Transcript Title

Now more than ever – why
pharmacy needs to act
Dr Judith Smith, Director of Policy, The Nuffield Trust
10 December 2014
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Agenda
Context of the one-year review
How we worked
What we found
What we concluded
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Context of the review
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Why a one-year review?
• Now or Never: Shaping Pharmacy for the Future (2013) set out
a vision for pharmacy as a care-giving profession
• RPS was challenged to take responsibility for demonstrating
progress toward that vision
• RPS fully embraced the ethos of the report and an independent
one-year review was commissioned from The Nuffield Trust to
explore progress since launch
• The review report is an independent assessment of progress
primarily intended as feedback for RPS and its partner
organisations in pharmacy
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Scope of the review
• An assessment of the extent to which progress is being made
toward the ideas embodied by Now or Never
• Recognises that the report does not exist in isolation - lots of
factors at play
• Picks up on wider policy developments since November 2014
• Need to be realistic about the timescale of the review - what
could be achieved in a year
• In essence a reality check of progress and momentum
primarily at a national level, and with a sense of emerging local
developments
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How we worked
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How we worked
Two discrete stages
SIX MONTHS
TWELVE MONTHS
Assessed initial impact and helped
refine scope of the 12 month review.
Overall assessment of progress made
and the key themes emerging.
Telephone interviews with the
Commission’s advisory group
members; review of latest policy
documents and press coverage;
extended meeting of Commission
advisory group and English Pharmacy
Board.
Detailed analysis of media, social
media, parliamentary and policy
literature; around 40 interviews with
stakeholders within and beyond
pharmacy; an electronic survey of
those who attended the parliamentary
launch of Now or Never.
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What we found
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Policy context
Five Year Forward View. Sets out plans for radical new models of
care across every part of the health service (2015-2020).
Includes:
- urgent and emergency care networks
- a commitment to more funding and priority for new models of
primary care, including ‘multispecialty community providers’
and ‘primary and acute care systems’ (ACOs)
- suggestion that all records could be shared at patient
discretion
Plus, the Better Care Fund and the Department of Health’s
Transforming Primary Care plan
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Initial impact of the report
• At least initially, Now or Never seemed to have greater impact
on practitioners and policy-makers beyond pharmacy than
within the profession itself
• Now or Never got the ‘pharmacy message’ to a much wider
audience
• Stakeholders outside pharmacy welcomed the opportunity to
hear about the potential contribution of pharmacy to health and
social care in the future
• Whilst the pharmacy world largely welcomed the report, the
initial enthusiasm for the messages does not seem to have
endured
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The pharmacy leaders’ response
• The RPS has taken on the goal of pharmacists becoming caregivers and has made significant advocacy efforts within
pharmacy and the wider NHS
• The RPS campaigns, innovators’ forum, work with NAPC were
all highlighted to our review
• The drive towards a broader role for pharmacists, however, has
been undermined by the continuing divided leadership of the
profession
• There is still a tendency for pharmacy to look inwards, missing
vital opportunities to be part of wider NHS plans and priorities
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There has been progress
The care-giving role of pharmacy has gained particular traction
the following areas over the last year:
• urgent and emergency care, and the potential for pharmacies
and pharmacists within these networks;
• public health, including initiatives such as pharmacies
delivering flu vaccination programmes;
• and pharmacists taking up roles within new general practice
organisations and networks.
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Development of care-giving services
• Pharmacists at a local level continue to persuade some local
commissioners to fund innovative services to support health
and social care, but such progress remains patchy and lacks
scale
• There has been disappointingly little progress over the last
year in shifting the balance of funding and commissioning
away from the dispensing and supply of medicines toward the
delivery of direct patient services
• Does this reflect the complex and often fractured nature of
pharmacy leadership in England, and hence a relative lack of
influence on policy?
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What we concluded
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1. Consistent and ‘can-do’ messages are crucial
• The different professional, owner/employer and policy
stakeholders in pharmacy must speak as one voice about the
role that pharmacists can play in the new models of care
advocated by NHS England
• There must be a consistent and ‘can-do’ message about how
pharmacy is a crucial part of the answer to challenges such as
urgent care, support for people with complex long-term
conditions, public health, and treating common ailments
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2. Progress in attitude needs practical national backing
• There has been progress in the attitude of NHS policy-makers
towards pharmacists providing care, for example for common
ailments, within wider urgent care networks
• This needs to be backed by funding and coordination, through
the national community pharmacy contract and/or new
payment mechanisms being put in place to support the Five
Year Forward View
• Pharmacists, GPs, and the wider NHS need a clear signal that
the NHS means business about pharmacists assuming a
wider care-giving role
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3. Local change and funding must gather pace
• National action will not suffice – change will continue to happen
locally too
• Pharmacists must make the case locally for their vital
contribution in the future, including support for frail older
people, managing medicines to help avoid hospital admission,
and supporting work on prevention and public health
• More guidance and support is needed from the RPS,
employers and other national bodies about how to become part
of local primary care federations and networks, and the new
multi-specialty community providers and other care models set
out in the Five Year Forward View
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4. Change offers opportunities for all of pharmacy
• The Five Year Forward View presents many opportunities for
community, primary and secondary care pharmacy
• New provider organisations will form and roles develop as part
of new models of care
• Pharmacy leaders must be at the centre of this national and
local debate and planning
• If not, community pharmacy in particular risks being overtaken
by the expansion of technology-driven dispensing and supply,
and local pharmacy services being delivered by new NHS
organisations
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5. It really is ‘Now more than ever’
• The financial context is tougher than ever. NHS England has set
out a direction of travel that is about integrated local care
providers, working in new networks that maximise the use of
technology and new professional roles
• RPS was prescient in commissioning work on new models of
care some 18 months ahead of the Five Year Forward View
• The challenge to pharmacy as a profession is to seize the
opportunities on offer - if they fail to do this, their role in the
community beyond 2020 looks bleak
• It really is now more than ever…
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21 July 2015
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