PCN Shake-up: What Can Community Pharmacy Do Now to Prepare?
Following the Government's NHS Long Term Plan, with PCNs needed to be up and running by 1 July 2019 and real collaboration starting in 2020/1, the attention now turns to the role of community pharmacy to start engaging with PCNs - but where to start?
This article first appeared in our Pharmaceutical and Life Sciences July 2019 law brief.
What Are PCNs?
The Government set out its plans for around 1,000 Primary Care Networks (PCNs) to be set up by 1 July 2019. PCNs are multi-disciplinary groups with GP practices at its core, but working in collaboration with other professionals, including pharmacists, to target the local community and deliver a wide range of services to patients.
The Government envisaged that each PCN will serve 30,000-50,000 patients. GPs will be reimbursed to fund 20,000 additional staff, including clinical pharmacists, physiotherapists, paramedics, physician associates and social prescribing link workers. Having a more joined up service allows patients to see the person most appropriate to help them more easily, leading to holistic and personalised care, prevention of illness and more informed decisions made. Data and technology will be used to assess population health needs and health inequalities, to deliver care, to support clinical decision making and to monitor performance.
PCNs will deliver seven new national service specifications negotiated with GPs and will include:
- Structured medication reviews and optimisation.
- Enhanced health in care homes.
- Anticipatory care.
- Personalised care.
- Supporting early cancer diagnosis.
- Cardiovascular disease prevention and diagnosis.
- Tackling neighbourhood inequality.
Role of the Pharmacist
The Government's plans include each PCN recruiting six whole-time equivalent clinical pharmacists by 2024. Their role will be patient-facing and clinical, including the following:
- Conducting medication reviews.
- Improving medicines optimisation and safety.
- Improving antimicrobial stewardship.
- Supporting care homes.
- Running practice clinics.
- Linking with other pharmacists.
They will need to have an additional 18-month training to perform this role.
Clinical pharmacists employed within PCNs are different to community pharmacy. So what is the role of community pharmacy?
Role of Community Pharmacy
Community pharmacy will be expected to support and work with PCNs, typically through the clinical pharmacist. Clinical pharmacists will not have a role in dispensing medicines. Aside from potentially filling that gap, community pharmacy's role will be to:
- Manage minor illness aspects of urgent care.
- Improve safety, outcomes and value from medicines.
- Support patients to prevent ill health.
- Signpost and refer people to the appropriate professional.
The plan also expects community pharmacy to provide staff to act as the clinical pharmacists.
The Government expects community pharmacy to start engaging with PCNs in a coherent way. So how will that happen?
Community Pharmacy Engagement with PCNs
The Government envisages about 11 community pharmacies per PCN, and they would work with PCNs through Local Pharmaceutical Committees (LPCs) from April 2020. LPCs would in turn engage with Local Medical Committees (LMCs). The LPCs and LMCs already represent the local community pharmacy and GPs practices locally. To ensure the most productive discussions, the Government recommends community pharmacies to have strengthened the collaboration between themselves before engaging with PCNs.
The Government has also produced some guidance for LPCs. It states that LPCs are best positioned to facilitate discussions both with other community pharmacies and with LMCs. The guidance adds that the exact role for local community pharmacies with PCNs will be for local bodies to agree. The guidance goes on to suggest a four step process for LPCs to begin engagement between community pharmacies and PCNs:
- Engage with Clinical Commissioning Groups (CCGs) and LMCs - to understand the developing landscape of PCNs within the CCGs' footprints.
- Start the conversation between local contractors - to ensure there is one voice communicating between pharmacy and the PCN.
- Understand mutual benefits and local priorities for patients through collaborative working.
- Agree ways of working between community pharmacies and how they will represent themselves to the PCN. This may include appointing an agreed accountable individual(s) to engage on their behalf.
The guidance suggest that these conversations between pharmacies should progress by end of September 2019, and then they should engage with the PCN.
If the LPC requires further support or comes across unexpected issues, they would be encouraged to feed into the Pharmaceutical Services Negotiating Committee (PSNC). The PSNC would produce supporting tools and guidance for LPCs. There will also be further guidance from NHS England in due course.
Our Recommendations
PCNs are going to be a big shake-up for community pharmacy, and an important step is making sure everyone is joined up in the provision of care. The questions are: can these different professions work together in a way that is better than they have done before? And what role for community pharmacy? Community pharmacy may feel threatened by individual pharmacists working directly within another body - what role for pharmacy (as opposed to the pharmacist)? Might community pharmacy lose good talent with people coming through the ranks?
Community pharmacy has been saying they want to get involved with providing more services, but the bread and butter and where they really help is with dispensing - and this is only mentioned in passing when the Government's paper said clinical pharmacists do NOT do dispensing (rather than saying this role will still be there for community pharmacy)? There are likely to be opportunities for pharmacy, but the exact role needs to be clarified, and the best place to start these conversations will be with LPCs to co-ordinate and speak as one voice.