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Jo Webber, deputy policy director, NHS Confederation
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The Broad spectrum feature is
open to any reader. Contributions of around 1,100 words commenting
on topical issues
may be posted to Graeme Smith, managing editor, or
e-mailed to graeme.smith@pharmj.org.uk for consideration
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Since the start of the year there has been a great deal of positioning by the main political parties over health services, with each trying to carve out a niche as the party of the NHS in England.
Given all this, it is worth noting that there is in fact a large degree
of consensus among the three main parties. All are more or less agreed
on the need for more responsive health services offering care that disrupts
people’s lives as little as possible.
This has been backed up by
an emphasis in various ways on preventive measures to ensure more expensive
treatments further down the
line are avoided as much as possible.
A “personalised” NHS was the main theme of Prime Minister
Gordon Brown’s recent vision for the NHS. This theme was echoed
by Health Secretary Alan Johnson in his speech at the Labour Party spring
conference.
At the start of the year, the leader of the Conservative Party, David
Cameron, made a speech at Trafford Hospital in which he highlighted the
need for patients to be “active” in taking steps to protect
themselves from illness — especially long-term problems such as
obesity.
The notion of active patients was also picked up by the Liberal Democrat
leader, Nick Clegg, in setting out his call for innovative health services
where “people need to be able to take more control both of its
management, and their own healthcare”.
This focus on a future of active patients who are in control of budgets
and who require a personalised service means that the policy agenda is
moving towards the provision of accessible and easy-to-use services that
can help patients take control of their health and offer straightforward
advice on how to stay healthy.
While all the political jockeying is set to continue, things are changing
even now. The pharmacy
White Paper [expected to be published just
after this went to press] is almost certain to mean an expanded role
for pharmacies. In a recent webchat via the Number 10 website, Alan Johnson
said of the White Paper that “we can use pharmacies to a much greater
extent in order to provide wider access to primary care. Many pharmacies
have rooms available for consulting purposes; very few are actually used.
Encouraging greater access would therefore be my priority, although the
White Paper will cover a whole series of new opportunities in this important
area of health care.”
The care pathways for those with long-term illnesses such as diabetes
and kidney failure are being re-examined so that more focus is put on
early intervention and giving patients the means to take steps actively
to live healthier lives. The world class commissioning work from the
Department of Health — which is generally held by primary care
trusts (PCTs) to be potentially extremely positive — is also geared
towards giving PCTs better tools to react to and predict the health needs
of the local communities they serve.
Positioned at the front end of care pathways, pharmacies should see a
real opportunity here. First, they tend to occupy premises in high street
locations or on busy streets where large numbers of local people pass
by on a regular basis. Not only that but, in rural areas, where other
services such as post offices are often in decline, they are also increasingly
focal points for local communities. They are in a prime location to make
health services more visible and deliver them more conveniently for patients.
Coupled with this, pharmacists make up one of the most trusted groups
of professionals. A recent Reader’s Digest poll put them,
with doctors, nurses, firefighters and airline pilots, among the most
trusted
professions. Delivering better, more personalised care has to be done
through professionals who are trusted by the public. Pharmacists are
in a prime place — both physically and in the minds of patients — to
make the most of this.
Indeed, many pharmacies are beginning to exploit these opportunities
and are offering mini-consulting rooms. As the Secretary of State
suggested, these rooms could be opened up so that district nurses and
other health professionals could use them. There is also the possibility
of tele-consultations if the technology can be made available.
Other options exist. For example, possible services could include blood
pressure readings, feet checks, and glucose level checks. Pharmacies
could even simply provide online access to the NHS Choices website via
a touch screen terminal while making sure help is on hand to discuss
the results entered.
Such is the potential. However, we should also be realistic about things
as they stand. The only organisations that could provide these
sorts of services right now on a national or even regional basis without
outside help are the largest pharmacy chains or supermarkets. Many smaller
and single outlet pharmacies will have little ability to cover initial
investment costs for services that could be added into their outlets.
The solution will therefore require pharmacies and PCTs to work in partnership. Again,
it would be optimistic to say that this can be sorted out and set up
overnight. It will be a challenge both for PCTs and individual pharmacies.
PCTs are only just getting to grips with the last round of reorganisations.
Many, however, are looking to build on the success of smoking cessation
services and are already looking to the wider health community to deliver
for their local population.
On the other hand, the idea of working in partnerships with large public
spending bodies such as the local PCT is something that will understandably
take some getting used to for single handed private businesses such as
small pharmacies. They are independent businesses and may well feel it
best to stay away from getting involved in the delivery of public service
objectives.
Nevertheless, there is an opportunity here and given the direction of
policy, this is not a passing fad. The key for both parties is to see
themselves as part of a network of providers offering services that are
relevant to the individual communities they serve. It is essential, therefore,
to set up strong relationships so that each side can gain a full understanding
of the other’s perspectives. As a result, change will have to be
seen as incremental rather than as any great leap forward. PCTs will
have the responsibility of making sure that networks are set up properly
with adequate resources and are maintained appropriately.
Other network
members must be clear about what can offer and what they would like
out of the arrangement. From this point, joint decisions can then be
made
on investment, strategy and the micro-purchasing of services.
Tackling this challenge successfully will reap real benefits for
network members and, more importantly, for patients. Patients view
health services
as a continuum that will move them through areas of care and specialties.
In striving to provide such seamless care, a networked model based
on sound communication and strong relationships offers real potential. |
The
Pharmaceutical Journal