1. Integrating Clinical Pharmacy into a wider health economy
Dr Bruce Warner, Deputy Chief Pharmaceutical Officer, NHS England

2. Community pharmacy already plays a vital role in:
Key facts and figures
1.6 million visits to community pharmacy every day, of which 1.2 million are for health reasons
Over 1 billion medicines dispensed in community pharmacy every year
£8 billion spend every year in primary care on NHS medicines
2.5% current yearly rate of prescription growth
Dispensing medicines
Advising on medicines use
Promoting good health and supporting the prevention agenda
Supporting people to look after themselves
But it could play an even greater role, as part of more integrated local care models, in:
Optimising medicines usage
Supporting people with long term conditions
Treating minor illness and injuries
Taking referrals from other care providers
Preventing ill health
Supporting good health
Medicines optimisation
Up to half of patients don’t use medicines in the way intended; many are simply thrown away
1 in 7 over 75s are admitted to hospital because of incorrect medicines use
70% of people in care homes may be at risk from medication errors

3. Carter Report
“’Hospital pharmacy’s primary function is to work closely with patients, doctors and nursing staff to choose, prescribe and monitor clinical outcomes of medicines’.
“Acute trusts must ensure their pharmacists and clinical pharmacy technicians spend much more time on clinical pharmacy services than on infrastructure activities”
“The delivery of hospital pharmacy services and the optimisation of medicines are intrinsically interwoven and, from a value perspective, can’t be separated. Simply put, the NHS needs to focus the pharmacy workforce to drive optimal value and outcomes from the £6.7bn it spends on medicines.”

4. The Pharmacy Integration Fund
Pharmacists’ skills make them invaluable to patients and the public, but too often those skills are not used effectively, resulting in avoidable hospital admissions, medicines wastage and sub-optimal care. NHS England has taken important steps to integrate pharmacy into the NHS and the Government would like to make further progress.
The Pharmacy Integration Fund will support a programme of work aimed at accelerating the integration of clinical pharmacy roles, including those provided by high quality community pharmacies with the appropriate skill sets, into primary care, so that they can become an embedded part of wider health and social care.

5. The consultation responses – up until 24th March 2016
24th March 2016 closing date
39 written responses specifically mentioned the Pharmacy Integration Fund in detail. Responses received from a range of stakeholders
Similar themes noted from interim responses at 12th February Particular focus on:
General practice integration with community pharmacy
Urgent care integration with community pharmacy
Care home pharmacy services
Workforce development
Digital development
Access to the Fund

6. The Responses- 24th March 2016
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
Community pharmacy
General practices
Multi-speciality community providers
Urgent care hubs
Care homes
NHS 111/OOHs
Primary care settings
Medicines optimisation
Evaluation
Infrastructure
Pharmacy Integration

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

8. 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

9. 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 best use 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

10. The review will:
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,

11. The review will:
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

12. In Summary Review the evidence base for current services
Identify barriers that prevent us making best use of the pharmacy workforce
Make recommendations as to what services should be commissioned in the future
Make recommendations as to the how those services should be commissioned