Community pharmacy is not integrated into the National Health Service, and poor relationships between pharmacists, primary care trusts and GPs are holding back service development, a new report by the All-Party Pharmacy Group, The Future of Pharmacy, has found.

The All-Party Pharmacy Group - which has a membership of more than 120 MPs and peers, making it one of the larger such groups in the Houses of Parliament - launched an inquiry last year to examine what pharmacists need to do boost their contribution to healthcare in both the community and secondary care settings.

At the time, the APPG welcomed positive developments such as the new pharmacy contract and roll-out of Medicines Use Reviews, but also described an environment of inconsistent progress and lack of “joined-up-thinking.”

Now, a year later, The Future of Pharmacy concludes that pharmacy’s potential in healthcare is not being realised quickly or consistently enough, and warns that, if barriers are not removed, the situation will not improve. To this end, the group makes several recommendations - based on the inquiry’s findings – which it believes will accelerate progress and improve services to patients.

‘Serious reservations’

Describing “serious reservations” about the Department of Health’s approach to service development in community pharmacy, the report calls for a range of new advanced services to be implemented locally by all PCTs to help stamp out postcode pharmacy, which, it says, is contrary to the best interests of patients and the NHS.

The services it believes should be offered by pharmacies include: the management of long-term stable conditions, building on MURs; sexual health screening and advice; managing minor ailments; diabetes screening via fingerprick testing; obesity and weight management; and a greater menu of diagnostic and screening services, all of which would help improve healthcare in the community and take some of the pressure of GPs by refining the flow of traffic into GP surgeries.

But the report points out that the national implementation of these services is not enough in itself, and highlights “serious problems” at the local level which, it says, need to be “urgently” addressed.

A key problem seems to be a lack of inter-professional team working and collaboration. During its inquiry, the group says it frequently came across examples of PCTs failing to engage adequately with community pharmacy. “PCTs have insufficient awareness and understanding of pharmacy’s capability. Some appear to have little interest. In many instances, these factors combined with budgetary pressures have led to little or no progress in service development,” the report claims.

New contracts

But Felicity Cox, Lead Negotiator for NHS Employers on the pharmacy contract, told PharmaTimes UK News that relations between pharmacy and PCTs have struggled over the last three years largely because PCTs have had to come to grips with financial problems and reorganisation, though she feels the situation will now improve.

And, in response to the report’s observation that communication is also poor between pharmacy and GPs, she said that the revised pharmacy contract, for which negotiations are due to start shortly, should help encourage more positive relations, and stressed that GP and pharmacy contracts need to operate side-by-side to weave pharmacy properly into the NHS team.

The APPG also identified the need for “a greater clarity of voice at national level, speaking effectively on pharmacy’s behalf” and “strong and dedicated representation and leadership,” at the local level to help meet objectives and foster collaborative working.

Responding to the report, President of the Royal Pharmaceutical Society of Great Britain, Hemant Patel, said: “The barriers that concern us are the need for greater pharmacy leadership at national and local level, greater collaboration between GPs and pharmacists, and across the healthcare professions.”

Better engagement

“To cement the role of the pharmacist in the multidisciplinary healthcare team and ensure that the NHS is really adding value to the care that patients receive we must engage more with professional bodies, such as the BMA, RCGP and RCN, so that a joined-up working approach is not only happening on the patient access level but also at a national level.”

And Paul Bennett, Chair of the English Pharmacy Board, said: “Implementation of pharmacy services in England has been slow to progress due to lack of funding, lack of open dialogue between pharmacists and GPs, and lack of awareness amongst commissioners of what pharmacy can achieve.”

But Speaking at the report’s launch, Lord Hunt, Minister of Pharmacy, said that “the pharmacy profession has broken through and there is now widespread recognition of what needs to be done,” and Dr Howard Stoate, Chairman of the APPG, challenged all involved to make the difference so that, by next April, the report's recommendations are being acted on to provide better and integrated patient care in the NHS.