Why pharmacies must think big

GPs and pharmacists have never had an easy relationship but that needs to be resolved if they want to collectively deliver large-scale health improvements.

Pharmacies approaching clinical commissioning groups with proposals are thinking too small and are not likely to meet with much success. They need to come to clinical commissioning groups (CCGs) with proposals that employ an economy of scale.

The pharmacy profession needs to mirror the collective approach taken by CCGs in terms of borough-wide and cross borough solutions. Pharmacies have also got to come up with good solid community-based services that GPs want.

I don’t want to see pharmacies sitting on the side-lines playing a waiting game and carping about CCGs

I don’t want to see pharmacies sitting on the side-lines playing a waiting game and carping about CCGs potential to encroach on their business territory. We have bigger fish to fry and our partners need to match that ambition.

Innovative delivery

Yes, we have to provide stability and continuity of care but that has to be married to a more inquisitive and adventurous attitude towards service delivery.

There is a huge potential and my advice to local pharmacy committees is to put their heads together, come up with some game changer ideas and then arrange a face-to-face with their CCGs.

I would be very excited to be approached in this manner. It is new territory for everyone but the business opportunities are there.

We are going out to tender for anti-coagulation services in Bexley, which is a big service because thousands of our patients use Warfarin. It’s currently delivered through secondary care that is expensive and not particularly patient friendly.

Seizing initiatives

What we want to replace it with is a community based extended hours service that people can access in the evenings and at weekends so they don’t have to take time off work. 

Elsewhere, asthma, cholesterol testing, diabetes management, hypertension and all sorts of long term conditions that don’t need acute intervention are ripe for large scale implementation

It is this sort of initiative that pharmacies are well placed to run if they raise their game and seize the initiative. The reward is a contract approaching half-a-million pounds. If they don’t seize this opportunity, then someone else will.

We’re taking about big money here when you consider that nearly a million patients use Warfarin in the UK.

I am also involved in setting up a group to design a formulary that works for primary and secondary care. We spend around £30m a year on drugs in Bexley, so again the contract value would be sizable.

Elsewhere, asthma, cholesterol testing, diabetes management, hypertension and all sorts of long term conditions that don’t need acute intervention are ripe for large scale implementation.

Thinking big

I’d like to see a situation where a GP stabilises a patient with a chronic condition and then passes them over to the care of a pharmacist freeing up our time to deal with other issues. This is the sort of thing that GPs are going to sit up and take notice of if it’s put on the table.

I keep coming back to the point about thinking big and acting big and pharmacies need to realise that CCGs priorities include the redesign of large scale services over wide areas involving hundreds of thousands of patients.

I’m all for working with colleagues in neighbouring boroughs to create a single unified service for something like diabetes. Pharmacies have to match that ambition.

So, put your thinking caps on, make a plan and come and talk to us. We’re waiting.

Dr Howard Stoate is chair of Bexley Clinical Commissioning Group