Pharmacy in a changing NHS

Use pharmacists’ expertise to help design NHS services for the future and improve patient care.

Integrated care and pharmacy

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The NHS in England is changing.

The NHS Long-Term Plan set out the ambition for local health and care organisations to become part of new Integrated Care Systems by 2021. These will typically cover a population of over one million people.

This aims to promote more integrated working, including between primary care, hospital trusts, local authorities, and the voluntary sector. Commissioners will make shared decisions with providers on how to use resources, design services and improve population health.

We’ll see changes to organisations, such as the end of clinical commissioning groups, and could see changes to how pharmaceutical services are commissioned.

The Government published a White Paper on this in February 2021. A new Health and Care Bill has been introduced in Parliament to enshrine the changes in law.

What does this mean for pharmacy?

Clinical and professional leadership Clinical and professional leadership

Clinical and professional leadership

Each Integrated Care System (ICS) will need to engage with different health and social care professions, local authorities and the voluntary sector, and work with providers across the system on how best to care for the local population.

They will be governed by an ‘ICS NHS body’, which will be responsible for NHS strategic planning and allocation decisions. An ‘ICS health and care partnership’ will be responsible for developing a plan to address the system’s health, public health and social care needs, which the ICS NHS body and local authorities will be required to ‘have regard to’ when making decisions.

We want these new reforms to be an opportunity for people working across the health service to shape the future of the NHS. Pharmacists must be included in this engagement and have a voice in local NHS decision-making, to help inform ICS planning and support services which make the most of pharmacists’ expertise to improve outcomes for patients.

A Design Framework set out expectations on the governance of ICSs, including the need for health and care professionals to be represented and involved in decision-making at all levels.

Read about RPS work on system leadership

Medicines optimisation Medicines optimisation

Medicines optimisation

Workforce - a group of pharmacists

The new reforms will also need to work alongside initiatives to support medicines optimisation, with the creation of a new role of ‘ICS Chief Pharmacist’ in every ICS to lead on this and support the safe and effective use of medicines across the system.

ICS Chief Pharmacists could play a really important role to working with pharmacists across a local area to develop an integrated approach to medicines optimisation and pharmacy services. They’ll need support from their ICS and nationally, and how they work with ICS leadership and governance is not yet clear.

Read about medicines optimisation on our hub page.

Read more in guidance documents from NHS England and Improvement:

Commissioning Commissioning

Commissioning

The commissioning landscape is changing. Clinical Commissioning Groups (CCGs) will be absorbed into their parent ICS. The ICS NHS body will take on most of the duties currently held by CCGs as well as many of the commissioning functions undertaken by NHS England, such as commissioning some specialised and primary care services. They will also be able to delegate functions to individual providers or groups of providers. ICS will become responsible for managing and distributing NHS funding at a system level.

The White Paper has proposed enabling “the transfer of appropriate primary medical, dental, ophthalmology and pharmaceutical services by NHS England to the NHS ICS body”. There is little detail yet on what pharmaceutical services might move from a national- to locally-commissioned model. This uncertainty also underlines the importance of pharmacists being able to engage with and educate ICS decision-makers about how pharmacy can support the delivery of the NHS Long-Term Plan.

Read about our expert advisory groups.

Workforce Workforce

Workforce

Local Education and Training Boards will be replaced with a Health Education England regional operating model. There’s no detail just yet on how this will work.

It is vital that the pharmacy workforce across all sectors are included in regional and local workforce plans and that their training and education needs are recognised and supported. Future changes to the workforce operating model must support a defined career pathway for pharmacists working in all areas of practice. ICSs will need to allow for pharmacist’s roles to cross organisational boundaries (e.g. acute trust, general practices, community). This must be backed by appropriate investment in the pharmacy education and training, to support professional development and advancement such as increasing the number of pharmacist independent prescribers.

Staff wellbeing is key to maintaining a supported and engaged workforce. ICSs must ensure that all health and care staff are equally supported by local wellbeing offers.

Find out more about Pharmacist Independent Prescribers.

Read about the future of pharmacy education.

Digital Digital

Digital

Integration of the healthcare team

Better integration will need the digital infrastructure to support it.

Each ICS will be expected to have a renewed digital and data transformation plan and implement a shared care record.

We’ve long called for pharmacists to be able to update a clinical record wherever they may work and so welcomed proposals from the Government to encourage better data sharing and interoperability between care records.

We’re working with the Professional Record Standards Body to make sure pharmacists needs are included in clinical record standards which facilitates the sharing of information across different care settings.

Pharmacists will also increasingly use data to help understand patients' needs, aid decision-making, and make best use of resources to improve health outcomes.

Our new Digital Pharmacy Expert Advisory Group will consider all aspects of informatics and how pharmacy can be better integrated into systems.

Other issues Other issues

Other issues

As well as supporting the development of Integrated Care Systems, the White Paper also included proposals on other topics such as:

Finalising the merger of NHS England and NHS Improvement (‘NHS England’).
Placing the Health Services Safety Investigations Body on a statutory footing.
Setting up national medicines registries to improve patient safety.
Professional regulation.

The Government has said it will consider how best to develop proposals to reduce the number of professional regulators. But proposals to cut costs should not come at the expense of patient safety.

Due to the breadth of practice that pharmacists undertake, the General Pharmaceutical Council must continue as a separate regulator and it should not be merged as part of any proposed reduction.

READ OUR ICS RECOMENDATIONS

What’s happening next?

A new Bill has been introduced in Parliament with reforms expected to happen in 2022. The NHS will also develop guidance on how these changes are implemented.

We support the aim to encourage greater collaboration between healthcare partners, improve the wellbeing of local communities, and improve patient care and safety. However, legislation alone will not guarantee success and how changes are implemented and supported on the ground will be key.

There are still questions about the detail of future changes and how this might work in practice, in particular around leadership and governance, clinical and patient engagement, and future changes to commissioning. Delivering integrated health and care services throughout England will also depend on investment in our workforce and a long-overdue upgrade to digital infrastructure.

With health and care staff already feeling the strain from the pandemic, implementation must minimise further disruption. We’ve called for early engagement with patient and professional groups, as well as the wider health and care system, to help make the changes a success.

Sharing your case studies

We want to help showcase the work of pharmacy teams in delivering patient care across the health service.

We want to hear from you about how pharmacists and pharmacy teams are supporting new ways of working and how others can learn from these examples.

If you have a case study you want to share, you can either download this template and email us or fill in this form online.

Join our ICS pharmacy leads forum

We’d love to hear from pharmacy leaders about how you’re engaging with these changes and what they mean for you. If you’re involved in leading pharmacy across an ICS, are interested in helping shape our work on pharmacy and integrated care, or if you have a great example of putting this into practice, email Ravi Sharma, Director for England at [email protected].

Later this year we’ll also be rolling out RPS Connect, a brand new digital service for members providing you with opportunities to grow your professional network, share best practice, and inform policy development.