Agenda item

Pharmacy and STP

a)    Stephen Blackman, Chief Officer, North of Tyne LPC, will highlight issues on behalf of the LPC.

b)    Andre Yeung, Chair of Northumberland Tyne and Wear LPN, will highlight opportunities for pharmacy to support the work being progressed via the STP.


Stephen Blackman, Chief Officer, North of Tyne LPC , advised the Joint Committee that he was here to highlight the role of Pharmacy which he considered was not addressed within the STP currently.


Stephen stated that Pharmacy can support both urgent care and primary care and the key message was that Pharmacy wants to transform and be part of the integration of services at both a national and regional level.


Stephen noted that 88% of the population is within a 20 minute walk of a local pharmacy and that there are 390 pharmacies in our area which deliver important services such as Stop Smoking. Stephen stated that the area has a long history of pharmacies delivering a range of services and in some areas pharmacies help with hospital discharges.


Stephen noted that the NHS 111 Community Referral Scheme was a great success.


Stephen stated that currently there is not a national contract for pharmacy but this is the direction that pharmacy wants to move towards.


In terms of the direction of pharmacy as set out in the Five Year Forward View there were three areas of focus; supporting long term conditions; acting as the first port of call for health advice and treatment and acting as a health and wellbeing hub.


Stephen stated that they had looked at the STP priorities and how it is aligned to the vision of the Forward View and it matches. They had also looked in detail at the services already being delivered and where Pharmacy can evolve and extend.


Stephen stated that currently they have a patchwork of services across the region and nationally and they would like to look strategically at a framework of services. Stephen stated that he considered that there was great potential for Pharmacy to be integrated.


In the area of long term care there are great opportunities as there is much more that can be done to support patients to manage their medicines and conditions eg asthma care. The Community Pharmacy Referral Scheme is already providing some support in this area.


In terms of transfers of care, pharmacy is also providing some help so that discharges can take place more quickly. Stephen stated that moving forwards there were opportunities to build on the foundations of the work already taking place and relieve pressure on other areas and be more integrated with primary and urgent care.


Andre Yeung, Chair of Northumberland Tyne and Wear LPN outlined further details regarding the Community Pharmacy Referral scheme and its achievements to date and opportunities for working better together.


Andre stated that he works closely with colleagues in the Durham, Darlington and Tees Valley area so that there is coverage across the whole region.


Andre explained that in August 2014 Durham University had carried out some research which suggested that community pharmacy bucked the inverse care law and deprived communities were best served by the services it provided.


At that time less than 1% of referrals from NHS 111 were going to community pharmacy and it was considered that there was scope for integration between the two. As a result a proposal was developed for the Community Pharmacy Referral Scheme which is regional and covers all ten CCGs across the North East and a population of 2.8 million with 618 pharmacies in that area. In order to tie in to urgent and emergency care systems the algorithms to NHS 111 were changed and it was identified that there were a potential 35,000 patients who could be referred to community pharmacy. The aim is to help increase resilience in urgent care by helping patients to self - care and by helping to deliver care closer to home. The project went live on 4 December 2017 and has been up and running for three months now. During this period Pharmacy has been seeing high levels of patients with 62.5% attending consultations with pharmacists and 30% receiving telephone consultations and 100% of patients are being supported with self -care. In terms of advice provided to patients 60% have been happy with the advice provided  and this has included the sale of over the counter medicines in some circumstances. Some cases are escalated to NHS 111 for other support or to GPs. There has been 85% patient satisfaction with the service overall. The service is providing real benefits as most of the patients supported would have gone to out of hours services of their GP if they had not been able to access this support.


Andre advised that the project was committed to run until September this year when there was to be a full evalutation of the project.


Andre echoed Stephen’s view that there were also other ways that Pharmacy could support the work being carried out in the STP around prevention which would save time in general practice for example in dealing with blood pressure.


Councillor Mendelson queried the position around funding and whether there might also be capacity issues if Pharmacy was to take on other areas of work.


Andre noted that time is precious for Pharmacy as with many other providers and if Pharmacy is taking significant numbers of patients out of the system and supporting them then they would require funding for this. Andre stated that the Local Pharmacy Network made a business case for this project to national colleagues and secured funding and it was hoped that if the project proves successful that this will then be rolled out to other areas.


Stephen noted that Community Pharmacy has had its budgets cut. Most regions have had 20% to 30% reductions in community pharmacy funding which has led to some redundancies although not to closures. Funding is difficult but there is capacity amongst Pharmacy teams is there was a shift in the service model and this would make Pharmacy more sustainable.


Councillor Taylor queried whether all pharmacies were willing and able to take on additional work and whether there was anything else which could be done to support pharmacies take on the types of work outlined.


Stephen stated that what was needed was to make the services outlined part of Pharmacy’s every day work when the new contract was put in place. Under the current framework pharmacies receive more money by dispensing more medicines. Stephen stated that they are suggesting that if there was a regional framework which included a number of services as part of pharmacy’s daily business this would ensure that Pharmacy was involved in the integration agenda.


Stephen stated that Pharmacists are keen to become independent prescribers but can’t issue medications and so they would like services to become a larger part of what Pharmacy does.


Stephen stated that Community Pharmacy is not the same as general practice. Much of the service provision is opportunistic as it relies on people coming through the door. This means that when they are designing services there is a need to understand what is to be achieved to ensure the right structures are in place and patients are targeted appropriately eg blood pressure.


Councillor Flynn


Councillor Charlton noted that some of the facilities at Pharmacies did not provide much privacy for consultations and queried whether this was likely to prove off putting for patients.


Stephen acknowledged that there is some variability in facilities although some now have three consulting rooms and a second Pharmacist. Stephen considered that facilities would develop.


The Chair asked Mark whether he had any comments on the issues highlighted in relation to future contracts and commissioning arrangements.


Mark stated that the points in the presentation had been well made and the pilots referenced and Andre’s role as part of NHS England was pivotal in taking matters forward via various processes. One of the starting points for this work was through the Urgent and Emergency Care Network where they are working to bring Pharmacy in.


Caroline stated that in the Urgent and Emergency Care Network Pharmacy is a cornerstone in the Behaviour and Child Illness App which identifies local pharmacies as a route for support services. Caroline acknowledged that there was a need to raise public awareness further that Pharmacy is the place to go in a range of circumstances.


Councillor Robinson highlighted the position of rural communities and noted that the Durham dales had lost a number of rural pharmacies due to the GP contract.


The Chair considered that it was surprising that Pharmacy was not yet integrated into the STP. The Chair hoped that consideration was being given as to how to change that position with a view to further progress being provided to the Joint Committee going forwards.