The NHS Long Term Plan presents a vision of health and care that is driven by prevention and tackling health inequalities. Central to delivering this is the creation of a fully integrated community-based healthcare system. This includes community pharmacy playing an important and integrated role as recognised in the Next steps for integrating primary care: Fuller Stocktake report.
Working in partnership with NHS England’s East of England regional team, system partners, community pharmacies and Local Pharmaceutical Committees (LPCs), Arden & GEM developed a community pharmacy strategy for the region, underpinned by a comprehensive programme of communications and engagement to take full account of the varying needs of different partners.
The strategy sets out a clear vision for the role of community pharmacy as part of an integrated primary and community care service, improving access to clinical advice, support and medications for patients, and reducing the burden on general practice.
The challenge
Community pharmacies play an essential role in supporting patient and providing a first point of contact for an increasing number of minor ailments. With the creation of Integrated Care Boards (ICBs) in July 2022, responsibility for commissioning community pharmacy services has moved from NHS England regional teams to ICBs from April 2023. As part of this change, all regions need to develop a patient-centred community pharmacy strategy to support the shift towards more preventative, community-based care.
NHS England East of England region engaged Arden & GEM to support the creation of a rolling Five Year Community Pharmacy Partnership Strategy.
The strategy would support the new delegated commissioning intentions and enable an integrated approach as part of primary care. Key to the approach was the focus on meeting patient needs, drawing on outputs from patient engagement and communications activity led by NHS England.
Development of the strategy was led by our Medicines Optimisation team, with specialist input from communications, engagement and transformation colleagues. Several challenges had to be addressed to achieve a cohesive regional strategy including:
- Complex stakeholder networks and priorities within six ICSs
- Structure, governance and commissioning responsibilities were still being defined as the strategy was being developed
- Many stakeholders did not have a clear idea of what they wanted from community pharmacy over the longer term, requiring a more guided approach to engagement
- The need to build relationships and trust among varied participants, many of whom brought different skillsets and knowledge
- Vital engagement with partners came at a time when staff were under significant pressure
- The initial timescale for delivery was short and reduced further as some stakeholders were redeployed to cope with urgent demand arising from COVID-19 and winter pressures.
Our approach
The success of the strategy would be dependent on effective engagement with those directly involved in commissioning and delivery. Arden & GEM's Medicines Optimisation and Communications and Engagement teams worked together to develop a listening and engagement programme designed to maximise input. This began with a comprehensive stakeholder mapping exercise across the region, covering commissioners, providers, LPCs, patients, NHS England, local authorities and wider system partners.
Recognising the demands on our key audiences, we developed a multi-channel approach to engagement, including dedicated questionnaires for different audiences, webinars and facilitated workshops. These were supported by a comprehensive communications campaign to raise awareness of the strategy and fact-finding activities to encourage people to get involved.
Our pharmacy experts conducted thorough horizon-scanning to inform the engagement and assess the strategic context. This ensured the strategy would align with national policies and local plans to strengthen the role of community pharmacies as anchor institutions in local communities.
A structured approach
Historically, community pharmacy has tended to operate relatively independently and it became apparent that many stakeholders did not yet have developed plans for how it could be integrated into broader primary and community care. Tackling COVID-19 continued to drive immediate activity and it was difficult for systems to take the time needed to clarify what they would need from community pharmacy.
It became clear that despite initially limited stakeholder input, putting forward an outline strategy would help galvanise thinking and prompt further engagement. This approach successfully sparked new input, with NHS England agreeing to extend the strategy deadline to allow for further engagement and stakeholders using the draft to prompt discussions about gaps and future intentions.
Working collaboratively with NHS England, we provided a clear structure with a series of prompts to support contributions, starting with co-produced vision statements to help guide priorities.
Our Health and Care Transformation team used the output from the second phase of consultation to draft a more detailed strategy and invite further feedback. Mindful of the need to balance iterative development and formal approval, we invited a broad cross-section of stakeholders to a 'page turn' meeting to incorporate final contributions before completing the governance process. This approach promoted collaborative working and helped to ensure buy-in from all stakeholder groups.
The strategy was initially signed off by the Regional Community Strategy Working Group and then by the NHS England Strategy Group. We developed a slide deck to help systems cascade and promote the strategy from January 2023.
The outcomes
The East of England region has a clear strategy to embed community pharmacy into the health and care system, benefitting patients by providing better access to healthcare advice and treatment and helping to tackle health inequalities. The rolling strategy has been designed to be reviewed on a regular basis, taking into account the pace of change and developing systems and structures.
"Thanks to extensive engagement undertaken by Arden & GEM, feedback from stakeholders has been really positive. Relationships throughout the region have been strengthened which will support the ongoing implementation of a community pharmacy strategy that improves integration within and broadens patient access to primary care."
Jackie Bidgood, Senior Community Pharmacy and Optometry Contract Manager at Hertfordshire and West Essex ICB (on behalf of the ICBs in the East of England)