Community Pharmacy FORWARD VIEW Supported by the Royal

Community Pharmacy FORWARD VIEW Supported by the Royal Pharmaceutical Society English Pharmacy Board

Context • Health and care system facing major challenges and significant change – People living longer – Science and technology – Health spending • Community pharmacy’s potential • Maximising efficiency and outcomes across the wider NHS (5 YFV) Community Pharmacy | Forward View Slide 2

United approach building on existing work Ongoing development of a long-term, sector and profession-led strategy Community Pharmacy | Forward View Slide 3

Thinking things through • Joint workshop in April • Key conclusions – Sector needs to become master of its own destiny …. but does not need to reinvent the wheel – Needs something that works with the NHS 5 Year Forward View – Needs something that realises the ambition of the sector and profession – Needs something that meets the needs of the public and the Government • Something that realises community pharmacy’s potential Community Pharmacy | Forward View Slide 4

Forward View: Key Messages (1) • Community pharmacy provides the most accessible healthcare in local communities – especially in under-doctored areas. • Successive Governments have called for community pharmacy to provide more health services in the community and relieve the pressure on GPs and A&E, but have not provided the resources or vision to achieve this. • The CPFV is the first sector-wide vision for the future of community pharmacy. It renews the dialogue between the community pharmacy sector, the NHS and Government, and provides the basis for working together more effectively in future. Community Pharmacy | Forward View Slide 5

Forward View: Key Messages (2) • We feel that community pharmacy is best placed to determine its own future within an integrated, sustainable, high performing health care system. • We are now inviting feedback from key stakeholders on how we turn our shared vision for the sector into a reality that will be good for patients, the public, local communities and the NHS, as well as for the community pharmacy network and all those who work in it. Community Pharmacy | Forward View Slide 6

Forward View Outline • The Forward View establishes a clear ambition for the future of the community pharmacy network • This future is already here – everything described is being delivered or developed today • Now need consistency across the country Community Pharmacy | Forward View Slide 7

Three core functions of the community pharmacy of the future 1. The facilitator of personalised care for people with long-term conditions 2. The trusted convenient first port of call for episodic healthcare advice and treatment 3. The neighbourhood health and wellbeing hub Community Pharmacy | Forward View Slide 8

Core functions of community pharmacy 1. The facilitator of personalised care and support for people with long-term conditions • Enhanced and expanded services including lead responsibility for coordination of care and supporting selfmanagement. • Based around principles of medicines optimisation; personalised care and support planning; & cost effective use of medicines • Key role in facilitating safe and effective transfers of care Community Pharmacy | Forward View Slide 9

Core functions of community pharmacy 1. The facilitator of personalised care and support for people with long-term conditions • Majority of repeat prescribing workload shifts from General Practice • Independent prescribing by community pharmacists routine • Better health outcomes, controlled costs and reduced demand achieved • New funding and delivery models required e. g patient registration; process and outcome based ‘care fees’; joint ventures with other providers Community Pharmacy | Forward View Slide 10

Expanded Services: Illustrated Pathway Example pathway for a person with asthma Diagnosis of asthma; patient prescribed inhalers through e. RD QS 3 Patient registers with pharmacy, Patient Activation Measure, (PAM) and adherence measured, written personalised action plan created with pharmacist Patient visits their registered pharmacy to collect e. RD Rx. Interval period for Rx agreed between patient and pharmacist, with guidance from the GP QS 4 Pharmacy team provides inhaler technique training Support similar to MUR/NMS type interventions provided over initial few weeks e. Discharge notes sent to patient’s registered pharmacy Discharged After Emergency Admission to hospital Smoking cessation, weight management advice offered if appropriate QS 4 Pharmacist checks patient’s inhaler technique and provides coaching Patient continues to collect e. RD Rxs Cycle of community pharmacy support continues for patient Pharmacist is an independent prescriber so prescribes the patient’s inhalers for the next 12 months on e. RD Patient signposted to local or national support groups Flu vaccine offered to patient at start of flu season Collection of next e. RD Rx Post discharge medication review/reconciliation, which includes reviewing inhaler technique and ensuring patient knows difference between the different types of inhalers Patient represents with respiratory symptoms End of e. RD Rx Pharmacist checks patient’s inhaler technique and provides coaching Support similar to MUR/NMS type interventions continue to be provided when Rx are collected QS 6 Pharmacist assesses asthma control and as an independent prescriber follows BTS/SIGN guidelines to prescribe additional step in treatment QS 5 Annual review with the pharmacist, based on a standard template which includes an assessment of inhaler technique; ACT; and a review of peak flow readings

Patient is recruited onto the care package service MUR type conversation with the patient Synchronisation of patient’s medicines Expanded Services: Illustrated Pathway Illustrative care pathway for a person with multiple morbidities Patient has multi-morbidities – transferred onto electronic Repeat Dispensing (e. RD) by GP practice Interval period for Rx agreed between patient and pharmacist, with guidance from the GP Collection of next e. RD prescription from pharmacy Support similar to MUR/NMS type interventions continue to be provided when Rxs are collected Care and support plan reviewed e. Discharge notes sent to patient’s registered pharmacy Individualised support – specific clinical assessments , device support, age-related support e. g. STOPP/START assessment, falls assessment, independent living advice Alcohol, smoking, weight management advice offered if appropriate. Recruitment onto locally commissioned services if available Patient visits their registered pharmacy to collect e. RD prescription PAM and medicines adherence measured, personal goals agreed – care and support plan produced Patient visits pharmacy for advice Necessary clinical referral back to prescriber – made under formal referral system Patient prescribed new medicine NMS type support provided Post-discharge MUR or medicines reconciliation (latter can be conducted by support staff) Provision of home delivery or MDS service (if appropriate) Flu vaccinations offered to patient (if appropriate). Pneumococcal vaccine offered if appropriate and not received on previous occasion Discharged after emergency admission to hospital Interval period for Rx agreed between patient and pharmacist, with guidance from the GP Patient continues to collect e. RD Rxs Support similar to MUR/NMS type interventions continue to be provided when Rxs are collected Care and support plan reviewed End of e. RD Rx

Core functions of community pharmacy 2. The trusted, convenient first port of call for episodic healthcare advice and treatment – ‘Pharmacy First’ ingrained in people’s behaviour (public &professionals) – Seamless triage to and referral from community pharmacy – Ability to access and add to an individual’s shared care record – Diagnostics, point of care testing and prescribing all available within community pharmacy setting Community Pharmacy | Forward View Slide 13

Core functions of community pharmacy 3. The neighbourhood health and wellbeing hub – ‘Go-to’ location for support, advice and resources on staying well – Build on Healthy Living Pharmacy ethos – Work with community leaders to understand local needs and develop services – Great connections with other local organisations – Work with employers to support work-based health initiatives – Support people to use technology, apps and devices to monitor and manage their own health – Skilled in health coaching and supporting behaviour change – Help people maintain mental and physical health and wellbeing Community Pharmacy | Forward View Slide 14

Conclusions • Collective vision established • Hope that partners in NHS, national and local government recognise and share this ambition • Hope the vision resonates with people who lie behind it – pharmacists and their teams • Hope it reflects the needs and ambitions of service users • Now need to work with others to turn it into reality Community Pharmacy | Forward View Slide 15

Next steps • • Listening, learning & collaboration Inviting feedback from key stakeholders Help turn a shared vision into a reality Nationally, we will use the Forward View to influence upcoming Government and NHS policy Community Pharmacy | Forward View Slide 16

Get involved This is our starter-for-ten – now we want to work with colleagues to turn this shared vision into a reality Get in touch and give us your feedback – Make suggestions on what steps need to be taken to help ensure this vision becomes a reality – Share stories that illustrate how teams are already leading the way in improving outcomes as part of integrated local health systems – Discuss the Community Pharmacy Forward View in more detail contact@cpfv. info Community Pharmacy | Forward View Slide 17

Initial reactions • Generally positive feedback received – we would welcome more • Many Local Pharmaceutical Committees now including on upcoming meeting agendas to discuss and guide local planning • Invitations to discuss with stakeholders incl. CCGs, STP leads, HEE • Described by pharmacy Minister, David Mowat as “spot on” “Now I have a ‘forward vision’ that feels achievable, realistic and timely” - Xrayser, C+D opinion piece Community Pharmacy | Forward View “Important work here on the need to secure a bright future for our vital community pharmacy sector” - Michael Dugher MP, Twitter Slide 18

Thank you Read the Forward View or its executive summary in full at pharmacyvoice. com/forwardview psnc. org. uk/forwardview Community Pharmacy | Forward View Slide 19