| The impact of Our Health, Our Care, Our Say |
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| Written by Neal Patel | |
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The community services White Paper, Our Health, Our Care, Our Say: A New Direction for Community Services, was a significant publication for the Department of Health – significant in that it represented a refocusing of policy away from the acute sector to primary care.
Indeed, the pre-publication working title, Care Outside of Hospital, gave an indication of the department’s barely hidden obsession with hospital reform – reform that was characterised by controversial policies such as the creation of foundation trusts and payment by results. Creating legislation to support the implementation of these policies was hard-fought, emerging far from unscathed after a tortuous passage through parliament. Interestingly Our Health, Our Care, Our Say requires little or no change to statute to allow the policy to be implemented, a fact that will lessen the impact of opposition. The effect? The written word is likely to be translated, relatively unchanged, into implemented services. The White Paper was significant for other reasons. It represented the first major piece of policy from a new health secretary. It was created through a different style of consultation, with so-called “hard to reach groups” being sought actively for their opinion. Once the paper was written, those same people were invited back to see if their words had been converted into government action. Lastly, it was a White Paper borne from a Green Paper not about health but about social care, meaning a large part of the text is devoted to joining up health and social care policy. But is this a significant event for pharmacy? Undoubtedly, yes. If last year is characterised as the year health service reform caught up with community pharmacy (evidenced by the introduction of the new contract), then this year may be remembered as the year health reform truly enveloped our sector. I will now describe the likely effect of policies that directly and indirectly affect community pharmacy. Community services
These key themes cover areas where community pharmacy has an interest now, and will increasingly have an interest in the future. Before considering them it is worth looking at the impact the White Paper will have on general practice, and not merely for interest – the policies laid out for GPs may soon be applied to community pharmacy. Primary care - the realityIt’s not often that a direct link can be made between prime ministerial embarrassment and health policy. But a televised pre-election Question Time Special, which allowed a discontented member of the public to lay bare the reality of GP waiting times to a seemingly out of touch PM, has done just that. From April 2006, GP pay has been linked to the availability of a consultation. However, whereas previous surveys of performance against these targets were carried out by the practice itself (allegedly leading to the “credibility gap” which tripped up the PM), some payment is being withheld in lieu of the results of the nationally administered patient experience survey. Extrapolate this system to community pharmacy and add in the thought that poor practice performance could trigger competition from private sector providers, one can see the application of this initiative to the control of entry system for pharmacy contracts. The aforementioned primary care trust triggers are designed to open up an area to competition if, for instance, lists are open but full, provider performance is poor in terms of opening hours or the capacity of primary care falls below what is deemed an acceptable level. All are gaps in service that could be fully or partially filled by community pharmacy. Healthy livingBuilding on the 2004 document Choosing Health, it is no surprise that the White Paper reiterates the policy of taking personal responsibility for health. After first admitting that the UK is currently spending less per head on public health spending than its peers, the White Paper describes mechanisms that will develop a more systematic response to requests for better services aimed at disease prevention and health promotion. These mechanisms include the development of an NHS Life Check for people at key life stages, engaging them in an assessment of their modifiable lifestyle risks such as smoking and weight. This Life Check is particularly significant for pharmacy. Early development work will focus on the check for 0–3, 12–13 and around 50 years of age. People will be able to complete the check online, or (as the White Paper puts it) at their “high street health care outlet”. Those at these key stages who have identified high risks via self-assessment will have the opportunity of follow-up with an accredited health trainer, receiving tailored healthy living advice and onward referral as appropriate. Commissioners will then be tasked to provide a set of core health and wellbeing services proportionate to meet local need, driven by the NHS Life Check. Consider that community pharmacy could act as a venue to carry out the assessment, host or employ their own health trainers, fill or prescribe information prescriptions and act as providers for specific services to improve health. With a parallel intention to include new measures that provide a clear focus on health and wellbeing in the Quality Outcomes Framework, demand for wellbeing services is likely to rise substantially. Care closer to home
These policies offer one threat but mostly opportunity for community pharmacy. A number of specialties emerge as the key ones to engage in building models of care outside the acute setting. Specialties such as dermatology combined with the framework for pharmacists with special interests will allow care to be shifted to pharmacies as well as GP practices. The combination of system reform policies such as practice-based commissioning (discussed elsewhere in this publication), and plurality and diversity of primary care provision allow pharmacists to be involved both with the redesign and provision of services. New funds are also available to those who wish to act as social entrepreneurs by both improving services for patients and investing profit back into communities, a model that could be adopted by like-minded pharmacists. Only the provision of more services on one site by redeveloping community hospitals remains contentious for our sector; if these centralised services include pharmacy, the local effect could be destablising. Long-term conditionsThe proposals set out in the White Paper constitute a co-ordinated approach to support and care for those with long-term conditions. By 2008, all those with both long-term health and social care needs will be offered a care plan and, by 2010, we can expect everyone with a long-term condition to be offered a care plan. Community pharmacy’s role in long-term care management is well established and, with most of these patients receiving medication, involvement of pharmacists is vital. Perhaps the pharmacist intervention having the most impact would be the encouragement of self-care. PCTs are being encouraged to commission a range of services that will engage and support people at high risk of poor health and those with long-term conditions; pharmacy should be outlining its credentials to provide such services. AmbitionOur Health, Our Care, Our Say outlines an ambitious programme for primary care, with an ambitious timeline. Many projects are targeted for completion in the next two years, so changes will be swift as well as sweeping. Community pharmacy needs to ready itself with equal pace to make the most of opportunities as they arise. However, we should be reassured that the Prime Minister sees pharmacy as part of the future of community services. In his forward he says simply: “We want to expand the role of local pharmacists.” With this permissive White Paper as our backdrop, the scale and direction of community pharmacy expansion remains largely in our own hands. |
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