Social Care Secretary Matt Hancock as part of the roll-out of the 5-year Community Pharmacy Contractual Framework.
The people involved in the early days in Scotland were Jonathan Burton, Gail Caldwell, Kirsten Cassells, Fiona Stewart and Professor Anne Watson.
It is unclear when the concept was first mentioned but in Scotland, Jonathan Burton in partnership with NHS Forth Valley took the concept forward several years ago. Director of Pharmacy Gail Caldwell supported the idea and led the development of what we now understand to be ‘Pharmacy First’ in Scotland.
Kirsten Cassells helped develop phase two of the roll-out in NHS Forth Valley. This phase saw the initiation of services involving treatment pathways through community pharmacy for conjunctivitis, thrush, cellulitis, eczema and bites.
Community Pharmacy Scotland took the concept forward and delivered a successful pilot back in 2017.
In a recent statement, Mr Hancock said:
“I want all patients to get the right care close to home, and to avoid any unnecessary visits to hospital. To help do that I’ve begun the Pharmacy First programme.”
The five year deal in England is entering its second year now and has heralded the announcement about a discharge referral service directly from hospital to community pharmacy.
The framework was agreed in July 2019 with NHS England and NHS Improvement and the Pharmaceutical Services Negotiating Committee (PSNC). It committed almost £13 billion to community pharmacy – £2.592 billion per year – to expand the role of community pharmacy, while continuing to support the introduction of new clinical services.
The Government has indicated that the key objective of the ‘Pharmacy First’ approach is to ease wider pressures on A&Es and General Practice.
As part of the second year of the 5-year Community Pharmacy Contractual Framework, there has been an announcement by Mr Hancock of an NHS Discharge Medicines Service which is part of a number of measures being introduced
As part of this drive, patients who have recently been discharged from hospital will get greater support from local pharmacy teams to manage their medicines.
From July, hospitals will be able to refer patients who would benefit from extra guidance around newly prescribed medicines to their community pharmacy. Patients will be digitally referred to their pharmacy after discharge from hospital.
The Government has said that the NHS Discharge Medicines Service will help patients get the maximum benefits from new medicines they’ve been prescribed by giving them the opportunity to ask questions to pharmacists and ensuring any concerns are identified as early as possible.
Research by the National Institute for Health Research shows that people over 65 are less likely to be readmitted to hospital if they’re given help with their medication after discharge. Previous local schemes around the country have demonstrated that patients who see their community pharmacist after they’ve been in hospital are less likely to be readmitted and will experience a shorter stay if they are.
In Scotland, there has been consistent collaborative work between Government and Contractor bodies. There has also been accompanying investment in community pharmacy in line with national strategies in a drive to gently shift the contractual model away from supply to one of advice and service.
Health and Social Care Secretary Matt Hancock said:
“I want all patients to get the right care close to home, and to avoid any unnecessary visits to hospital. To help do that I’ve begun the Pharmacy First programme, asking pharmacies to do more to support people in the community, as they do in other countries like France. It’s good for patients and great for the NHS because it reduces pressure on GPs and hospitals.
“These new services will help strengthen what community pharmacists can do, helping interrelation with General Practice and hospitals, and help them deliver safer, more efficient patient care right across the NHS.
“This new contract bolsters the enhanced role highly-skilled pharmacists are playing in preventing ill health and helping us to stay well in our communities.
Bruce Warner, NHS England deputy chief pharmaceutical officer, said:
“Preventing ill health is a key part of the NHS Long Term Plan and over the next year, we will introduce the new Discharge Medicines Service to help people most in need of support with their medication, as well as begin to test a variety of new measures to identify people with undiagnosed conditions.
“This will make even better use of the valuable and extensive clinical skills of community pharmacists so that people can ‘walk in’ and get the health advice and help they need, providing an excellent foundation on which we can build for the future.”
Strachan’s Pharmacy Group and ex-NPA Chair Ian Strachan commented:
“The recent CPCF announcement only prolongs the suffering &uncertainty for community pharmacy. These briefings lack funding, substance &detail as another year without substantive funding. What is clear is they’ll be plenty of bureaucracy &uncertainty.
“National vaccination programmes are flagship policies for public health. It is potentially dangerous and unreasonable to bolt on such a tier within the existing funding envelope. Who on earth is briefing NHS England?
“A premature Medicines Bill to legislate Hub and Spoke across different legal entities, now that’s interesting! Centralised procurement unevidenced automation on to public will lead to unforeseen economic and political costs. Where have these policies come from?”
Claire Anderson, Chair of the English Pharmacy Board, said:
“The five-year framework announced last year offered some certainty for pharmacists planning ahead and it is important that this settlement is being expanded. The Community Pharmacist Consultation Service shows great promise for referral services that will be rolled out and we need to build on this platform to show what a key role pharmacy plays in providing urgent patient care.
“It is great to see a proper way of utilising the pharmacy integration money to support the transformation of community pharmacy and the acknowledgement of the hub and spoke challenge for independents. We also welcome the recognition of the role that pharmacy plays in supporting the safer use of medicines through the new Discharge Medicines Service.
“Nonetheless, it is frustrating that money remains at the same rate for new services and the limited details on some of the updates in the deal, particularly regarding the review of the Pharmacy Quality Scheme.
“Pharmacists and community pharmacy teams work incredibly hard every single day but they are already extremely stretched financially in terms of resources and capacity. The wellbeing of the workforce needs to be a priority to ensure they can deliver on this deal. We would like to see this integrated into future agreements between PSNC, NHSE&I and DHSC.
“With the expansion of the Community Pharmacist Consultation Service, we will continue to work with the Government, NHS and pharmacy stakeholders to get more details on these services and explore new ways of improving these funding models for the future.”
Pharmacy in Practice is a UK pharmacy publication with its roots in Scotland.