James Roach evaluates how partnership working between a community pharmacy and primary care setting has significant potential if scaled up.
Working with the National Pharmacy Association; Jaunty Springs, an innovative GP practice; and Basegreen Pharmacy, a community pharmacy in Sheffield, I evaluated an integrated primary care service delivery model which has significant potential if scaled up and offers pharma a role as a catalyst for change.
Pharmacy key facts
There are around 11,500 community pharmacies in England
• Each pharmacy serves approximately 5000 people
• 1.6 million people walk into a pharmacy every day which equates to each pharmacy seeing 136 patients without an appointment every single day
• In almost all cases, access to a pharmacy
will be far easier than a GP.
Challenges to the healthcare system
Work in primary care is becoming more complex and intense due to:
• The ageing population
• Increasing numbers of people with chronic long-term conditions
• Decreasing numbers of people who want to self care
• Increased numbers of initiatives redirecting work from hospital settings to community and primary care settings
• Rising public expectations
• Significant workforce challenges in relation to recruitment and retention in primary care.
These challenges are summarised in figure 1.
The opportunity is real
Although there are many challenges facing healthcare, there are opportunities for community pharmacy and the pharmaceutical industry. As NHS England’s own data demonstrates, there are 30 million consultations in general practices that could be delivered in a different setting, see figure 2.
This leads us onto the integrated primary care service delivery model which is partnership working between the National Pharmacy Association, Jaunty Springs GP practice and Basegreen Pharmacy in Sheffield.
The core ethos of the model is that any patient who could be managed in a community pharmacy should be referred there to reduce practice workload, improve the patient experience and encourage positive patient behaviours towards self care and care management.
The community pharmacy accesses the GP practice’s SystmOne from the pharmacy consultation room, utilising the existing N3 connection for virtual review, booking of patients and updating of the patient record in real time. Patients are given the choice of healthcare professional in either the practice or through undertaking a consultation with the community pharmacist in their consulting room. Community pharmacy is able to undertake direct consultations with patients in the pharmacy or for older patients in their place of residence. In-depth medicines data analysis is also led by the community pharmacist.
Patients have access to the full community pharmacy team which consists of two community pharmacists, one full time equivalent (FTE), one of whom was an independent prescriber, two dispensers, 1.5 whole time equivalent (WTE) accuracy checking technician and medicines counter assistant. This team, working in tandem with the general practice team, generates a high-quality, seamless integrated care service for the patients.
Key benefits to the health system
Upon evaluation of the model there were clear benefits for the health system. It offers the opportunity to create more capacity in primary care through a highly scalable model. It has the potential to reduce average waiting times in primary care settings which reduces pressure on the whole GP team. As a result, average waiting times at the GP practice are lower than the local and national average.
The community pharmacy team supports patients in taking their medicines, enhancing adherence and supporting quality and safety of prescribing within the practice. This in turn eliminates prescribing errors at source and in real time by allowing the community pharmacist to access the full GP record and make changes.
It creates a critical change in patient behaviour, making pharmacy the first port of call for a range of conditions and there is also increased support for frail older patients in their own home, and those registered individuals residing in residential care.
The model also brings the additional benefits of utilising existing patient and professional relationships and breaking down silos within the health system, which have led to improved trust and confidence in the clinical input of the community pharmacy team.
Quantitative benefits to the health system
Under the model, more than 1000 interventions were carried out by the community pharmacist over a nine-month period. From the pilot, it was demonstrated that every four minutes of pharmacist time saves approximately two minutes of GP time, whilst also improving quality. For every day of dedicated community pharmacist support for general practice, one whole session of GP clinical time is created, meaning an additional 25 patients can see their GP every week.
“There are currently 11,500 community pharmacists and this evaluation demonstrates that if every pharmacy was to provide just one day of clinical support to general practice each week, it would release in excess of 18 million GP appointments per year”
Small steps can make a big difference
Operational integration between community pharmacy and general practice can be delivered through existing IT capabilities, supported by a template Memorandum of Understanding to govern data sharing between practices and pharmacies and a shared care arrangement. This is possible without the need for legal or structural integration. The evaluation of the pilot established that:
• Read-write access to GP clinical systems is already feasible within a community pharmacy setting, and adds significant value
• There is real potential in using community pharmacy differently – to explicitly support general practice, and to provide better and more integrated care for patients
• The availability of routine access to the GP clinical system is the key enabler to unlocking the potential of community pharmacy to deliver more advanced and holistic clinical care in a different setting.
Integrating primary care under a single purpose
The evaluation details no service specifications, because there are none. The modus operandi is integrated care because ultimately an holistic approach is the best for the patient and, in the long term, for the health service. Through alignment of priorities, sharing of information and respect for the skills and clinical competence of the community pharmacy team, there is a real opportunity for primary care to come together almost as a single organisation with a single purpose.
Changing patient behaviours
A notable feature of the Jaunty Springs integrated care model is that the vast majority of the interventions were made from the community pharmacy consultation room, rather than on the premises of the GP practice, with patients being booked directly to see the community pharmacist in the community pharmacy. For the GPs and community pharmacists involved that has been key in changing patient behaviours
in terms of how they access core services.
Above all, it’s been great for patients in the area, who have benefited from the improved access to medicines support. We have adopted the successful principle that any patient that could be well managed by the community pharmacist should be referred there to reduce practice workload, improve the patient experience and encourage positive patient attitudes towards self-care.
Where could pharma play a part?
Given that such a programme is critical for the future sustainability for the NHS, industry partners could work with their existing contacts in primary care and community settings to enable a different type of service model in this space.
This is a credible area where industry could act as the catalyst for change in health economies and transition from a supplier of a product to an innovation and service development partner.
This is critical for the sustainability of the NHS, and pharma can play a real part in impacting on it as well as helping to sustain key parts of their existing supply chain (general practice and community pharmacy) and unite under the common purpose of sustainability.
James Roach is Director of Conclusio Limited. Email firstname.lastname@example.org