The pharmaceutical industry and community pharmacy – a better way of working?

pharmafield logo - pharma news

Deborah Evans and Michael Holden look at how the role of the community pharmacist will change as part of the White Paper’s vision for pharmacy, and how this will create new opportunities for partnership working with the pharma industry.

Over the last three years much has changed that has impacted and continues to impact on community pharmacy in England and the pharmaceutical industry (See box 1). These provide both opportunities and challenges for community pharmacy as it realises its full potential within the primary healthcare team. Overcoming these challenges, managing the change, dealing with the insecurities and threats and optimising the opportunities is being met with varying degrees of success by the NHS, industry and pharmacies. The model is moving away from just medication supply to one that increasingly involves the delivery of clinical services.

These provide both opportunities and challenges for community pharmacy as it realises its full potential within the primary healthcare team. Overcoming these challenges, managing the change, dealing with the insecurities and threats and optimising the opportunities is being met with varying degrees of success by the NHS, industry and pharmacies. The model is moving away from just medication supply to one that increasingly involves the delivery of clinical services.

As a consequence of the Pharmacy White Paper (Pharmacy in England – building on strengths, delivering the future), published April 2008, the pharmacy contract in England is now undergoing a review to meet future needs and deliver more quality markers.

Needs

As the NHS moves away from provision and further towards a commissioning role, the roadmap for pharmacy is becoming clearer; it needs to be, and be seen to be, a clinical profession providing quality healthcare services. Financial and distribution changes related to medicine supply have created some tensions between the industry and community pharmacy over recent years.

We must acknowledge that new operating models are here to stay in some form or other, and community pharmacy needs the support of the industry to manage the change, overcome skill and knowledge gaps, support service development and facilitate effective engagement and integration with other primary care providers and commissioners.

The traditional product model for the industry is changing to product-plus-service as financial balance-driven medicines management strategies and evidence based prescribing impacts on turnover and competitive position in the market. Companies are looking for additional strategies to grow and protect their portfolios.

To achieve a win-win, all parties need to identify and address each other’s needs through effective partnership working.

Opportunities

The White Paper highlights pharmacy’s significant place in the NHS, and while the focus is mainly on community pharmacy, its context is wider, including hospital pharmacy, professional regulation and education and training. The vision is one of an enhanced clinical role for community pharmacists as providers of new patient services including case finding, long-term condition support, medicines management and prescribing, plus the improved delivery of existing services like health awareness, self care and compliance support from ‘Healthy Living Centres’.

The White Paper also seeks to:
• improve access to medicines and promote their safe and effective use
• increase implementation of repeat dispensing to deliver benefits to all
• reduce medicines waste through improved management and compliance
• overcome the challenges associated with accessing medicines out of hours
• improve access in rural areas, e.g. Dispensing Doctors may be able to sell OTC medicines
• establish information exchange between secondary and primary care interface
• commission services for the safe delivery of oral chemotherapy
• embed safe medicines practice in primary care to reduce unplanned hospital admissions.

Medicines Use Reviews (MURs) remain a high priority area for the NHS with improvements in service quality and targeted therapy areas based on local health needs. Peer review, Continuing Professional Development, research, audit and decommissioning of MURs from those failing to meet quality standards are all recommended in the White Paper.

Change is essential

Community pharmacy will need to change both culturally and operationally to provide additional patient value, whilst delivering excellence and consistency in services. It will need to:
• be repositioned, recognised and valued by all as healthy living centres
• change the business model to an expanded range of patient clinical services
• deliver the core supply role safely, consistently and efficiently
• adopt legislative changes to deploy the whole pharmacy workforce
• improve inter-professional relationships, particularly with GPs
• have access to Summary Care Records
• electronically capture interventions and use new technologies
• be more focused on measurable quality outcomes
• build on professional, clinical and leadership competencies to deliver services.

What does this mean for industry?

Partnership working, where engagement and outcomes deliver benefits for both parties whilst complying with regulations, guidelines and governance arrangements is the solution; making this happen is the challenge.
• Pharmacy services will increasingly impact on the choice of and compliance with treatment, delivering improved health outcomes and reduced unplanned attendances and admissions.
• Pharmacy will be more actively engaged in the early identification of long-term conditions through integrated screening and risk assessment programmes with an associated increase in pharmacotherapy interventions for these new patients in line with national and local guidelines.
• Extended public health initiatives including smoking cessation, weight management and sexual health services may involve appropriate provision of Prescription Only Medicines.

What should you consider?

• Recognise pharmacy as a key health professional and enabler of improved adherence to medicines; ensure pharmacy is a key customer in national and local plans.
• Support the development, implementation and evaluation of patient services to create the evidence base for commissioning of other services.
• Facilitate multidisciplinary relationships, particularly with GPs, to optimise patient care.
• Work with national and local pharmacy bodies to support clinical development and develop implementation skills, including project management, patient communication and behavioural change (e.g. Motivational Interviewing).
• Ensure that your knowledge of pharmacy is current and credible.

What do you need to know?

• How well do I understand this customer, their needs and how I might add value?
• How long will the full integration into primary care take and which of my customers are moving fastest?
• What services are likely to be commissioned locally? Are these relevant to my portfolio and what value can pharmacies add to the target patient group?
• interdependencies within the local primary care team and how might I add value?
• What are the clinical training needs for pharmacy in my product area and how might I support continuing professional development?
• How many patients on my medicines are not complying with their treatment and if they were, what would this mean to their health outcomes and product penetration?
• How can the pharmacist add value to improving compliance with my medicines?
• What role does the pharmacy have in case-finding in diabetes, vascular risk, osteoporosis and COPD and how can I support this?
• What are my competitors doing with pharmacy?

Pharmacy activities to be implemented widely

• Minor Ailments Scheme to be incorporated into contractual framework
• Partnership between pharmacy stop-smoking services and local NHS services
• National template for commissioning of chlamydia screening
• Expand pharmacy-based contraceptive services
• Integral in delivery of the vascular risk assessment programme
• Enhance the role of pharmacy in the care of patients with diabetes
• Support for patients on new treatment for the management of LTCs
• Systems in place to support early detection and prevention of some cancers
• More robust standards and metrics for Essential and Advanced services
• Harmonise accreditation for pharmacists
• Financial incentives for quality innovation with penalties and sanctions for poor performers

For more information:
• Pharmacy in England – building on strengths, delivering the future, Department of Health, April 2008: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_083815
• PSNC summary: www.psnc.org.uk/pages/whitepaper.html
• The contractual framework for community pharmacy in England and Wales 2005: www.psnc.org.uk
• Scottish Pharmacy Contract: http://www.communitypharmacyscotland.org.uk/
• Northern Ireland Community Pharmacy Strategy – Making it Better: www.dhsspsni.gov.uk/makingitbetter.pdf
• Building the Community- Pharmacy Partnership: www.cdhn.org/bcpp/

About the authors: Deborah Evans MRPharmS and Michael Holden MRPharmS run balance, an operating division of The Tipping Point Ltd, which helps community pharmacy, the pharmaceutical industry and NHS commissioners to meet their needs and those of their patients.
www.balancesolutions.org.uk