Day 31: PCN & Community Pharmacy

I've had some time to think and reflect on the conversations I've had with my local LPC and local community pharmacy contractors over the past two days. I hadn't planned to attend last night contractor's meeting but after Monday's LPC meeting, I felt it was really important that community pharmacy understand that they need to engage at every available opportunity. Or even better make opportunities happen by building relationships.

Having worked in various sectors including community pharmacy; I can see the potential of pharmacy being at the forefront of patient care. I think we often forget how lucky we are to have the NHS. In many other countries model of care looks different, often the first point of care is the community pharmacist. The community pharmacy is often the most accessed healthcare setting for the local community for various ailments and health concerns. The community pharmacy team knows the patient, the family and are privileged to have insights to their private lives.

PCNs must look to include community pharmacy for the ambitions of the Long Term Plan and rightly serve the community as an inclusive team of healthcare professionals. There are pockets of innovation happening already between GP and community pharmacies. I bet these successes have taken time to develop and relationships have been built to create trust. Having knowledge of how both micro systems in General Practice and Community Services works helps understand the opportunities. You can begin to see similarities in pressures and appreciate the concerns about PCNs.

Unfortunately couldn't take a photo of the team. So busy in there! Diane and her fab team provide so much to the community. Diane is an incredible strong woman.

So here's a list of my random thoughts about Community Pharmacy and PCN (not General Practice alone):

1. PCN has the vision to serve the local community population, through collaboration with all healthcare providers. Community Pharmacy is a healthcare provider.

2. PCN groups together a number of different surgeries and encourages them to work collaboratively. As group of neighbouring community pharmacies, could contractors do this too? Include multiples? Yes. We have some super powerhouse GP organisations that through PCN boundaries are having to work based on geographically place based sites creating break off chucks into various PCNs. Why would multiples be any different?

3. PCNs have been created to realise the delivery of the DES Network Contract. Not know what is? Please check national resources for details. However we need to be aware that income stream comes from various contracts for both General Practice and Community Pharmacy. There are national contracts and local services all generating income. Do we all know what each other are commissioned to do? Do we all know what additional services we provide? I'm guessing no. It was clear from Monday's LPC meeting with LMC, there are still some unknowns in both camps. No one's fault really. We all do our best in our respective worlds. If you're more outwardly curious, you might be fully awareness and in tune. PCN now is bringing down these barriers.

4. PCN has funding. Through not prescriptive. Funding must used wisely. But like all business negotiations ask the WHY? Why should a PCN invest in a service? What could community pharmacy be confident in delivering? At what scale? How much would it cost? What would the outcomes? How does the service impact on the local needs of the community? Community Pharmacy needs to think about ideas and concepts for a business case to pitch to PCNs. The conversations and discussions could start with "what are our local community needs?" Then over to community pharmacy to co-design something that is beneficial for all. PCN is not about dictation. This is community pharmacy's opportunity to co-produce services that matter.

5. Look at your friends network. Look at the relationships you hold with family members. You are likely to do more for people you care about and know well. Working relationships are the no different. No one is entitled here. Trust and respect is earned. Honest and open relationships allow strength and growth in collaborations. If you don't know your local PCN clinical director it's ok. Information feeds in to PCN team at various levels. I knew about my local community pharmacists from introductions by the doctors at Slieve. This is the time to know more about the surgeries that surround you. Get to know the practice teams. Who is the Practice Manager? Who is the lead prescription admin?

6. National steer. Community pharmacy are awaiting national contractual changes. DES specifications for 2020/21 is still unknown. e.g . What is classed as a structured medication review? What is deemed as enhanced care to Care Homes? We equally need to keep updated and share information that we have.

7. Think clinical and non-clinical. It would great to have lots of projects that generate some fantastic clinical outcomes but it's also worth looking at the digital agenda and inefficiencies in processes. How well is EPS and eRD being using in the PCN? Is there opportunities to tackle pharmaceutical waste and offer appropriate deprescribing service?

8. Engage. Invest some time into going events. Use social media. Twitter has been amazing for this. It can feel overwhelming but there's a supportive network out there. It just might not be a fellow pharmacist that guides you through this. Disappointingly I was informed that the contractors meeting was one of the lowest turn out. When I was working in community pharmacy there was always the same regular faces at engagement events. Does information get cascaded? Is there no interest in pharmacy anymore? Do we still remember why we chose to become pharmacists? Do we actually want pharmacy to evolve?

Whilst there's no finish line and rush to do something right now. The ask is really to start forming these relationships. It's not easy and sometimes it is soul destroying. I've heard some horror stories and I have experienced plenty of closed (slammed-shut) doors. However I firmly believe positive actions will win at the end of day and the achievements that come your way will feel so much bigger. There are no firm answers to PCNs. This year is all about connecting and reaching out for help. I know I am one Clinical Director in one PCN. I'm not expecting to do everything myself. But I know I am trying to do what I can to make difference for people I care about. My patients. My team. My profession. My world.

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LINKS:

https://www.england.nhs.uk/publication/network-contract-directed-enhanced-service-des-specification-2019-20/

https://psnc.org.uk/our-news/a-summary-of-the-network-contract-directed-enhanced-service-des-2019-20/

https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdf

This resource is the best one to start conversations:

https://www.england.nhs.uk/publication/guidance-for-lpcs-how-to-help-contractors-get-involved-with-primary-care-networks/