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Georgina Craig is the Company Chemists Association
lead for primary care and commissioning policy
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At a recent meeting on the future of general practice, Kate Billingham,
Deputy Chief Nursing Officer at the Department of Health, sought to broaden
the debate by proposing that the key to the future of the NHS was to
focus on the thing that brings people together; namely providing patient
care. This struck a chord with the audience.
It seems that the next big
challenge for the NHS is marrying a philosophy of patient choice and
competition (or plurality and contestability to use the jargon of the
day) with the need for a range of providers to work together towards
one common goal; delivering high quality services to the patients under
their care.
The Government has pursued a deliberate policy over the past five years
to break down professional boundaries. Even if all other things had remained
equal, this pits one professional against another. Doctors’ representatives
derided pharmacist prescribing when it was announced; although they supported
nurse prescribing. The “GPs with a special interest” scheme
quickly became the “practitioners with special interest” initiative.
The general philosophy seems to be that professionals should be able
to develop their practice, within their competence, as far as they would
like to take it.
The relationship between community pharmacy and general practice specifically
is worthy of further exploration. It is important to recognise that GPs
and pharmacists have always been in competition, even before the days
of dispensing doctors and GP-owned pharmacies. However, until now, most
would probably say, it has mainly been about “business”;
the business of dispensing. Now the tables have turned, and pharmacy
seems to be encroaching on traditional GP service provision. This is
new territory. And although GPs are more than happy to let pharmacists
take minor ailments off their hands, they are a lot less comfortable
to discuss the possibility of, say, a pharmacy-based anticoagulant service.
And yet, community pharmacy and general practice have so much in common:
independent contractor status; the feminisation of the work force (today,
70 per cent of medical students are women) and the consequential rise
in part-time working; shared challenges in providing services in deprived
areas; a highly complementary skill set; and the list goes on. GPs and
pharmacists could learn so much from each other if they worked together;
in fact, they could be an unbeatable team.
Primary care providers face two key challenges over the next few years:
shifting care closer to home, and, as laid out by Gordon Brown in his
first leadership speech on the NHS, the need to “fit services more
around the lifestyles of working people and their aspirations”.
Both stem from a more consumer-focused approach to the NHS. Government
recognises that most voters only use the NHS occasionally but, when they
do, they want instant access in a convenient location. This is the reason
why Gordon Brown wants general practice to extend its opening hours again.
Key to a consumerist approach is delivering services to people where
they live, work and shop; hence the location of most pharmacies today.
Those
charged with strategy within private health care businesses are recognising
that the future lies in primary care; witness BUPA’s
recent announcement of the sale of its hospital division and its expansion
into care homes. These strategists also see pharmacies as the ideal location
for a range of health care services, as demonstrated by Boots The Chemists’ decision
to host a range of primary care services in its stores and Sainsbury’s
widely publicised discussions with Department of Health about housing
GP surgeries in-store.
It may be that big business is quicker to recognise and respond to these
changes. But imagine if general practices and community pharmacies across
a primary care organisation could put their differences aside and enter
into a new kind of business partnership, characterised by collaboration
in both service development and delivery.
Collaboration with community pharmacy opens up a whole range of new delivery
mechanisms for both traditional general medical and secondary care services.
Would you need a Saturday surgery if your practice nurse was working
out of the local pharmacy? Together, general practices and community
pharmacies could redesign primary care services, opening up access to
urgent care in a range of high street and health care settings; offering
a choice of services to people with long-term conditions, tailored to
the needs of the working population, as well as those who would prefer
to go to the surgery; and designing innovative care pathways to enable
services to shift to the community — for dermatology, sexual health,
cancer care and diabetes, to name but a few. And with the possibilities
created by pharmacist prescribing, actively supported by general practice,
they could create an integrated team who could transform primary care
beyond all recognition. Everyone would win.
General practice has a good history of working collaboratively with its
own kind to provide services; out-of-hours co-operatives being the most
recent example. Community pharmacy does not. It is only just starting
down this road, with a number of local pharmaceutical committees exploring
how they might provide a locus for contracting for primary care services
with local commissioners. There is virtually no history of GPs and pharmacists
working together to develop and provide services. So how might it happen?
Oddly enough, the answer may lie in practice-based commissioning (PBC);
but not PBC as we know it. At the moment PBC is almost exclusively the
domain of general practice. And, on the back of PBC, GPs are, once again,
forming collectives to share management costs and commissioning responsibilities.
But it does not need to be that way. If PBC were more inclusive, things
might be different. Working closely with community pharmacy contractors,
as equal partners in PBC consortia, pharmacists and GPs could start to
explore how, working in partnership, they could transform patient care.
It seems that there is a real danger, echoed in Gordon Brown’s
recent comments, that competition in primary care will lead to one profession
being seen as a substitute for another in pursuit of efficiency savings.
What primary care professionals need to recognise is that the really
big win would be through collaboration. Then the possibilities are endless;
it is just a question of imagination and a shared vision: delivering
great patient-centred care to local communities. Let the collaboration
begin! |
The
Pharmaceutical Journal