Integrating healthcare providers has been an objective of national policy for more than three decades. This has started to gather pace with the introduction of the Health and Care Bill, which is expected to put integrated care systems (ICSs) on a statutory footing from April 2022. Its aspirations are to bring together providers and commissioners with the intent of improving patient outcomes, while ensuring UK taxpayers derive greater value for money.
These responsibilities will largely be the function of integrated care boards (ICBs) and integrated care partnerships (ICPs). How an ICS comes together and how community pharmacy can exert influence within it will differ between ICSs, but there must be a strong pharmacy voice on these decision-making forums (the ICB and ICP). In addition, there must be both local authorities and sufficiently remunerated community pharmacy roles embedded in these decision-making forums.
What is more, it must be delivered within the neighbourhoods they serve, because it is at this level that the real operational change will be led, and community pharmacy must be part of this. Outcomes are improved when providers and users deliver in the dwellings and townships they serve.
This last point is the biggest irony facing integrated commissioning, in my view. Resources are going to be a key challenge, so making best use of them is essential. As one of the biggest sectors in primary care, with almost 11,500 pharmacies in England residing across community heartlands, surely our sector with its credentials of trust and convenience should be the natural choice to fulfil the ambitions of ICSs and the ICPs, which support bringing all this together?
Instead, community pharmacy has barely been acknowledged, to say nothing of its policy and strategic absence from the boards and the decision-making forums of these ICSs.
The key to changing the stalemate is both cultural and leadership within the NHS. My fear is much of this leadership is now in situ, with hardcore views and attitudes towards community pharmacy. This has to change if we are to avoid a dominance by the NHS and once again find pharmacy outside the tent.
On a positive note, I am pleased the government has listened and taken heed of AIMp’s call for the programme to be suspended until July 22. As I stated way back in summer 2021 in my blog for C+D, with looming reviews and enquiries pending post COVID-19, April really was not the time to implement a far-reaching programme of structural change in the mist of so much uncertainty.
Leyla Hannbeck is chief executive of the Association of Independent Multiple pharmacies (AIMp)
