Pharmacies should deliver five more mandatory services, report finds

The King’s Fund and Nuffield Trust “vision for community pharmacy” report, published yesterday (September 19), set out a raft of recommendations for the sector over the next 10 years.

The think tanks were commissioned by CPE to develop the “vision” to “underpin a strategy for the sector” and support CPE with negotiations, it said.

The report recommended that in addition to all essential services currently included in the community pharmacy contractual framework (CPCF), all pharmacies should also be commissioned to provide five more mandatory services “over the next five years”.

These five extra essential services, which should be “nationally specified and priced” and “provided by all community pharmacies”, are:

Enhanced Healthy Living Pharmacy activities including social prescribing, in collaboration with primary care networks (PCNs)
The community pharmacist consultation service (CPCS) including walk-ins
A common conditions service
A new medicine service
Deprescribing and amendment of prescriptions

The report added that three more essential services should then be added on top of these “over the next five to 10 years” – hypertension and atrial fibrillation case-finding, flu and COVID-19 vaccinations and cancer detection and referrals services.

It also made recommendations on a variety of optional services, such as expanded contraception and smoking cessation services and long-term condition management with independent prescribing, as well as clinical services pilots such as the management of minor injuries.

And it said that while distance-selling pharmacies should not have a “separate contractual arrangement”, they would “still need to be able to deliver the requirements of the core essential services contract”.

Commissioners would also need to ensure that there are “sufficient financially viable in-person providers in their area”, it added.

“Deliverable by most”

The document said that this “much more clinically focused role”, expanding on the “emerging Pharmacy First concept”, will mean that the sector is seen as “first port of call for many common ailments and some long-term conditions management”.

There is “clearly significant variation within the sector in terms of capacity and capability” currently, the think tanks added.

But they said that they had “sought to design an approach that is deliverable by most community pharmacies” so that “implementation is likely to be more successful” – with the opportunity for some to “move further faster”.

“A national offer that is offered by all will be understandable to the public and may also avoid the frustration of people and patients being turned away from services,” they added.

Acknowledging some challenges with pharmacy premises, the report said that “in some instances”, larger pharmacies with clinic rooms could act as “hubs” for other community health services.

It “may be appropriate” for some community pharmacists to “work from GP surgeries, community health service clinics or other locations”, it added.

“Thriving businesses”

The report set out that under the think tanks’ vision, the proportion of income related to dispensing will fall over the longer term “as funding for other services grows”.

But it stressed that “core income” must be maintained due to the “financial fragility of many parts of the community pharmacy sector”.

“Pharmacies will be thriving businesses”, it said, “continuing with their core role as a key part of the medicines supply chain…while broadening the range of contracted and funded activities they undertake”.

According to the think tanks, NHS England (NHSE) will “need to take a more active role in the economic regulation of the sector”, which will require it to “develop a good understanding of the cost structures” in the sector.

This will allow it to “ensure that pricing and contract decisions do not lead to unintended consequences in terms of market entry and exit and that…the funding going into community pharmacy is appropriate to ensure sustainable services”, they said.

The report also set out that under its vision pharmacies will:

Diagnose and manage a wide range of acute common ailments, including prescribing medications when clinically appropriate, such as acne, athlete’s foot, chickenpox, conjunctivitis, haemorrhoids, hay fever, urinary tract infections and thrush
Refer people directly for diagnostics such as blood tests and to secondary care, rather than via GPs
Offer “some longer consultations on an appointment basis” while also “maintaining the walk-in nature of community pharmacies”
Use remote consultations and new technologies such as “advanced diagnostics, pharmacogenomics and wearables”
Provide smoking cessation advice and support for vapes as well as tobacco products
Provide “evidence-based advice on vitamin supplements”
Have a “structured post-registration career roadmap” for pharmacists and pharmacy technicians
Be offered “financial incentives to support collaboration” with GPs rather than to “foster competition”

It stressed that a “carefully positioned” information campaign would be needed at both national and local levels to ensure that the public is aware of the services available in pharmacies and that these are “not seen as downgrading the level of service that can be expected”.

Meanwhile, the report said that CPE and NHSE should “set out a timetable for the renegotiation” of the pharmacy contract.

It also recommended changes to the law to allow prescription dispensing “without a pharmacist on site”, saying that this will “level the playing field” with GPs.