Simon Dukes Pharmaceutical Services Negotiating Committee The Future of Community Pharmacy: How pharmacies fit into the NHS Long Term Plan Simon Dukes Pharmaceutical Services Negotiating Committee

The Future of Community Pharmacy Pharmacies in England A five-year deal for pharmacy New services: CPCS and Hepatitis C Supporting our NHS colleagues Working within Primary Care Networks

Community Pharmacy: Key statistics 11,600 pharmacies in England - Independents (1-5 pharmacies) 38% - Multiples (6+ pharmacies) 62% 89% of the population can reach their local community pharmacy within a 20 minute walk An estimated 1.6 million visits to pharmacies take place daily

Community Pharmacy: Key statistics Over 90% of pharmacies now have a private consultation room Community pharmacies are accessed by people who may not access other NHS services, helping to reduce health inequalities NHS income for a typical community pharmacy accounts for 85% of their total turnover

The five-year CPCF agreement PSNC negotiates with DHSC and NHS E&I Deal fixes funding at £2.592bn per year from 2019/20 through to 2023/24 Sets out the expansion of clinical service delivery through pharmacies, in line with the aims of the NHS Long Term Plan

Ambitions of the five-year agreement Pharmacies will adapt to provide new services The settlement will: “Expand and transform the role of community pharmacies and embed them as the first port of call for minor illness and health advice in England.” Matt Hancock, Secretary of State

Negotiations: Political Context This was not the deal pharmacy wanted We argued for further investment Highlighted rising costs, threats to viability and the impact of cost-saving tactics The deal secures future funding for as long as possible from Treasury, who are seeking efficiencies in dispensing We believe it was the best deal available This was not the deal that PSNC wanted – we pushed hard for further investment in the sector. But we were unable to extract more money from Treasury, who see us as an expensive way for them to get medicines to patients. We outlined how rising costs were already threatening the viability of many community pharmacies warning that cost-saving tactics would reduce capacity to deliver the new services. The Government is not interested in covering pharmacy contractors’ costs; it wants to commission cost-effective services, including a significantly more efficient dispensing service. We believe Government no longer wants to pay for 11,600 community pharmacies: they believe there are too many pharmacies not utilising technology to the full.

What does this mean for pharmacies? The deal guarantees a future for those pharmacies who are up for change Specific challenges will be around: dispensing efficiencies  freeing up pharmacists’ time wider use of clinical workforce branch viability and consolidations coming together locally in PCNs working closer with GPs The deal guarantees the sector a future – not one that will be easy to attain, but one that does present opportunities for those who are willing to engage with it and to change. What that change might look like is something that all businesses will need to think about. It will mean looking at the dispensing process and seeing how this can be made more efficient to free up pharmacists’ time to focus on clinical services. For large businesses it will mean some difficult decisions about the viability of some branches. For independent contractors, particularly those in clusters of pharmacies, it will mean some incredibly difficult conversations with other local pharmacy businesses to work through how you can deliver what the Government wants either working in partnership, or even through consolidating your businesses. For everyone it will mean looking at your businesses and stopping doing the things you are not paid for. And no matter the size of your business, it will mean coming together with other pharmacy businesses locally to ensure that you are all a part of the emerging PCNs.

Two new national services in 2019/20 The Community Pharmacist Consultation Service (CPCS) Hepatitis C testing service Capacity being released through the decommissioning of MURs (replaced by structured clinical medication reviews) Hepatitis C testing will be available to people using pharmacy needle and syringe programmes. This service supports the Government’s new national Hepatitis C elimination programme

Supporting NHS Colleagues: The Community Pharmacist Consultation Service (CPCS) Helping people with minor illnesses and those needing urgent supplies of medicine Pharmacist will provide healthcare advice or assess whether an emergency supply of medicine is appropriate Onward referrals will be made if needed GPs to be notified electronically

Supporting NHS Colleagues: The CPCS Referrals initially to come from NHS 111 Pilots to test expansion with referrals from GP practices (reception teams) Increasing patient awareness of pharmacy as the ‘first port of call’ for minor illness Reducing pressure on practices and urgent care providers Supporting patients to self-manage their health

Driving pharmacy clinical service development Through the five-year deal, a range of pharmacy services will be piloted If successful, these may be commissioned nationally in future years The Pharmacy Integration Fund and the PCN Testbed programme are NHS development initiatives that will be used to provide the necessary funding for pilots

Reimbursement Changes and Consultation PSNC, BMA and DDA worked on shared principles Our response is principle-based: - Base prices on suppliers we purchase from - Remove dispensing at a loss - Fair distribution of margin - Certainty of reimbursement prior to dispensing - Smooth transition to new systems - Preventing any patient safety risks Time to revisit generic substitution

Conclusions Pharmacy’s new deal does much to integrate us with general practice Supporting medicines safety, optimisation and prevention CPCS: a new chance for us to help Collaboration will be key – both at PCN and individual practice level

Contact Information psnc.org.uk cpcf@psnc.org.uk 0203 1220 810