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Commission into Future Models of Care



Now or Never: shaping pharmacy for the future urges a radical shift in the role of pharmacists in England towards improving care for those who need it most.
The report envisages pharmacists across England expanding their role by treating many common illnesses, supporting people with long-term conditions and challenging wasteful, dangerous or inefficient use of medicines.
The authors warn that unless this shift takes place, the NHS will be letting down taxpayers and patients by missing opportunities to do more for less, and many community pharmacists risk being forced out of business as austerity and technological change drive down income.
The report’s recommendations are summarised in an Executive Summary, and include:
  • Pharmacists and their employers must shift their focus away from dispensing and supply of medicines towards providing a broader range of services
  • They must drive change at a local level, proving to decision makers in the NHS and local government that they should be doing more
  • The pharmacy profession should appreciate that there will be no new money: change will come from using existing funding better
  • Pharmacists should work with other professionals in joint teams, and should come together in networks, or chambers like barristers, to provide large-scale new services
  • The Department of Health (DH) and NHS England (NHSE) must include pharmacy in plans for the future of out-of-hours and urgent care, public health and the management of long-term conditions
  • DH and NHSE should be open to pharmacists holding contracts individually or as groups rather than through employers, and should use their positions to shift funding from dispensing and supply towards new services
  • DH and NHSE should work with leaders of pharmacy to create a united narrative about the future of the profession
  • The Royal Pharmaceutical Society and other groups representing pharmacy should take responsibility for making these changes happen, and should work in a coordinated way to improve professional leadership. This should include the creation of a Leaders’ Forum where innovative pharmacists can spread and improve best practice.
  • The report of the Commission, chaired by Nuffield Trust Director of Policy Dr Judith Smith, finds that pharmacists have a marginalised position in the NHS and in health policy. It warns NHS England, the Department of Health and pharmacy leaders including the Royal Pharmaceutical Society that a united effort must be made to change this.
It warns that pharmacists need to step up locally and nationally to lead in improving the use of medicines, and the NHS must be ready to take advantage of their expertise. It is unacceptable that while the NHS spends £12 billion a year on medicines, between 30-50% of patients do not take them as prescribed, and 6% of emergency admissions to hospital are caused by avoidable reactions to medicines.
The report concludes that re-focusing pharmacists as care-givers could reduce demand on GPs, out-of-hours and hospital services, improve access and care for patients and free up capacity within the NHS. This could play a major role in enabling the health service to cope with the unprecedented financial squeeze it faces, while still providing care free at the point of use, and improving access and dignity for patients.
The report also shows case studies of pharmacists providing vital health services ranging from vaccination to the management of anticoagulation for people at risk of stroke. In some areas, pharmacists are working with other health professionals to visit frail elderly people after they are discharged from hospital, or managing caseloads of patients with long-term conditions within a GP practice.
Dr David Branford Chair of the Royal Pharmaceutical Society English Board said:  “Study after study has demonstrated that the best outcomes for patients and the safest use of medicines come when pharmacists and doctors work closely together as a part of a multidisciplinary team. 
“As hospitals change and much of expert care moves beyond the hospital, pharmacists need to be a part of the core team looking after patients. Safer care will be enabled by better use of technology, allowing patients to share their care record with pharmacists. 
“Pharmacists need to contribute to better care across all parts of the health service. Priorities are improving the care of people in care homes, supporting older people to stay well in their own homes and working alongside GP, nursing and social care colleagues to keep people safe and to improve health outcomes. I am certain the profession will rise to the clear challenge set out in this report.”
Report author Dr Judith Smith said: “The pharmacists I met during my work for this Commission are demonstrating that their profession has far more to offer than the public or many people in the NHS understand. Yet all too often their potential is going untapped, and this must change if the NHS is to be able to assure taxpayers that people are being supported to get the best use out of their medicines and pharmacies.
“With care for the frail elderly and emergency out-of-hours treatment at the top of the agenda, the door is open for pharmacists to secure a wider and important role in caring for patients. It won’t be open for long, though, and only concerted and determined action from the profession itself can make sure that they don’t find themselves shut out.”

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