Community pharmacies that don’t get involved in their ICSs in the next weeks and months are ‘missing a trick’, NPA chair Andrew Lane has said.

Speaking to The Pharmacist, he argued that opportunities are available now to gain funding for locally commissioned services and to influence prescribing policies, build relationships with GPs and ICSs, and ways to balance services and supply.

Contractors who want to take advantage of additional services should liaise with their LPC, he advised, adding that the pharmacy bodies are ‘pivotal’ in negotiating the role of community pharmacy on a local level.

It is important for pharmacy to get involved in conversations within the next ‘weeks and months’, ahead of changes in April 2023, he added.

From April 2023, all ICBs will be expected to take on responsibility for all pharmaceutical, general ophthalmic and dental services.

The NPA is working nationally to ensure the change ‘brings a much more enlightened and encouraging regime leadership’, and ‘support the clear voice of independent community pharmacy with a stronger hand in national, regional and local representative structures’, he said.

He added: ‘I think local systems, if they actively invest resources to community pharmacy development, will see a greater return on the pharmacy pound that they spend.’

Funding at the local level

Mr Lane said that funding for local additional services such as PGDs are ‘really down to the local level’, although clinically ‘there might be some good ideas coming down from the centre’.

He explained: ‘Different systems have different priorities. And [the ICSs] are prepared to fund if it's a priority for them’.

In Gloucestershire, where Mr Lane chairs the LPC, Mr Lane said there are good relationships with ICS leaders who will work together with the LPC to submit a joint business case for community pharmacies delivering clinical services. ‘If the system sees benefit in the service, we see benefit in providing that service for the right fee,’ he said.

In South West London, where he also works within the ICS, he said, ‘I'm seeing open arms to community pharmacy from system leaders – in other words, that they're looking to see what we can bring.’

He added: ‘It really is an opportunity now to ensure that local LPCs get organised to make sure that they're ready for this new world.’

Influencing prescribing policies

Mr Lane also highlighted the opportunity set the agenda for medicines management. ‘At ICS level we do have some opportunity to influence the way prescribing policies move forward,’ he said.

Community pharmacies that don’t get involved and wait ‘to be told what to do by their system’ are ‘missing a trick, because they could be starting those conversations now’, he added.

For instance, he said that LPCs could influence whether branded generics are prescribed within their ICS, which would impact profit margins for smaller independent pharmacies, as well as influencing the prescribing policies implemented by pharmacists in general practice and community.

‘We are helping set the system policy that those ARRS pharmacists then have to put in place. We've certainly become one step ahead of that decision making process,’ he said.

Building relationships with GPs and ICSs

Mr Lane said that relationships between GP practices and community pharmacies is currently ‘very piecemeal’, and that ‘it's important to make sure that GP practice and pharmacy practice are seen as one within the integrated care system at primary care network level’.

He added that LPCs should start building relationships with PCN clinical directors ‘so they all understand some of the values that community pharmacy can bring.’

For example, he said that when his LPC had proposed that community pharmacy could take on the treatment of some UTIs under a PGD, a GP had said that they would ‘love to get UTIs off my desk’.

Mr Lane acknowledged that ‘relationships take time to form’, but that LPCs could draw upon the legacy of community pharmacy’s success during the pandemic, as well as reports setting out the value of community pharmacy in primary care.

For example, the Fuller stocktake report into integrating primary care, published in May, and the Taylor report commissioned by the NPA and published in September, highlighted that community pharmacists are the last named face-to-face clinician available to patients, as there is no longer a guarantee that they would be able to see the same ‘family doctor’ each time they visit a GP practice.

After the Fuller stocktake report was published, the NPA called for community pharmacy to be viewed as 'the front door to the NHS'.

Balancing services and supply

However, Mr Lane acknowledged the ‘fine balancing act’ between delivering services and dispensing prescriptions.

He pointed to challenges with capacity, particularly for pharmacies with one pharmacist delivering a ‘significant volume of prescriptions’, who must find the ‘headroom’ to carry out additional services.

He added: ‘But not every single service needs to be done by the pharmacist. It's important to recognise that the pharmacy team needs to be upskilled and supported, technicians equally, to make sure that the pharmacy team could deliver what the NHS wants to pay us for.’

‘The way pharmacy operates now will have to change’, he argued, highlighting that many pharmacies don’t currently use Advanced Checking Technicians.

‘We've seen some of those ACTs being poached by the system, which is never good, but we've got to make pharmacy an attractive place for those technicians to want to stay in community pharmacy,’ he added.

However, Mr Lane stressed that ‘you never really want to separate the dispensing operation from the service provision’.

He explained: ‘We've always said we should maintain supply as well as build services on the back of that supply. And I think that's the crucial thing for me, and also the NPA - that people realise that we cannot separate those two.’