Pharmacy contract reform is needed to ‘free up’ integration of primary and community care, a House of Lords select committee has been told.
In a new report, the Integration of Primary and Community Care Committee has published evidence from various care professionals and academics in an inquiry into the obstacles to providing joined-up healthcare services.
According to the report – called Patients at the centre: integrating primary and community care – various witnesses in committee hearings stated that multidisciplinary teams deliver better care to patients, but current contracts do not do enough to incentivise this model of care for pharmacy.
Among those quoted in the report is Ewan Maule, a member of the Royal Pharmaceutical Society’s English Pharmacy Board, who said: ‘What we have at the moment does not necessarily work well for citizens or the healthcare service, so we need more reform in some contracting aspects to free up the proper integration that we all know we need.’
The report observed that, since a pharmacy is remunerated based on the number of prescriptions it dispenses, it will not receive funding for the time a pharmacist spends meeting with a GP to discuss how a patient could have unnecessary or excessive medications removed from repeat prescription, although such actions ‘could be cost saving’.
Witnesses at the committee’s hearings expressed the view that primary and community care contracts should have aligned incentives, so that services are not in competition and are more likely to collaborate.
Mr Maule emphasised that, while the current contract system ‘benefits many’, it particularly favours larger businesses.
Therefore, Mr Maule explained, it is crucial to ensure that contract reform does not jeopardise smaller community-based pharmacies, as their loss would significantly affect the broader health service.
This ‘delicate balance’ has deterred major contract changes, often leaving smaller pharmacies at a disadvantage, the report stated.
Mr Maule also warned the committee that the current contract incentivises ‘a pill for every ill’, rather than a situation where ‘taking someone off a medicine was as valuable to them as starting someone on medicine’.
Multidisciplinary working is less likely to occur if it is not directly funded and therefore primary care contracts must be adjusted to ‘encourage all those contractor groups to work together in a way that is patient-centred’, he added.
The report makes a number of recommendations to improve integration within primary and community care, including ‘a more simplified and flexible’ system for awarding contracts and allocating funds within the NHS to encourage multidisciplinary working.
The select committee advises that the Department of Health and Social Care (DHSC) and NHS England (NHSE) should reform the contract process and ensure new contracts are flexible in the commissioning of primary care.
The report also recommends for different ownership models for GP practices to be explored, in order to facilitate ‘more joined-up and better care’.
Baroness Pitkeathley, chair of the Integration of the Primary and Community Care Committee, said: ‘We need more joined-up care, and more focus on preventative services if the NHS is going to be able to address the problems posed by the growing number of people in our society with multiple health issues which need complex and continuous care.
‘It is not an impossible task but requires, as our report sets out, more flexible systems, better data sharing, shared training of staff, good leadership and mutual respect between the many different professions in the system.
‘The reward will be better value for money, a more efficient system and above all, better outcomes for patients.’
DHSC and NHSE were contacted for comment.
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