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GPforwardViewApril 27 2016

Pharmacy organisations have questioned the focus on general practice within primary care, following NHS England’s announcement of the General Practice Forward View last week.

Concerns have been raised about the timing of the announcement and the additional £2.4 billion funding for GPs when community pharmacy is fighting a proposed 6% cut of £170 million in remuneration from October. There are also concerns about the apparent lack of support for involving community pharmacy services in the GP Forward View programme.

Among the proposals in the GP five year plan are that:

  • NHS England will “earmark an extra £2.4 billion a year for general practice services by 2020-21” meaning spending will rise from £9.6 billion in 2016-17 to over £12 billion by 2021, a 14% real terms increase;
  • there will be an additional £500 million national ‘turnaround’ package will support GP practices, plus additional funds from local clinical commissioning groups;
  • the pilot scheme with 470 clinical pharmacists in the 700 general practices will receive a “new central investment of £112 million to extend the programme by a pharmacist per 30,000 population for all practices not in the initial pilot – leading to a further 1,500 pharmacists in general practice by 2020”;
  • NHS England will be able to fund up to 100% of the costs for GP premises developments, up from a previous cap on NHS England funding of 66%, with a proposed date of introduction of September 2016.

Pharmacy Voice, the body representing pharmacy owner organisations, criticised the announcement, saying: “When community pharmacy is midway through a consultation on a funding cut of more than 6%, today’s announcement from NHS England of a significant financial investment into GPs will feel very hard to swallow.

“As we have seen so many times in the past, the General Practice Forward View does not simply place GPs at the centre of the primary care system but implies that they are the only meaningful providers of first contact care and advice and ongoing community-based support for patients. As a result, NHS England’s increase in ‘primary care’ investment in fact sits entirely with GPs.”

Pharmacy Voice said the proposals “ignore and undermine” the role played by community pharmacy team members and many other dedicated healthcare professionals working in primary care. “If we are to meet the challenges of increasing demand, resource constraints and changing public expectations, the emphasis should be on strengthening co-operation and integration across primary care. This will not be achieved by investing in one end of the system, while making cuts elsewhere.”

Commenting on the changes to allow greater NHS investment for GP premises upgrades, Pharmacy Voice said: “Moves to change rules and allow NHS England to fund up to 100% of premises developments in general practice will also shock and frustrate community pharmacy business owners; these concessions that community pharmacy never sees are made to another NHS-funded providers.

“At the same time, the huge value that the NHS derives from private investment in the existing community pharmacy estate is overlooked, and the opportunity to use this infrastructure even more effectively to expand access to primary care is missed.”

In its response to the GPFV announcement, the National Pharmacy Association has argued that “sustained investment in local pharmacies would be a far bigger stride towards creating a world class health service” than simply to put more pharmacists in GP practices.

NPA Chairman Ian Strachan said: “There is already a highly qualified workforce in local pharmacies right across the country and a well established infrastructure for delivering care in those settings. Community pharmacies are a ready-made solution on the health service front line, close to where people live, work and shop.”

The NPA has also argued that “investment in services such as a national Minor Ailments Scheme in community pharmacies would help free up access to GPs.” It costs the NHS an extra £1.1 billion a year to treat minor ailments such as coughs and sore throats at A&E or GP practices rather than community pharmacies. “Much of the routine management of treatment for people with long term conditions such as asthma and diabetes should also be transferred to community pharmacies – freeing up GPs to meet complex care needs for these groups.”

The Royal Pharmaceutical Society has recognised the £112 million investment creating jobs for an additional 1,500 pharmacists to the 470 currently piloting the scheme. “The creation of around 2,000 new jobs for pharmacists, in an era of austerity where value must be proven rather than assumed, shows a strong commitment to the profession from the very top of NHS England,” said the RPS.

However, it has flagged up the NHS England consultation on proposals on a ‘Pharmacy Integration Fund’ as part of the community pharmacy reform programme. “We have been clear in our submission to NHS England that the ‘Pharmacy Integration Fund’ should not be used to directly employ pharmacists in GP surgeries,” it said.

Celesio, the parent company of LloydsPharmacy and pharmaceutical wholesaler AAH, described the £2.4 billion “cash injection” into GP practices and the “failure to recognise the considerable value that the existing army of community pharmacists could deliver to the NHS” as “extremely disappointing”.

Cormac Tobin, Managing Director of Celesio UK, said: “We are disappointed that the full value, expertise and potential to support the system that already exists within our community pharmacy network is not front and centre of NHS England’s thinking.

“Essentially, we think they’ve missed the point in this thinking, and are missing the opportunity that the network of trained community pharmacists, who are willing and able to support, could afford the sector.”

Links:

NHS England announcement

NHS England General Practice Forward View

NPA response

RPS response

Pharmacy Voice response

Celesio response

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