A Study of Pharmore+: Pharmacy Walk-in Service Pilots

8 Conclusions

What did the pilots demonstrate they can do?

8.1 The aim of the pilots was to broaden access to and choice of health and health improvement services through extended opening hours and offering a wider range of services. All pilots reported they had successfully achieved their aims and had offered safe and effective care for people who reported positive experiences about treatment and services provided. In some cases the pilots were also able to demonstrate that the community pharmacy services helped to avoid patients using GP and A&E services. Pilots also demonstrated the potential for linking up with other relevant NHS services and positive benefits this afforded for both patients and services. Another key finding was the willingness of independent pharmacy companies to engage with other parts of the NHS to develop and deliver services.

8.2 All participating pharmacies thought that piloting new services was worthwhile and that, despite the challenges they faced, they were able (on the whole) to deliver the services they set out to test within the pilot. Importantly, pilots were able to raise the pharmacy profile both among the public and other health professionals about the potential of community pharmacy to deliver a wider range of health and health improvement services.

8.3 Perhaps what has emerged as most important is that the pilots have demonstrated the potential for pharmacy to contribute as part of wider health services; complementing out-of-hours services, expanding access to services to wider range of people and providing greater patient choice.

What are the implications for future models of walk-in services or expanding community pharmacy services

8.4 The findings from the study indicate that there is no 'one-size-fits-all' approach to implementing models of walk-in services or expanding the services offered by community pharmacy more generally. Instead the services offered by the pilots in each area were determined by practical considerations (equipment, space and facilities available), willingness of local NHS and other services to collaborate and in consideration of local service needs. However all were based on common principles, such as better choice and access to appropriate treatment. It is these principles which should underpin any national policy on the future development of community pharmacy and local service redesign rather recommending a particular model of community pharmacy.

8.5 With this in mind, the findings highlight a number of key issues and principles to consider when developing both future national policy on community pharmacy services and local services themselves:

• Community pharmacy services should respond to local health priorities and be considered in terms of its potential to contribute to these in the context of a wider health services planning system.
• Community pharmacy services should not be seen in isolation, but be developed in collaboration with wider health and health improvement services.
• To ensure this happens, the pilots suggested that broader engagement will be required at NHS Boards and CHP levels about local health priorities and the potential for community pharmacy to deliver these as part of a wider NHS services.
• There is also a need to raise awareness among health professional and the general public about the skills and expertise available and making links with local services and organisations to work in collaboration as part of the wider health serves

8.6 NHS Pharmaceutical Services are provided through a network of community pharmacy contractors, ranging from small independents to large retail pharmacy chains. Changes and/or enhancements to the services they provide on behalf of the NHS (and to some extent the potential impact on premises) requires consultation and agreement with the contractors concerned. To enable the implementation of the Pharmore+ initiative, pilots needed to work closely with large scale multiple organisations which required considerable effort, particularly when considering organisational requirements by both the contractor and the NHS, for example in setting up compatible IT systems and use of premises.

How can key challenges be addressed?

8.7 Pilots experienced a number of difficulties with implementation including; ensuring the right equipment and facilities were available within the pilots to implement the service; establishing workable information system for the data sharing; and the recruitment, training and support for staff delivering the service. Pilots also noted challenges in engaging with NHS local stakeholders, emphasising the importance of securing support from clinical directors and working close with out of hours facilities to develop their services.

8.8 If community pharmacy services are to continue to expand to meet local needs, consideration needs to be given to addressing some of the infrastructure problems experienced by the pilots. This should include:

• National leads need to consider the systems and governance for information sharing between NHS and Community Pharmacies.
• Developing IT systems which are more compatible between NHS and multiple pharmacy organisations to enable information sharing.
• National leads should consider how existing pharmacy staff (in particular pharmacy prescribers and pharmacy technicians) can be supported to utilise their skills to best effect.
• Consideration should be given to development of national training programmes to ensure that pharmacists are appropriately trained and supported to provide enhanced services and how training may be undertaken to support multidisciplinary working. However any programmes would need to be complemented locally by ongoing support and training to ensure that pharmacy staff skills are refreshed.

8.9 Finally, the pilots have demonstrated the potential for community pharmacy to provide better access and choice and appropriate treatment for people as part of wider health and health improvement services. Any development needs to see the patient as the starting point: with the emphasis on quality and patient choice. Pharmacy development of generalist and specialist services needs to focus on patient outcomes and generate evidence of impact on these.