More than £1 billion could be saved by the National Health Service through better use of pharmacists in improving outcomes in public health and long-term conditions, a new research paper has found.
The paper – by The Bow Group Health Policy Committee – concludes that Enhanced Pharmacy Services are “an under-utilised resource that can deliver innovative, cost-effective services to patients in a highly accessible manner, whilst facilitating the NHS to achieve its Quality, Innovation, Productivity and Prevention (QIPP) objectives”.
The NHS is facing a huge funding shortfall and targeted efficiency savings of £20 billion. Against this backdrop, the paper argues that if the new government is to have a realistic shot of achieving a genuinely patient-centric service, pushing care further into the community, improving health outcomes and creating a more economically affordable NHS, then it is crucial that is fully utilises the skills and expertise of all healthcare professionals.
To date, the NHS has been “caricatured” by politicians as a service of doctors and nurses when, in reality, it spans far more than two medical professionals, and full advantage of all its resources – particularly pharmacists - must be taken in order to give the NHS the best chance of reaching its objectives, the report stresses.
Pharmacists, which operate deep within the heart of communities, are well placed to reach patients and their skills and expertise must now be fully exploited to potentially save a huge wad of cash and help improve the NHS. For example, more than £812 million alone – that’s more than 4% of the £20 billion savings target – could be saved if all patients with minor ailments (around 57 million a year) went to see a pharmacist (£17.75 per consultation) instead of a GP (£32).
Furthermore, Pharmacy Enhanced Services – such as smoking cessation, weight loss and sexual health programmes - are “directly aligned” with the coalition government’s focus on public health and disease prevention, it argues, while emergent Healthy Living Pharmacies could potentially play a significant role in helping patients make better lifestyle choices, thereby helping to reduce health inequalities and the future strain on health services.
Around 30-50% of patients do not take their medicines as directed, and the cost of hospital admissions resulting from this is thought to be around £200 million a year and rising (with the ageing population), and again pharmacists are ideally placed to help ensure proper treatment compliance through Medicines Use Reviews. A key recommendation of the Bow Group is that MURs should be carried out before and after planned hospital admissions for patients with long-term conditions to reduce medication errors and related costs.
According to the paper, excellent outcomes from Pharmacy Enhanced Services in some areas of the country have been achieved, and yet commissioning of such services is “patchy and far from universal”. It believes there are many reasons for this, including poor measurement and recording of outcomes and lack of understanding from commissioners, and it makes several recommendations to boost the use of these currently under-utilised services.
Improving relations, new fund and QOF
For one, it calls for “sustained efforts” to improve and cement GP/pharmacist relations, and that local pharmacists should have representation within local GP consortia and on local Health and Wellbeing Boards “to help optimise the local integration of patient care”.
In addition, any savings made by pharmacy contractors under the current Community Pharmacy funding mechanism in excess of the profit threshold should, rather than being returned to the Department of Health, sit in a new Enhanced Pharmacy Service innovation fund, which should be free from political interference and used to enable better commissioning of Pharmacy Enhanced Services.
Another recommendation is the development of a truly outcomes-based pharmacy Quality and Outcomes Framework that complements the existing GP QOF, to improve the provision, quality and range of enhanced pharmacy services based on better outcomes measurement. According to the Royal Pharmaceutical Society of Great Britain, such a QOF is possible but must be integrated with the existing scheme for general practice, “to enhance rather than challenge the work of other healthcare practitioners and to encourage collaborative ways of working,” the report notes.
The Bow Group concludes that it hopes in the “new era of politics” with a “new kind of Government” the NHS “will embrace the opportunity to better reach out to all healthcare professions and healthcare professionals” and warns that, if it fails to do so, “it will not just be a missed opportunity that is dispensed. It will also be a failure to properly prescribe an innovative solution to help facilitate a better NHS”.