The government's vision for a 'neighbourhood health service' must go beyond simply scaling up GP services and should capitalise on community pharmacies, a leading thinktank has warned.

Utilising hyper-local settings that already have good relationships with patients could make the service more effective, the thinktank Reform said in a report released today.

Leaders should empower local leaders to take risks, while creative use should also be made of resources such as Primary Care Network (PCN) staff, the report suggested.

In its pre-election manifesto, the Labour party said: 'The National Health Service needs to move to a Neighbourhood Health Service, with more care delivered in local communities to spot problems earlier.'

And recent NHS England guidelines have set out guidance on creating an 'integrated local approach to NHS and social care delivery'.

But there remains confusion and variation around what this could look like in practice.

'Top-down, GP-led approach' comes at cost of other practitioners

The Reform thinktank report, which draws on interviews with local and policy leaders, said that most current visions for a neighbourhood health service looked at scaling up GP care.

But it suggested that a smaller-scale approach was needed, and a neighbourhood health service should prioritise integration of services within a neighbourhood, including pharmacy, public health, social care, and community and voluntary, community, faith and social enterprise (VCFSE) sector services.

And Reform stressed that community pharmacies, local authorities and the VCSE sector should be in the ‘driving seat’ in the design and implementation of neighbourhood services.

'Interviewees argued that current neighbourhood-level health strategies tend to be dominated by primary care networks [PCNs], which tend to take a top-down and GP-led approach, to the detriment of other primary care practitioners, such as dentists, pharmacists, audiologists and optometrists, and the wealth of other organisations which contribute to population health at this level – particularly local government and social care providers, and the VCFSE sector,' the report noted.

It highlighted one project, Compassionate Frome, which utilised 'meaningful and personalised relationships between healthcare professionals and residents' to reduce hospital admissions.

And it suggested that in regularly-used sevices, such as community pharmacies, such relationships could be developed and clinicians could notice health changes and intervene where necessary.

'Capitalising on these relationships and enabling healthcare professionals outside of general practice to deliver a range of services will be a vital part of an effective Neighbourhood Health Service,' the report said.

The report pointed to a health hub based in an Andover shopping centre which reduced 'did not attend' rates at health checks to 5%, compared to the national average of 20%.

The service 'demonstrates how using spaces which are convenient to people, such as shopping centres, can help to improve people’s relationship with health services and, in turn, enable people to achieve better health and wellbeing outcomes,' the report said.

And it suggested that 'the places people have regular connections with should be used to deliver primary care services'.

'For instance, in England, 89% of the population has access to a community pharmacy within a 20 minute walk. Places like this, with higher footfall and levels of accessibility, should be capitalised on to bring primary care services closer to patients,' the report said.

Neighbourhood health service leaders must support local innovation

For a successful neighbourhood health service, leaders need to give local service providers the opportunity to test innovative approaches, work autonomously and directly with citizens, take positive risks, and be flexible in how they delivered frontline services, the report suggested.

Neighbourhood health leaders need to be 'supported and have the capacity to drive change at a hyper-local level: thinking strategically about the long-term needs of a neighbourhood; working to integrate the services and providers operating in their patch; managing change processes; and ensuring that feedback from residents is used to continuously improve services over time' the report added.

It suggested that directors of public health (DPHs) could play a 'vital' role in implementing neighbourhood health and 'ensuring that place-based considerations are properly fed in'.

Neighbourhood health service needs integrated assets, data and resources

The report suggested that workforce could be 'creatively deployed'. For instance, leaders should consider 'how staff in PCNs can be deployed to work in neighbourhood teams or be based in other hyper-local settings'.

And physical and virtual neighbourhood assets could be used to help deliver health services, it added.

In particular, it stressed the importance of a ‘virtual neighbourhood’ as well as a physical one and suggested 'having a better awareness of the organisations and services that already exist in an area and creating tools (such as apps and online booking portals) to make them more accessible to patients'.

Collating data and insights across services could also help enable more effective services, the report said.

'In many parts of the health system, there are long-standing challenges around data controllership and how data is shared between organisations – particularly general practice and other providers of primary care (like community pharmacy, optometry, audiology and dentistry) and between NHS providers, local authorities and the VCFSE sector.

'Nonetheless, there are pockets of excellence where places and organisations have collaborated to integrate data and design prevention-oriented services,' it said.

'Huge potential' for community pharmacy in neighbourhood health service

The report was supported by Boots pharmacy, and drew on interviews with local and policy leaders:

  • Professor Kate Ardern, former director of public health for Wigan Council
  • Dr Michael Dixon CVO OBE, chair of the College of Medicine and Co-Chair of the National Social Prescribing Network
  • Professor Sir Sam Everington, GP at the Bromley by Bow Centre and former chair of the NHS Tower Hamlets Clinical Commissioning Group
  • Dr James Flemming, GP and director of the Green Dreams Project
  • Paul Ogden, senior adviser, Local Government Association
  • Amit Patel, chief executive, Community Pharmacy South West London
  • Charlotte Ruthven, senior policy and delivery manager at the NHS Confederation
  • Albie Stadtmiller, chief executive, Voluntary Action Camden

Chief executive of the Company Chemists' Association (CCA) Malcolm Harrison said the 'timely report' recognises 'the huge potential to harness community pharmacy to deliver effective neighbourhood health'.

'With more pharmacies in more deprived communities, a workforce typically drawn from nearby neighbourhoods and highly trusted by patients, the community pharmacy network is ideally placed to improve health outcomes,' he said.

'The government has set an ambition to move care closer to the community and moving from treating sickness to preventing ill health. This report sets out some actionable steps to realise these shifts which we hope the Department and NHS take forward.

'Community pharmacy can play a significant role in delivering a neighbourhood health service, provided that the sector is afforded with the investment and support it requires.'

Read how pharmacists could be deployed across settings to deliver population health, as part of our workforce investigative series.