The move by the NHS community pharmacy sector to bolster its clinical offer to patients by expanding into hypertension case-finding and smoking cessation services is a welcome development, but the wider crisis in primary healthcare provision remains.
From October, more than 11,000 pharmacies which have signed up to the ‘community pharmacy contractual framework’ (CPCF) – a five-year deal already agreed by NHS England (NHSE), the Department of Health & Social Care (DHSC) and the Pharmaceutical Services Negotiating Committee (PSNC) – will offer the first of these services, providing blood-pressure checks to people aged 40 and over, under the mantle of hypertension case-finding.
According to NHSE, this service simply involves a free blood-pressure check as part of a 10-15 minute consultation with a trained member of the pharmacy team, following which patients “may be invited to take home a blood-pressure monitor” to take further readings, or alternatively they may be referred on to a GP.
Whether the roll-out of this quick-turnaround service, piloted last autumn, turns out to be an effective move only time will tell – NHSE claims that 3,700 strokes and 2,500 heart attacks could be prevented, and around 2,000 lives saved, over the next five years as a result of its introduction – but GP surgeries, by contrast, often recommend taking readings at home over the course of seven days to gain a more reliable idea of a patient’s blood-pressure.
The second service, piloted last November and scheduled for roll-out next January, is a smoking cessation programme, offering free advice and support sessions over 12 weeks with a trained member of a pharmacy team, for smokers recently discharged from hospital.
While both initiatives are clinically driven, free at point of access for patients, and therefore come with considerable PR benefits for whoever offers them, neither are provided free to the health service. All NHS community pharmacies – from small independents to national chains – are private companies and therefore get paid extra for running these new programmes, on top of the income they receive for operating existing services such as dispensing prescriptions.
In the case of blood-pressure checks, pharmacies are paid a set-up fee of £440, plus £15 for each clinic check and £45 for each ambulatory monitoring (which involves using a body-worn device over a 24-hour period). Target-driven incentive fees of up to £1,000 are also on offer. For the upcoming smoking cessation service, the set-up fee is even higher, at £1,000, while consultation fees vary between £10-£40.
The DHSC’s current ‘vision’ for the five-year contractual framework under which pharmacies provide these and other services to the NHS is for these commercial interests to become “more integrated in the NHS [and to] provide more clinical services”. This builds neatly on NHSE’s stated ambition for a new service model, outlined in the NHS Long Term Plan, to boost “out of hospital care” by dissolving the “historic divide between primary and community health services”.
Echoing this ambition, in its press release about the hypertension case-finding and smoking cessation launches, pharmacy trade body PSNC said these new ‘advanced’ services “help to embed community pharmacies even further into the NHS in line with the sector’s vision for its future”.
It’s questionable whether patients will ever trust pharmacists as much as they would their GP, however, despite all the positive press coverage last week on the launch of the blood-pressure checking service – and despite the King’s Fund thinktank describing community pharmacy as “one of the four pillars of the primary care system in England”.
To consider why, one only has to look at NHSE’s pharmacy staff toolkit guidance on ‘minor illness’ pathway consultations offered by community pharmacists. This reveals that training courses for these consultations are not mandatory, and that pharmacists must only “be satisfied that they are competent to provide [them]”.
But with many GP surgeries still restricting in-person access during the pandemic, following former health secretary Matt Hancock’s announcement last year that all medical consultations should henceforth be “remote by default”, CPCF’s latest initiatives were perhaps to be expected, especially as NHSE has recently – allegedly –been conducting ‘negative briefings’ suggesting GP practices had simply shut down for the duration.
Evidence actually points to surgeries opening up again, however, with GP appointments up 31 per cent compared with pre-pandemic levels, and more than 50 per cent of appointments delivered face-to-face throughout the pandemic, according to figures from NHS Digital.
Those figures nevertheless mask a profession that is in crisis: the number of fully qualified, full-time equivalent GPs per patient has dropped by 10 per cent in the past five years, and vacancy rates show one in seven posts are unfilled – all this against a background of rising patient registrations, an ageing population, trainees experiencing burnout because of the pandemic and increasing numbers of patients testing positive for covid.
This situation led the Royal College of General Practitioners in July to call for a five-point emergency rescue package for general practice, and just last week the British Medical Association followed suit by launching ‘Support Your Surgery’, a public campaign to rally support for GP surgeries and push for increased government investment.
With primary care in such urgent need of support, simply adding blood-pressure monitoring and smoking cessation to the pharmacist’s repertoire – and coincidentally boosting the commercial sector’s role in the health service – comes across as an empty gesture by the DHSC and NHSE. Backing GP surgeries with the investment they need instead would surely have a greater impact on the nation’s health.
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