Equity and excellence: Liberating the NHS
The Coalition Government published its health White Paper Equity and Excellence: Liberating the NHS in July 2010. The NHS of the future will focus on prevention as well as cure, those in healthcare will be incentivised for outcomes and not activity and the quality of services provided will be rewarded rather than quantity.
The context of these proposals is important as finances are constrained and the NHS cannot afford to be complacent about the use of the most common health intervention i.e. medicines. Like Ministers, the RPS sees the main role of pharmacists as ‘optimising the use of medicines and supporting better health.’ We welcome active involvement in refining the proposals outlined in the consultations to develop solutions that work best for patients and maximise the use of pharmaceutical resources.
We oppose an increase in regulation of pharmacies unless it improves patient safety and we are concerned that the outcomes from these consultations could lead to a duplication of effort and bureaucracy. The role of Monitor needs to be more precisely defined in relation to pharmacy and the services they provide.
Different elements of a whole service could potentially be commissioned by different organisations in the future, such as the NHS Commissioning Board, GP consortia and local authorities. We are concerned about how all these partners will work together to ensure services are not fragmented, so that patients can continue to receive high quality care.
Key improvements that would help deliver quality against the NHS Outcomes Framework include providing access to summary care records for relevant health professionals to ensure more consistent care and improve patient safety, the development of a quality and outcomes based contract for pharmacy to raise standards and for this to be aligned with contracts for other healthcare professionals and an outcome measure for effective medicines management in pharmacies.
We support the aim to strengthen public health provision and believe that having a pharmaceutical public health focus within the new national public health body is essential, especially in terms of equity, as pharmacy already works extensively with vulnerable patients who often do not access the NHS via the traditional routes.
The 'Any Willing Provider' model is one that is familiar to community pharmacists, but the playing field must be level with the same information and opportunities being given to all providers.
Our message to Government is clear - we have the skills, expertise and experience to prevent people becoming unwell through public health interventions, as well as improving their health by making the most out of medicines.
- Medicines are the most common health intervention that patients receive from the NHS;
- Pharmacists are the medicines experts;
- Pharmacists should be involved in all aspects of healthcare involving medicines including the new local and regional structures proposed by the Government;
- Pharmacists are committed to quality;
- Pharmacists can enhance patient outcomes from medicines use and drive efficiency on costs.
Regulating healthcare providers
- Monitor, Care Quality Commission and the General Pharmaceutical Council must avoid adding to the burden placed on pharmacists by duplicating regulatory activity.
Commissioning for patients
- Community and specialist pharmacy should be commissioned nationally;
- A level playing field must be given to all providers, including pharmacy, by GP –led commissioning consortia.
Transparency in outcomes
- We support a quality and outcomes based contract for pharmacy.
Local democratic legitimacy in health
- Public health provision, could be massively enhanced by the inclusion of pharmacy based services.
Next steps for the profession
The English Pharmacy Board discussed their responses on behalf of the Society to the consultations and set the organisation the following aims:
- to enhance pharmacy provision within the new NHS commissioning processes
- to help deliver the agenda for pharmacists whilst taking into account current and future workplace pressures
- to ensure pharmacists, as the experts in medicines, are working with patients and their medicines wherever there is that interaction within patient pathways
In order to achieve these aims the Society will:
- position pharmacy to help deliver the new NHS agenda so, as a profession, we can contribute fully to the delivery of the optimisation of medicines and the prevention of ill health.
- work with the QIPP programme to demonstrate and enhance pharmacists’ role in medicines optimisation
- work with PAG, PCPA, GHP and PDA to transfer the current skills and roles of primary care pharmacists into the new NHS structures
- work with DH and other pharmacy organisations to identify and develop local clinical pharmacist leaders
- work with members to provide support tools, including harmonised quality standards for service provision
- work with a variety of partners to develop potential practice models for pharmacy to enable pharmacy to deliver and operate effectively within the new NHS
Click on the image on the left to view our interpretation of the proposed NHS structure as outlined in the consultations published by the Department of Health. It may change or be further clarified following consultation responses.
Find out more information about the roles and remits of the organisations involved.
Acknowledgement: Pharmacy Voice: The Changing NHS and Public Health Landscape: What does it mean for local representation?