1. Section Title COMMUNITY PHARMACY RPS VIEW These slides reflect our current thinking and initial submission

2. Our purpose and who we are The Royal Pharmaceutical Society leads the profession of pharmacy to improve the public’s health and wellbeing The RPS is the professional membership body for pharmacists and pharmacy in GB and an internationally renowned publisher of medicines information. We advance the profession of pharmacy for public and patient benefit, to improve the health of the public and to secure the future for our members

3. What we do We are committed to improving patient care and safety through developing professional practice: Advancing both pharmaceutical science and pharmacy practice to improve the safety and efficacy of medicines and quality of pharmaceutical care Promoting research and evaluation to inform professional practice and evidence led patient benefit Supporting the continuous professional development and improvement of our members

4. What we do Leading and promoting the advancement of science, practice and education in pharmacy to shape and influence future delivery of pharmacy Providing timely and relevant medicines information and advice Recognising professional development through the RPS Foundation and Faculty programmes Ensuring the voice of the whole profession is heard at the highest levels of healthcare and government through expert advocacy, our responses to consultations, policy documents, and the RPS expert advisory panels, forums and groups

5. Our strategic goals 2016 - 2021 We will improve the public’s health and wellbeing We will be the professional voice of pharmacy We will support the education and development of the profession We will be a global publisher of medicines information and advice We will drive and support research and innovation in medicines and healthcare We will be a viable and sustainable organisation Our ultimate goal is to improve patient care; as evidenced by our commitment to developing pharmacists and aiding other healthcare professionals to use medicines more efficiently and effectively

6. Our concerns about Government proposals Potential for cuts to reduce access to pharmaceutical care Must maintain access to unique clinical expertise of a pharmacist throughout medicines supply process Concerns around new supply models Lack of an impact assessment Growing population vs. reduced capacity Potential future cuts Lack of recognition of clinical skills of community pharmacists

7. RPS key messages on Government proposals We do not support the 6% cut in funding to the community pharmacy contractual framework The RPS believes that pharmacists should be wherever medicines touch patients, whether this be in a community pharmacy, a hospital, a GP practice, a care home or an urgent care clinical hub Overarching objective of reforms should centre on improving patient access to high quality care, advice and medicines from pharmacists including those working in community pharmacies

8. NHS England to commission independent community pharmacy services review to advise the Chief Pharmaceutical Officer Timetable: anticipated to run from May to October 2016 Richard Murray, Director of Policy for the King’s Fund, has agreed to chair the independent review Community Pharmacy Review

9. Terms of reference In the context of: - the changing patient and population needs for healthcare as set out in the Five Year Forward View, in particular the demands of an ageing population with multiple long term conditions, - the changing demands and roles in primary care as set out in the GP Forward View - emerging models of pharmaceutical care provision from the UK and internationally - the evidence of sub optimal outcomes from medicines in primary care settings - the objective to improve value through integration of pharmacy and clinical pharmaceutical skills into patient pathways and the emerging new care models the review will: - examine the evidence base, value and operationalisation of the ‎clinical elements of the current community pharmacy contractual framework and other clinical services provided by community pharmacy that are commissioned by NHS England - identify the barriers that prevent maximal utility of community pharmacy and the community pharmacy workforce in integrated, safe, clinical and cost effective, high quality care of patients with acute and long term conditions and examine how those barriers might be addressed - taking into account the barriers identified, make recommendations for commissioning models and clinical pharmacy services that both integrate and transform the clinical contribution of community pharmacy and the pharmacy workforce to the delivery of good outcomes and patient care, whilst considering the relevant evidence generated from local commissioning of community pharmacy clinical services and aligning with the emerging new care models, - make recommendations for commissioning models for community pharmacy and the pharmacy workforce that deliver good patient outcomes and optimal value for money for the taxpayer, when compared to services delivered elsewhere in primary care, taking into account both published national clinical priorities and the need to be able to respond flexibly to local clinical priorities”

10. DH – Leading the nation’s health and care 9 Funding distribution: options Community pharmacy in 2016/17 and beyond Taking all of these elements into account, and working within the fixed envelope of £2.63bn for 2016/17, we therefore have different options for how we distribute funding. The diagram below illustrates how the £2.8bn funding is currently distributed across difference fees and payments, and shows where the decisions lie in how we might distribute funding differently in the future. -There are options for how the £170m savings in 2016/17 are made; some fees could remain the same while some could be altered to allow other payments to be introduced -Funding for the pharmacy access scheme will come from this total in 2016/17 -We could reduce the amount available for dispensing fees (single activity fee), to establish a quality payment. * indicates fees that will be ceased, in favour of a single activity fee

11. Our view on the Pharmacy Access Scheme? “We would like to see improving patient access to high quality care, advice and medicines from pharmacists working in community pharmacies” Funding should be maintained at a sufficient level to ensure quality of service provision and reward & retain pharmacies in the right place Improve access to high quality clinical services & increased opportunities for face to face contact Criteria need to also include quality of service provision Access for vulnerable patients & carer is very important More functional integration into U&E care networks Promotion of health under threat already due to PH cuts

12. The Responses- 24th March 2016 11 Vanguards Community pharmacy services review New care models Service evaluation methodologies Workforce development Digital integration Referral pathways Patient registration Care record – read/write Monitoring/reporting process Transfer of care Diabetes Mental health Learning disabilities Health improvement Well being Transfer of care Community pharmacy General practices Multi-speciality community providers Urgent care hubs Care homes NHS 111/OOHs Primary care settings Medicines optimisation EvaluationInfrastructure Pharmacy Integration

13. RPS view on Pharmacy Integration Fund “Purpose of fund should be to ensure better access to high quality pharmacist expertise and knowledge across all care settings, and in particular primary care” Should be for supporting change in pharmacy and integration into health systems to benefit patients Used to support local innovation using a system wide approach Invest in pharmacists to reduce pressures elsewhere in system Read and write access to patient records must be a pre-requisite Support extended clinical role of pharmacists in GP practices, care homes & urgent care clinical hubs Integration should begin with integration across pharmacy profession See more pharmacists become independent prescribers

14. DH – Leading the nation’s health and care 13 Quality and services - Feedback during the consultation to date Community Pharmacy in 2016/17 and beyond Commission a home delivery service Patient registration with pharmacies for all those with long term conditions Commission a national minor ailments scheme Enable direct to community pharmacy referrals from NHS 111 Allow the delivery of advanced services outside the pharmacy Commission a national emergency supply of medicines scheme Link pharmacy remuneration to patient outcomes More independent prescribing Proposals for new services Funding/commissioning changes

15. DH – Leading the nation’s health and care 14 Modernising services - Feedback during the consultation to date Community Pharmacy in 2016/17 and beyond Community pharmacies already provide the types of service the Government wishes to promote People don’t want to use online channels for their medication Market entry system has stifled competition and innovation Remuneration for distance selling pharmacies should be lower than standard pharmacy contractors The factors preventing people from having a seamless online experience are outside the control of community pharmacy, e.g. EPS rollout Directory or nomination system needs to ensure patients can make their own choice A split between the view that the system is already offering this… And the view that there is room for change.. And some key risks… Community pharmacies already provide the types of service the Government wishes to promote Need to retain face to face interaction with patients Risks to supply chain if more supply moved online Working-age people with long term conditions could benefit from getting medicines more easily Current system does not facilitate online services Risk of increased prescription direction A centralised, NHS-branded website could give patients the confidence to order line

16. DH – Leading the nation’s health and care 15 The digital pathway for NHS prescriptions A future vision for this digital pathway could look as follows: Patient orders repeat prescription via Patient Online and chooses home delivery or collection Prescription transmitted via EPS to patient’s chosen pharmacy Patient collects prescription Patient specifies home delivery and selects preferred pharmacy offering delivery Patient specifies collection and selects preferred pharmacy Prescription is delivered to patient’s home Improving the patient journey is a priority for the National Information Board. NHS England IT colleagues are in the process of establishing a programme of work and are currently doing discovery work to understand what patients want from the journey. Community Pharmacy in 2016/17 and beyond

17. RPS views on new models of medicines supply “The supply of medicines provides a touchpoint with patients and enables an interaction to take place between the patient and the pharmacist potentially including an intervention either around medicines or lifestyle advice.” “Digitalising medicines supply and having more remote access to medicines may reduce this important interaction.” Regardless of route, medicines supply should be safe & effective, person-centred, timely, equitable and reduce waste Provision of pharmaceutical care by a pharmacist should be embedded throughout any medicines supply process

18. How is the RPS responding? Giving the profession a voice National media coverage Comprehensive response to consultation as one of the organisations named by DH Meetings with Local Government Association and patient representative groups Meetings with the Minister (Alistair Burt), Heidi Alexander, Shadow Sec of State and other key political figures as well as Department of Health Working with pharmacy organisations Engaging with patient groups 27 LPF events have been held around England, with over 2,000 attendees (approx.)

19. How is the RPS responding? Supporting the profession through these changes Specific webpage with updates and support for pharmacists: www.rpharms.com/communityreformswww.rpharms.com/communityreforms Update emails from Sandra Gidley (EPB chair) to all England members Producing guidance on new roles for pharmacists working in community settings including care homes and urgent care Briefings on the NHHS landscape – first one on Five Year Forward View

20. Our asks of you Please send the thoughts, concerns and comments from your LPF to Heidi Wright at heidi.wright@rpharms.com heidi.wright@rpharms.com Please send any examples you have of integrated working between community pharmacists and GPs to Heidi.wright@rpharms.com Heidi.wright@rpharms.com Please send any examples you have of community pharmacists being commissioned to deliver services where the funding is from outside of the core contract to Heidi.wright@rpharms.com Heidi.wright@rpharms.com