Health and Social Care Committee
Inquiry into the implementation of the National Service Framework for diabetes in Wales and its future direction
DB 22 National Pharmacy Association
Bay Tree House
Colwinston
Cowbridge
Vale of Glamorgan
CF71 7NL
Tel: 01656 658703
25th October 2012
Dear Mr Drakeford
Subject: Health and Social Care Committee Inquiry into the delivery of the diabetes NSF and its future direction
The National Pharmacy Association (NPA) is the trade body which represents the full spectrum and vast majority of community pharmacy owners in the UK, including across Wales. We count amongst our members nationwide pharmacy multiples, regional chains and independent pharmacies. This spread of large and small member companies, our UK-wide geographical coverage, and our remit for NHS and non-NHS affairs means that we are uniquely fully representative of the community pharmacy sector. In addition to being a representative voice, we provide members with a range of commercial and professional services to help them maintain and improve the health of the communities they serve.
In my role as the Representation Manger for Wales I am the sole representative for community pharmacy on both the All Wales Diabetes Forum and the Task & Finish Group established by the Minister to look into the delivery of diabetes care and therefore feel that I have an excellent feel of the way that community pharmacy can make a significantly greater contribution to the care of the people of Wales living with diabetes.
As the NPA is not among the pharmacy organisations called to attend an oral evidence session I have included below and overview of my thoughts as I am anxious to have an opportunity to contribute to the debate.
Community Pharmacy and its potential contribution to integrated diabetes care in Wales
Introduction
There is a network of over 700 community pharmacies in Wales, located where people work, shop, travel and live. They can be found in large conurbations and also right at the heart of local communities. In areas of deprivation there are a larger number of pharmacies than in more affluent locations. The location of the network, when combined with longer opening hours, means that, for many people, community pharmacy is the most accessible part of NHS Wales. Research by Public Health Wales clearly shows that there is a higher concentration of pharmacies in areas of deprivation where diabetes care needs are greatest.
Community pharmacists are highly trained healthcare professionals and are the medicines experts on the high street. They are trusted and respected by patients and are an excellent source of advice for many. The vast majority of patients, especially those with prescribed medicines for chronic conditions, will have contact with their pharmacist on a monthly basis and therefore have significantly greater contact with their pharmacy than they do with their GP practice. It is this expertise and regular interface with diabetic patients, alongside a patient-centred service, that is currently not being effectively leveraged.
It was back in 2003 when Derek Wanless recognised the need for full engagement of all healthcare providers and recommended a movement of workload to community pharmacy: this has yet to happen. More effective utilisation of the community pharmacy network will not only bring on stream underutilised capacity; it will in addition, release capacity in GP practices. Release of capacity in GP practices is essential in facilitating the delivery of the Setting the Direction objectives.
To fully engage the community pharmacy network in integrated diabetic care is not a big ticket investment. There is no investment required in real estate and no employment costs to be borne by NHS Wales. Whereas there will be a need to fairly reimburse contractors for services provided; it will be an extremely cost effective investment. NHS Wales will only need to reimburse community pharmacy for the time that it is involved in the delivery of services i.e. there are none of the usual employment costs or overheads to be covered. In addition the majority of the risk is borne by the contractor and not the Health Service.
In addition to the above community pharmacy has one other unique advantage that sets it apart from other healthcare providers. Community pharmacies across Wales are visited on a daily basis by people who are well as well as by people who are ill. They have an extremely high footfall, particularly the larger chains and supermarket pharmacies, and therefore there is no better location to deliver educational messages and to facilitate lifestyle change.
In producing this paper I have considered how these distinct advantages can be better utilised, to support improved identification and management of diabetes in a way that fully integrates with GP practice provision. I feel that the key lies in a partnership approach to caseload management, utilising community pharmacy where it adds value, will improve patient services and will free up time for other healthcare professionals to focus on their distinct areas of expertise.
Community pharmacy’s potential contribution to diabetes care
Population awareness
As I write this report community pharmacies across Wales are gearing up to raise awareness, amongst the general population, of the risk of developing diabetes and stoke through a national public health campaign. As the cost and requirement to deliver public health campaigns is already built into the commun