Pharmacy First service agreed as Recovery Plan set to launch

By Gabriel Blaazer

Negotiations have concluded around the implementation of the Pharmacy First scheme, which is now set to launch in full on 31st January 2024.

The government, NHS England, and Community Pharmacy England (CPE), which represents all community pharmacy owners in England, have reached agreement regarding the launch of the new national Pharmacy First service, set out in this year’s Delivery plan for recovering access to primary care.

CPE’s Committee unanimously accepted the proposed deal, which outlines how the £645 million investment pledged in the Delivery plan will be used to support the rollout of expanded community pharmacy services. The agreement was reached following months of negotiation between CPE, the Department of Health and Social Care and NHS England.

Public Policy Projects has recently advocated for an expansion of pharmacy services in England in its report, Driving true value from medicines and pharmacy, which was chaired by Yousaf Ahmad, ICS Chief Pharmacist and Director of Medicines Optimisation at Frimley Health and Care Integrated Care System.

It is now confirmed that the Pharmacy First services will be launched on 31st January 2024 as an Advanced Service, subject to the required IT infrastructure being in place. Under the new service, pharmacists will be able to offer advice and prescribe treatment for seven minor ailments, including sore throats, insect bites and uncomplicated urinary tract infections for women. Patients will be able to access the service without an appointment, as well as via referrals from NHS 111 and GPs.

Following consultations with pharmacists, patients with symptoms indicative of the seven conditions covered will be offered advice and prescription-only treatments where necessary, under a Patient Group Direction (PGD). CPE hopes that in the future, independent prescribers will be empowered to complete episodes of care without requiring a PGD.

As per CPE, the following stipulations have also been agreed:

The writing-off of previous funding over-delivery worth £112 million for CPCF Years 3, 4 and 5. If this money had been re-claimed from pharmacy owners over a year, it would have resulted in a reduction in the Single Activity Fee of around 10 pence per item.
Protecting baseline CPCF funding: the new money will be accessible as soon as possible rather than risk further over-delivery against Year 5 CPCF funding – the writing off of some Year 5 projected over-delivery supports this.
The inclusion of an upfront payment for of £2000 for Pharmacy First to support pharmacy owners to prepare and build capacity for the new service.
Increasing service fees to support ongoing capacity to deliver Pharmacy First, and for an uplift in fees across all services.
Reducing activity thresholds at the start of the scheme to “more achievable levels”.

The National Pharmacy Association (NPA) has welcomed the announcement, while also repeating calls for an increase in core funding for the community pharmacy contract to underpin sustainable future growth for the sector. NPA Chair, Nick Kaye, said: “We welcome this commitment to invest in a nationwide Pharmacy First service for common conditions. The new funding, whilst welcome, will not in itself solve the financial crisis in community pharmacy, but it is a substantial investment in a key service that could be a stepping stone to more.

“NHS England have put their faith in us, having seen community pharmacy successfully deliver other clinical services at scale. I’ve no doubt that pharmacies will once again deliver an impressive return on investment for the health service.

Highstreet pharmacist Boots has also welcomed the announcement pharmacy reforms. The chain announced today that it will roll out the NHS Pharmacy Contraception Service, allowing pharmacists to provide contraceptive advice and prescriptions, in the coming months. The service has already been successfully piloted in 22 stores in England.

The NHS Blood Pressure Check Service will also be expanded to most Boots stores in England, allowing pharmacists to check patients’ blood pressure and provide advice on reducing their risk of cardiovascular disease. Boots has said that the new and expanded NHS services will be good news for patients, pharmacy teams and GPs alike.

Seb James, Managing Director of Boots UK & Ireland, said: “We welcome the government’s announcement of plans to launch new contraception and minor ailments services in England, which will make life easier for patients to access the care and medicines they need quickly and help reduce GP wait lists.

“We have been working with our pharmacy teams in stores to roll out these new services to patients in England. We are already commissioned to deliver similar services for the NHS in Scotland and Wales and these are very popular with our patients and pharmacy team members.

“The free NHS blood pressure checks that we offer at most of our stores in England can save lives by spotting potential cardiovascular problems at an early stage, which also helps to reduce the burden on the NHS longer term.”

Not just for Christmas: Winter clinics a shining example of innovation we cannot overlook

By Dr Owain Rhys Hughes

Amid news that no funding is expected for community acute respiratory hubs this winter, Dr Owain Rhys Hughes explains why these are a shining beacon of innovation that the NHS cannot afford to overlook.

As winter fast approaches, the NHS is gearing up for another incredibly tough season. Waiting lists have hit a new record high of 7.8 million people and ongoing staff shortages continue to pile pressure on overstretched services. Innovation has a vital role to play in supporting the NHS to navigate these periods of intensified pressure. The winter clinics that provided lifeline support during last year’s winter months, which are yet to receive repeat funding for this year, are a shining example of the importance of such innovation – and the danger in overlooking it.

While primary care services deal with an existing backlog of appointments and referrals, the additional influx of patients expected to hit GP surgeries during the winter months – due to spikes in cold and flu complaints, for example – threatens to be overwhelming. Expanding the capacity and resources of primary, community and secondary care during this period is therefore essential. Winter clinics provided a crucial first line of defence for patients experiencing cold and flu symptoms last year. This deflected pressure from GPs and emergency services, boosting their capacity to see the patients they really needed to see.

Without initiatives like these, which facilitate the joined-up collaboration desperately needed to ease pressure on individual services and streamline patient triage, the NHS is facing a winter of unprecedented strain. A lack of capacity within primary care could leave many patients turning to A&E for support. In turn, this could place excessive pressure on secondary care, pushing up wait times for those in most urgent need of treatment.

We cannot afford to overlook the vital necessity of innovation that can unlock and support more collaborative care delivery and boost clinical capacity where it is needed most.

Winter clinics are just one example of the value and potential of such innovation during times of excessive pressure and need. There is a wealth of holistic and tech-powered solutions offering the tools for wider collaboration and more effective clinical communication. Harnessing these is essential to providing the infrastructure and support needed to ensure that the NHS can continue delivering exceptional levels of care amid growing strain.

Streamlining referrals into secondary care and introducing new sites for care delivery and diagnosis is a key way in which innovation is helping to do this. The rapid rollout of Community Diagnostic Centres (CDCs) across the health service is providing additional capacity and working to help reduce the number of patients being sent into secondary care for diagnostic tests and consultation. This is not only helping to diagnose illnesses such as cancer sooner, but is also allowing for triage to a wider range of services, ensuring only those who really need to be seen in urgent care are sent into hospital.

Another way in which diagnosis and referrals are being streamlined to free up capacity is through the introduction of digital advice and guidance. The use of digital tools to connect clinicians across different services can enable GPs and community clinicians to contact specialist consultants in real-time. This allows for advice and guidance to be easily and securely shared, and joint referral decisions to be made. As a result, the number of unnecessary referrals into secondary care can be reduced. Meanwhile, patients can be triaged to the most appropriate form of care sooner, avoiding repeat referrals and additional admin for GPs, boosting their capacity to spend with patients.

In my role at Cinapsis, I’ve seen this have an incredibly positive impact. Through our work in Norfolk and Waveney, for example, we’ve seen the use of digital advice and guidance reduce the wait time for specialist advice from 50 weeks to just 48 hours. This benefit has a knock-on effect by reducing the number of patients entering secondary care when they don’t need to. It also saves GPs time previously spent on copious admin and processing unnecessary referrals, freeing them up to see a higher number of patients.

As each new winter brings a fresh wave of increased pressure on our NHS, we must do everything we can to brace for and reduce the strain it puts services under. We cannot remove this pressure altogether; but we must embrace innovation wherever possible to facilitate the cross-service collaboration and vital communication needed to help clinicians unlock capacity and manage heightened patient demand.

Dr Owain Rhys Hughes, Founder and CEO, Cynapsis

Pioneering diabetes prehab service launches in Wirral

By Integrated Care Journal

Service uses population health data to identify those most at risk of having surgery postponed

One Wirral CIC, a non-profit community interest company that proactively helps to bridge gaps in health services and support for local communities, has launched a ground-breaking diabetes prehabilitation service to reduce surgery postponements, tackle waiting lists, and improve postoperative outcomes for patients. The service uses population health tools and analysis of hospital waiting lists to identify and support those most at risk of having surgery postponed.

Since April 2023, the service has supported two Primary Care Networks – Moreton and Meols PCN and North Coast Alliance PCN, funded by the North West Coast Clinical Networks. However, the service will now be extended across Wirral to all Primary Care Networks. The goal is for the approach to be adopted nationally.

The diabetes prehabilitation service uses the Cheshire & Merseyside Combined Intelligence for Population Health Action (CIPHA) population health management system, on Graphnet Health’s CareCentric platform. CIPHA surgical waiting lists at Wirral’s Arrowe Park Hospital are used to identify diabetic patients who are awaiting surgery and have a HbA1C (hemoglobin A1C – a test commonly used to diagnose diabetes and prediabetes) over 69mmol/mol or a BMI above 40.

The early identification of patients at risk of having their surgery postponed removes the need for GP surgeries to make referrals. The service also receives referrals directly from secondary care, for people that have had their surgery postponed, and have diabetic risk factors.

Once identified, patients are contacted within 48 hours and booked in for an appointment with a diabetes prehabilitation health coach, in a local community setting, such as a library. If a person’s HbA1c is over 69, they are automatically booked in for an appointment with a diabetes specialist nurse, who will look at medicines management and optimisation. Once they have seen the health coach and nurse, they commence a personalised prehabilitation lifestyle plan, which they follow up until surgery, whether that is a matter of weeks or months.

Lucy Holmes, Wellbeing Lead at One Wirral CIC, explained: “The population health and data-driven approach means we are able to contact the right people at the right time and give them the best intervention before their procedure, without anyone slipping through the net. We look at their lifestyle and they’re encouraged to participate in activities, including the free diabetes exercise sessions that are held in the community each week. Their medications are also assessed. It means we’re looking at a person from a holistic point of view, not just clinically and not just non-clinically. It’s a true community-based, multi-disciplinary team approach.

“We’re so pleased to be able to roll this out across Wirral, but it’s an approach that could easily be lifted and shifted. We would love to see it adopted nationally, because we have seen the many benefits of getting people fit before surgery.”

Dr Dave Thomas, Wirral Diabetes GP Lead, added: “With diabetes, we know that if someone is living with excess weight or their sugar levels are very high, then that comes with additional surgical risks, higher complication rates, they’re more likely to have a longer hospital stay, and they’re more likely to generally have a poorer outcome. So, a service where we’re getting people fit and healthy, and optimising their diabetes care prior to their operation can only benefit the patients. From a Wirral-wide point of view, it’s going to help reduce surgical waiting times, reduce complication rates, and it will allow us to reduce hospital stays.

“This really is a fantastic service. We haven’t seen anything like it anywhere else, which is really exciting and hugely positive for the patients that we’re supporting.”

To hear more about the benefits of the diabetes prehabilitation service, please click the video link: Wirral Diabetes Prehabilitation Service | How It’s Changing Lives.

New report from PPP calls for a pharmacy-led transformation of health and care

By David Duffy

PPP’s report stresses the need to support and empower the pharmacy sector and align its priorities with system-level health and care objectives.

A new report from PPP calls on integrated care systems (ICSs) to harness the unique capabilities of the pharmacy sector and implement a pharmacy-led transformation of health and care delivery. The report was launched at PPP’s ICS Delivery Forum event in London on Wednesday 1st of November 2023.

The report, Driving true value from medicines and pharmacy, is chaired by Yousaf Ahmad, ICS Chief Pharmacist and Director of Medicines Optimisation at Frimley Health and Care Integrated Care System, and is the culmination of three roundtable events attended by key stakeholders from across the pharmacy sector and ICS leadership. Insight from these roundtables has also been accepted as evidence in the Health and Care Select Committee’s recent inquiry into the future of the pharmacy sector.

Emphasising the connectedness of pharmacy and local communities, the report calls for the value of pharmacy to be recognised beyond its potential to produce financial savings, and emphasises the need to leverage its diverse workforce, locally situated premises and unique patient knowledge in the delivery of system-level priorities.

It also concludes that the pharmacy profession must better articulate its value to constituent parts of ICSs, and that they require support to develop their voice, vision and leadership to meaningfully contribute to the delivery of integrated care. The report suggests that to enable this, primary care network (PCN) leadership must become more diverse to include the representation of pharmacy, and that pharmacy ambassadors should be expanded upon to provide inspiration to new recruits.

The report recommends that the NHS undertake regular regional reviews of the impact of the Additional Roles Reimbursement Scheme, so as to ensure that the local pharmacy workforce is not unnecessarily depleted while ensuring effective support for general practice. The report also calls for ICSs to establish more effective pharmacy leadership development programmes to enhance the sector’s influence at system level.

The report outlines major barriers to the progression of the pharmacy sector, including workforce pressures, outdated IT infrastructure and contractual mechanisms that hamper efforts at major reform. Although noting that the government has set out to address issues around workforce and digital maturity via the NHS Long Term Plan and the Delivery Plan for Recovering Access to Primary Care, it argues that ICSs have the power to go further by shifting to integrated, outcomes-focused contractual models. These, the report says, would enable the community pharmacy sector to focus on improving health outcomes and addressing health inequalities in partnership with wider primary care service provision.

Left to right: Ursula Montgomery, Michael Lennox, David Tamby Rajah, Yousaf Ahmad.

Driving true value from medicines and pharmacy has been published in the week after the government published its response to the Health and Social Care Committee’s expert panel on the evaluation of the government’s commitments to pharmacy in England. In its response, the government didn’t recognise the expert panel’s overall rating of ‘requires improvement’ as being reflective of progress to date, but stressed its commitment to enabling pharmacy to maintain a central role in the NHS.

Report chair Yousaf Ahmad, ICS Chief Pharmacist and Director of Medicines Optimisation, Frimley Health and Care Integrated Care System, said: “This report underscores the critical linkage between medicines optimisation and integrated care. While cost savings are a compelling aspect of effective medicines optimisation and of pharmacy, the true value of medicines and the pharmacy team encompasses the entirety of health and care delivery.”

The National Pharmacy Association’s (NPA) Local Integration Lead, Michael Lennox, said: “As one of the stakeholders involved in the development of this report, the NPA welcomes its publication.

“You can draw a straight line from key NHS reports like Fuller and Hewitt to this excellent new document about engaging community pharmacy in integrated care systems,” Mr Lennox said. “The NPA has been involved in all of these strategically significant reports and our recently published prospectus for future services features prominently in this latest document.

“This report has some useful recommendations for NHS England, including that the impact of the Additional Roles Reimbursement Scheme is placed under constant review for each region, ensuring that the local community pharmacy workforce is not unnecessarily depleted. There are challenges for pharmacy leaders too, for example, the need to focus on improving health outcomes in partnership with the wider primary care team.”

David Tamby Rajah, Pharmacy Consultant, Community Pharmacy South West London, said: “This report reiterates the key role pharmacy can play in the newly introduced ICSs, the importance of successfully integrating community pharmacy, and the value of pharmacy to the NHS Primary care recovery plan, medicines optimisation, and their connection to local communities.

“The importance of population health management to pharmacy is highlighted as we plan for the future. This is the right time for all pharmacy sectors to have a joined-up conversation and seek further collaboration to support the challenges the NHS now faces.”

The full report can be downloaded here.

New report highlights how pharmacy can redefine role within NHS

By Integrated Care Journal

The National Pharmacy Association (NPA) has published a new report outlining how independent pharmacies are ready to redefine their role within the NHS.

The NPA has published a medium-term prospectus for the development of pharmacy services, calling it a challenge to old ways of thinking and an opportunity to redefine the sector’s role in the NHS.

It follows months of dialogue with NPA members about what a clinical future could look like for the sector.

The document, Making Changes, Meeting Needs, will be shared with the King’s Fund and Nuffield Trust who are currently working on a new vision for the future on behalf of Community Pharmacy England.

Among the ambitions in the NPA’s prospectus are:

Improve the management of long-term conditions such as asthma, hypertension, heart failure and diabetes.
Expand preventative interventions to help make the NHS a wellness, health-inequality reversing service.
Shift focus from a downstream dispensing role to an end-to-end prescription management role, with a focus on good pharmaceutical outcomes.
Become the go-to professionals for optimising the use of medicines, including upgraded Structured Medication Reviews and post-discharge reconciliation.
Offer prompt and accurate diagnosis, risk stratification based upon genotype and the capacity for personalised treatments.
Increase medicines safety right across the care pathway.
Build on hospital touchpoints – preparing people going into hospital for elective care, give them a soft landing back into the community and reduce readmissions.
Dramatically improve access to primary care.

Making changes, meeting needs — Credit: National Pharmacy Association

With informed policy-making and sufficient public investment, NHS community pharmacy could during the remainder of the 2020s develop much further as a clinical care and safe medicines supply service, in ways that will cost effectively benefit patients, public and the NHS, the document states.

NPA Chair, Nick Kaye, said: “Building out from the existing portfolio of services, there are some major opportunities within this decade, encompassing prevention, medicines optimisation, long term medical conditions and urgent care.

“We are seeking to challenge orthodoxies that have limited the sector’s scope for too long. At the same time, these ideas are firmly planted in reality because our start-point is what our paymasters in the NHS want, not what we can dream up.

“Some of this is about redrawing the borders of pharmacy practice – for example applying pharmacogenomics to pharmacist prescribing.

“Other aspects are about re-imagining what is our domain as a sector; we are rightly based firmly in the community but our impact ought to be felt and formalised across the entire system, including hospitals. We need to be ‘in the community but out of the box’.

“We are confident that the large majority of NPA members – by their nature innovators – are open to the idea of ambitious, transformative change.”

While pushing the boundaries of clinical service development, the NPA says it is also clear that the safe supply of medicines should continue to be a foundation stone upon which other pharmacy-based support is built.

In a foreword to the document, Dr Claire Fuller, Chief Executive of the Surrey Heartlands Integrated Care System, praised the NPA for backing a “can-do agenda” for the sector. “This is the kind of thinking – based in an understanding of what commissioners need – that makes people like me sit up and take notice”, she said.

Making Changes, Meeting Needs lists the enablers that would need to be in place in order to turn these ambitions into reality. They include digital connectivity, a boost to workforce and a supportive national contractual framework (in May, the NPA published its ‘New Deal for Community Pharmacy in England’ which describes such a framework).

The NPA is inviting people to offer feedback on their report, please write to independentsvoice@npa.co.uk.

Pharmacies could free up more than 30m GP appointments, Company Chemists’ Association says

By Gabriel Blaazer

Report calls on government to “go further and faster” in giving more capability to pharmacy to prescribe prescription-only medicines and reduce pressure on general practice.

A new report from the Company Chemists’ Association (CCA), whose members include Asda, Boots, LloydsPharmacy, Morrisons, Rowlands Pharmacy and Superdrug, has urged the government to be bolder in its plans to expand pharmacy services, announced in May as part of its Delivery plan for recovering access to primary care.

Included within the Department of Health and Social Care’s (DHSC) plans is £645m to enable the expansion of pharmacy services in England over two years, intended to help relieve pressure on GPs – including an approach it dubs Pharmacy First.

This includes ambitions for community pharmacies to be able to supply prescription-only medicines for seven minor health conditions (Pharmacy First), increase their provision of the oral contraception and blood pressure testing services, and the delivery of improved IT system connectivity between general practice and community pharmacy in England.

The measures are expected to free up an additional 10 million GP appointments per year once scaled – equivalent to around 3 per cent of all appointments – but the CCA have urged the government to move faster and be “bolder” in their plans and accelerate plans to train pharmacists in England to act as ‘independent prescribers.

By their own estimates, the CCA expect the plans for Pharmacy First will free up around 6m appointments annually. They estimate that a more ambitious Pharmacy First service could free up 30m+ GP appointments per year, five times as many as in the government’s current plans.

In their new report, Pharmacy first and independent prescribing, the CCA argue that giving community pharmacy additional capability to supply non-prescription medicines and additional prescription-only medicines is a necessary and urgent step.

“There are an estimated 23,000 pharmacists currently in England without independent prescriber qualifications. A simple extrapolation of the plans currently in place indicate that it will take until 2040 to train the entire workforce. We need 95 per cent of community pharmacists to be trained as independent prescribers by 2030,” said Malcolm Harrison, Chief Executive of the CCA.

The CCA argue that their recommendations would effectively create 11,000 urgent care centres in England. With an estimated 90 per cent of the population located within a 20-minute walk of a local pharmacy, they believe that a “Pharmacy First” approach could transform access to care and help address under-provision of clinical services in certain areas. They say, for example, that “ambitious commissioning could position pharmacies as the ‘go-to’ place for urgent and emergency care”.

Alongside the expansion of prescribing capabilities and certain clinical services, the CCA are also calling for:

A fairer funding framework for community pharmacies. Community pharmacy is chronically underfunded. The current annual funding shortfall equates to more than £67,000 per pharmacy in England. The funding announced in the recent Delivery Plan is new money for new activity and does not address the historic underfunding of the sector.
A bold approach to harnessing Pharmacist Independent Prescribing. All pharmacists registering after 2026 will be independent prescribers (IP). There are an estimated 23,000 pharmacists currently in England without IP qualifications. Under current plans, it will take until 2040 to train the entire workforce.
A flexible and future-looking legal and regulatory framework that enables pharmacists and pharmacies to deliver and safe and effectively of medicines and to provide appropriate clinical care directly to patients.

Malcolm Harrison added: “Government plans to rollout Pharmacy First are welcome, but are only a drop in the ocean. Under current plans, pharmacies are expected to free up 6m GP appointments annually – but our analysis shows pharmacies could do five times this number.

“Action to address the historic underfunding of pharmacies and a roadmap to utilise the clinical skills of pharmacists are essential to achieving this. The Covid-19 vaccination programme showed what pharmacies can do when the Government places its faith and investment in pharmacies. An investment in community pharmacy is an investment in greater capacity for the NHS, enhanced resilience in primary care and better patient outcomes.”

A spokesperson for DHSC said: “Community pharmacies play a vital role in the NHS and we are providing them with an additional £645m investment that could free up as many as 10m GP appointments a year. This is on top of the agreed annual £2.6bn of funding set out in the pharmacy framework.

“We are also taking a range of actions to modernise and enable better use of resources and automation, allowing pharmacists to provide more care for patients.

“We are working closely with NHSE and Community Pharmacy England to launch Pharmacy First by the end of 2023 and will share an update on timings shortly.”

GPs urged to join rapidly growing digital registration service

By Integrated Care Journal and Gabriel Blaazer

More than 240,000 online patient registrations have been completed through new national online service designed to make registering patients quicker and easier.

More than 900 GP practices – around one in seven nationally (14 per cent) – have already enrolled for the digital Register with a GP surgery service, which is managed by NHS England. The service, which enables patients or carers to go online to find and register with a local GP practice, is now available via the NHS App, with more than 240,000 new registrations processed.

GP practices process around 6 million registrations a year, with many still using paper forms, which prospective patients often have to collect themselves. Feedback from the 2020/21 GP Bureaucracy Review identified GP registration as a high volume and difficult task for practices and patients and the new service has been designed to simplify the process for both service users and practices.

The new online service has been trialed at GP surgeries across the country and has been shown to save practice staff up to 15 minutes per registration, by helping to reduce paperwork and administration time. The service, available to all practices, has been rigorously tested with users and a wide variety of patient groups, including charities who support homeless people and asylum seekers.

Patients can access the service using individual practice websites and the NHS website’s Find a GP service (which is also available through the NHS App), with the service automatically checking they live in the catchment area of a given practice.

The patient’s information is then automatically emailed to GP practices in a structured format aligned to their IT systems, helping reduce the time it takes staff to process registrations. The service is fully integrated with NHS login, which enables people to use one login to access several health and care services, verifying their identity. It also matches patients to their NHS numbers, with a 90 per cent first time match rate, further cutting administration for practices.

The service is fully compatible with translator services, ensuring accessibility for patients and a new-look paper form is still available for those who wish to use it.

Stephen Koch, NHS England’s Executive Director of Platforms, said: “This service reduces the administrative burden for general practice as well as making GP registration even more accessible to the public, offering patients more choice, convenience and consistency.

“We’re pleased to see a growing number of GP practices are coming on board, helping them save time and money. By recently integrating the service with the NHS App, we hope even more GP practices will take advantage of this new digital tool.”

Dr Shanker Vijay, Digital First Clinical Lead for London and a practising GP, already uses the service and assists other practices to introduce it. He said: “We live in a ‘one-click’ culture and we recognise that many busy people want online solutions.

“Vulnerable patients and those with physical access needs don’t need to visit the GP surgery to register, and people can access the service at any time, including outside of working hours to fit around their other responsibilities.”

There are also plans to make the service compatible with a number of Robotic Process Automation (RPA) solutions, which use bots to enable registration information to be automatically added into GP clinical systems at the touch of a button, as an optional extra. Full clinical system integration is also planned for next year.

More information on Register with a GP surgery is available here. Practices interested in offering the service can self-enrol or contact the dedicated support team, or attend the upcoming webinar on June 14, 2023 by registering here.

English pharmacies to offer prescriptions for seven conditions under GP access plans

By Integrated Care Journal

Patients to receive quicker, more convenient access to NHS care from high street pharmacies, in a major expansion of services under new plans to improve access to primary care.

Patients who need prescription medication will be able to get it directly from a pharmacy, without a GP appointment, in plans announced by the government today. Published as part of the government and NHS England’s primary care plan, the policy forms part of the government’s efforts to free up 15 million GP appointments in England over the next two years.

The reform means that, by next winter, people suffering from seven common conditions, including earache, sore throat, or urinary tract infections, will be able to access medication directly from a pharmacy, with the government investing £645 million over two years to expand community pharmacy services.

Almost half a million women will also no longer need to speak to a practice nurse or GP to access oral contraception and will instead be able to access it directly from their local pharmacy. There are also plans to more than double the number of people able to access blood pressure checks in their local pharmacy to 2.5 million, up from the 900,000 carried out last year.

Ending the 8am ‘rush’ for appointments is a key part of the plan. This will be supported by investment in better phone technology for GP teams enabling them to manage multiple calls and redirect them to other specialists, such as pharmacists and mental health practitioners, if more suitable. During trials, this has increased patients’ ability to get through to their practice by almost a third.

Extra training will also be provided to staff answering calls at GP practices, so that people who need to see their family doctor are prioritised while those who would be better seen by other staff such as physiotherapists or mental health specialists are able to bypass their GP.

Prime Minister, Rishi Sunak, said of the plans: “I know how frustrating it is to be stuck on hold to your GP practice when you or a family member desperately need an appointment for a common illness. We will end the 8am rush and expand the services offered by pharmacies, meaning patients can get their medication quickly and easily.

“This will relieve pressure on our hard-working GPs by freeing up 15 million appointments, and end the all-too stressful wait on the end of the phone for patients.”

In another significant step, up to half a million people a year will be able to self-refer for key services, including physiotherapy, hearing tests, and podiatry, without seeing their GP first.

The plan also commits to further reducing bureaucracy for general practice and building on the work of the Academy of Medical Royal Colleges. Local health systems are being tasked with making fit notes available via text and email to patients, to avoid unnecessary return trips to their GP.

In the run up to the NHS’ 75th birthday on 5 July, the new plan aims to support primary care services to continue to adapt and innovate to meet patients’ needs, with nine in ten people able to access their GP records, including test results, on the NHS App within the next year.

Demand for access to GPs is steadliy increasing, with the number of people over 70, who are five times more likely to need a GP appointment than teenagers, growing by a third since 2010. GP teams are already treating record numbers, with half a million more appointments delivered every week compared to pre-pandemic.

The NHS Chief Executive, Amanda Pritchard, said: “The care and support people receive from their local GP is rightly highly valued by patients and so it is essential that we make it as easy as possible for people to get the help they need.

“GPs and their teams are working incredibly hard to deal with unprecedented demand for appointments. But with an ageing population, we know we need to further expand and transform the way we provide care for our local communities and make these services fit for the future.

“This blueprint will help us to free up millions of appointments for those who need them most, as well as supporting staff so that they can do less admin and spend more time with patients.

Health and Social Care Secretary, Steve Barclay, said: “This plan will make it easier for people to get GP appointments.

“By upgrading to digital telephone systems and the latest online tools, by transferring some treatment services to our incredibly capable community pharmacies and by cutting unnecessary paperwork we can free up GPs time and let them focus on delivering the care patients need.”

Responding to the announcement of the GP Access Recovery Plan, Nuffield Trust Chief Executive, Nigel Edwards, said: “These are practical measures which should make getting treatment easier and more convenient for patients. Enabling pharmacists to provide more care to patients and take some pressure off general practice is long overdue.

“However, it will need to be implemented carefully. The number of community pharmacies has actually been shrinking as their workload has risen. We will need to check there is genuinely new funding and serious support so that patients aren’t just shuffled between two overloaded parts of the NHS. If not many pharmacists are actually able to take this up, it could become confusing for the public, and the new digital systems which the plan intends will help allocate patients to different services won’t have enough options.”

New survey finds public awareness of pharmacy services as low as 13%

By Integrated Care Journal

Findings from pharmacy tech startup Charac reveals more than half of patients do not use their local pharmacies for anything more than minor illnesses.

A new study from Charac, an NHS-integrated one-stop platform for independent community pharmacies, has provided a new insight into public perception and patient usage of pharmacies. Awareness of the full scale of services is as low as 13 per cent of those surveyed, and 53 per cent are not using pharmacies for anything further than very minor ailments.

With pressure on the NHS reaching unprecedented levels, Secretary of State for Health & Social Care Steve Barclay has acknowledged the importance of a ‘pharmacy first’ policy for England. This is designed to allow pharmacies to act as another entry point into the health service, and to relieve some of the pressure from general practice. However, this is yet to be realised in policy, and Charac’s research has found that patient knowledge of pharmacy services remains worryingly low.

Knowledge of services

More than 50 per cent of patients were not aware of the majority of services pharmacies provide. Most respondents were only aware of 4 out of 15 potential services, being minor illnesses, repeat prescriptions, emergency contraception, and flu vaccination. Knowledge of services was as low as 13 per cent for chlamydia screening and treatment, for example.

Usage of services

The only pharmacy services that more than a third of respondents reported using were for minor illnesses, such as colds, flu, and low-level digestive issues (58 per cent), and for repeat prescriptions (47 per cent). In fact, these were the only two services that the majority of respondents would go to a pharmacy for instead of their GP – 57 per cent for minor illnesses and 52.5 per cent for repeat prescriptions, respectively.

Furthermore, patients on the whole are still using pharmacies for traditional services, such as ordering prescriptions (96 per cent) and disposing of old medication (80 per cent). While satisfaction with pharmacy services remains high, with almost half of respondents giving their pharmacy the highest satisfaction rating, patients evidently remain hesitant to use pharmacies as the first port of call.

Santosh Sahu, founder and CEO of Charac, said: “Though it is great to see patients largely very happy with the services provided by their pharmacies, it’s clear that patient confidence in various services other than prescriptions is low. To push a ‘pharmacy first’ policy, more must be done to provide pharmacies with better resources and increase patient confidence.

“Both funding and improved digital access can make a tangible difference in equipping pharmacies for the future. Charac’s platform is helping pharmacies improve their online presence, as well as helping them generate a steady income by digitising processes such as consultations and prescriptions.”

Acute Care, Health Inequality, News, Primary Care, Thought Leadership February 23, 2023

The NHS must break the cycle on heart failure

By David Duffy

Integrated Care Journal recently spoke to Dr Ashton Harper, Head of Medical Affairs (UK & Ireland) at Roche Diagnostics, to examine the heart failure diagnostic pathway and identify where the biggest opportunities in NHS diagnostics exist.

In the midst of its most challenging period of pressure, diagnostics have a significant role to play in helping to alleviate patient backlogs and free up vital resources across the sector – and nowhere is this more critical than with heart failure.

The health challenge that heart failure, a serious and chronic disease that prevents the heart from pumping blood through the body, poses to the NHS is both immense and relentless. An estimated one million people live with heart failure in the UK, with approximately 200,000 developing the condition every year, creating a profound and multifaceted set of health challenges for the NHS.

Writing in a recently published report by PPP for Roche Diagnostics UK & Ireland, Professor Sir Mike Richards described diagnostics as a “Cinderella” service within the NHS. Yet the UK’s capacity to diagnose heart failure has been consistently hampered by broader capacity challenges in NHS diagnostic service provision, as well as the lack of uptake of, and access to, innovation. A combination of workforce shortages and outdated facilities have historically contributed to late diagnosis and poorer health outcomes. This realisation directly informed Professor Richard’s 2019 report, which led to the introduction of community diagnostic centres (CDCs).

A ‘silent epidemic’

Heart failure is notoriously difficult to diagnose, in part because its key symptoms – breathlessness, exhaustion and ankle swelling – can be caused by a number of other conditions. As a result, late diagnosis of heart failure is unfortunately common, often only occurring once a patient has presented in secondary care following the onset of severe symptoms.

“If heart failure patients are picked up early in the community in primary care, the evidence shows that management of the disease is much better”

“Current estimates are that 80 per cent of patients are diagnosed [with heart failure] after a hospital admission,” explains Dr Harper, “and a significant proportion of those will be emergency cases, and so these patients are at the late stage, requiring more intense and complex treatment.” This matters because heart failure patients who require hospitalisation account for “somewhere in the region of a million inpatient days every year, which is about 2 per cent of total NHS annual bed days”. It is also estimated that between 2-4 per cent of the total annual NHS budget is spent managing patients with heart failure (up to £6 billion in 2022/23) and according to Dr Harper, “the majority of this burden is due to hospitalisation – and hospital admissions for heart failure have increased by 50 per cent in the last decade alone”.

“Somewhere in the region of 70 per cent of the total annual cost [of managing heart failure] is actually utilised by the management of stage four patients alone,” says Dr Harper, “but if heart failure patients are picked up early in the community in primary care, the evidence shows that management of the disease is much better; they have a better quality of life; and significantly reduced requirements of both primary and secondary care services ongoing.”

Diagnostic reform

“The NHS must look to adopt innovative diagnostic tools at a faster rate”

As was made clear in Professor Richards’ report, the NHS must conduct a wholesale rethink of diagnostic service provision. “Early diagnosis is key to effective management and better outcomes for these patients”, explains Dr Harper, “but while the use of medicines which are deemed to be beneficial and cost effective is mandated in the UK, diagnostics aren’t. It can often take 10 or more years for a diagnostic test to be widely adopted across the NHS.” As such, the NHS must look to adopt innovative diagnostic tools at a faster rate.

NT-proBNP tests are fast, cost-effective, non-invasive and recommended by NICE for the diagnosis of heart failure. Recently updated NICE Quality Standards, recommend that this test be conducted on all patients presenting to primary care with a possible heart failure diagnosis, but this guidance is not universally followed with recent data showing that only 18.3 per cent of heart failure patients had an NT-proBNP test recorded.

“Following the NICE guidance for NT-proBNP testing can reduce unnecessary referrals and allow GPs to better identify patients that do need more urgent referrals for echocardiograms”, Dr Harper notes, which is important because “we’ve got massive echocardiogram backlogs, with patients waiting months”, many of whom may not need one at all. The ability to preclude a heart failure diagnosis early would reduce the echocardiogram bottleneck, meaning those who really need one can access one sooner. “I think mandated funding for NT-proBNP would go a long way,” says Dr Harper. “This approach could help to potentially flip the site of primary diagnosis from 80 per cent in hospital to 80 per cent in the community, and therefore reduce pressure on the NHS.”

Reprioritising and reframing the issue of heart failure

Dr Harper believes that “there’s a strong case for heart failure to be prioritised by NHS England in the upcoming NHS Long Term plan refresh with clearly defined targets, such as exist for stroke and cardiac arrest.” Accordingly, “there needs to be increased collaboration between the NHS, industry and patient organisations to tackle inequalities in the diagnosis and management of patients.”

Much of this comes down to a need to educate and raise awareness of heart failure and its symptoms. “It has been described as a ‘silent epidemic’ because it hasn’t received as much attention as other pressing healthcare issues,” Dr Harper remarks. This lack of awareness has produced some alarming disparities, particularly around gender and misdiagnosis.

“Clinicians seeing female patients with the symptom of breathlessness should have heart failure at the top of their differential diagnostic list”

“There is an historical presumption that heart failure is a more male-dominated disease rather than female,” he explains, “when actually it’s about a 50/50 split.” Despite this, women are more likely to be misdiagnosed than men or to wait for much longer than men for their diagnosis. Dr Harper continued, “clinicians seeing female patients with the symptom of breathlessness should have heart failure at the top of their differential diagnostic list.”

Echoing recommendation three of Breaking the cycle, Dr Harper also encourages widespread adoption of the Pumping Marvellous Foundation’s BEAT symptom tracker. If shared with the wider public, this checklist – Breathlessness, Exhaustion, Ankle Swelling, Time for a simple blood test – could increase heart failure symptom awareness and ensure that more cases are identified sooner and treated more effectively.

Conclusion

“Ensuring primary and secondary care professionals share a common goal is key”

A coherent and system-wide approach will be needed if capacity is to be increased across all diagnostic modalities, but especially in heart failure. “Ensuring primary and secondary care professionals share a common goal is key,” Dr Harper says, “[and] the introduction of integrated care systems is a great opportunity to foster this collaboration.”

“By increasing diagnostic capacity in the community, we might be able to reduce the pressure on hospital admissions and NHS bed days,” and the use of NT-proBNP tests to confirm or rule out suspected cases of heart failure will be crucial. Taking the present opportunity to radically overhaul the heart failure diagnosis pathway will help to decrease the societal burden of the disease, create extra capacity for the NHS and, most importantly, help heart failure patients lead longer, healthier lives.

Breaking the cycle: Tackling late heart failure diagnosis in the UK, finds that late diagnosis of heart failure is a significant hindrance to the effective management of heart failure. It makes a series of recommendations to NHS England, Health Education England, and integrated care systems, as well as patient groups and industry to come together to improve heart failure diagnosis across the entire healthcare system.

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