In April 2016, a review of community pharmacy clinical services was commissioned by the Chief Pharmaceutical Officer to help inform him about the future provision of clinical pharmacy services.

The need for an in-depth Clinical Services Review for community pharmacy was determined by:

• The changing needs for healthcare, in particular the demands of an ageing population with multiple long term conditions;
• Emerging models of pharmaceutical care provision;
• Evidence of sub-optimal outcomes from medicines in primary care settings; and
• The need to improve value through integration of pharmacy and clinical pharmaceutical skills into patient pathways and emerging new care models.

The Review and its conclusions

The review was informed by a steering group, but was carried out independently by Richard Murray, then, Director of Policy at the King’s Fund. Richard Murray’s report was published by NHS England on 14th December 2016.

Report of the Community Pharmacy Clinical Services Review

PSNC Briefing 072/16: A summary of the Murray Review of Community Pharmacy Clinical Services

The report concluded that there needed to be “renewed efforts to make the most of the existing clinical services that community pharmacy can provide and to do so at pace”.

It set out how the skills of community pharmacists and their teams could be used to help people to manage long-term conditions and to embed medicines optimisation within care pathways. This may require national action through the Community Pharmacy Contractual Framework, as well as local progress on integrating pharmacies into evolving models of care, the report stated.

The report sets out a number of recommendations for the future development of community pharmacy services including:

• Incentivising use of electronic repeat dispensing so that this becomes the default for repeat prescribing;
• A redesign of MURs to develop them into full clinical reviews including ongoing monitoring and follow-up of patients, consideration of prescription duration, and utilising independent prescribing as part of the care pathway;
• Consideration of making smoking cessation services an element of the national contractual framework;
• Use of the Vanguard programmes to develop the evidence base for community pharmacists, including integrating community pharmacists into long term condition management pathways, involving them in case finding programmes, and using new ways of contracting that mitigate any perceived conflicts of interest;
• Support from NHS England and national partners to help STP leads to integrate community pharmacy into their plans and local commissioners to contract for services; and
• Joint work by PSNC, the Royal Pharmaceutical Society and national GP representatives to explore what practical steps can be taken to unravel professional boundary issues and ensure closer working between community pharmacists and GPs.

The report also called for NHS England to set out how it intended to deliver on its commitment to ensure that minor ailments services are commissioned across England by April 2018. It stressed the need for community pharmacists and their teams to share information with clinical records held by other healthcare professionals, and said pharmacy technicians should be able to work under Patient Group Directions to improve better use of the skill mix within pharmacies.

The report recommended that a formal group be established, including representatives of community pharmacy, to have oversight of progress and recommend further action where needed.

A rapid review of the evidence for community pharmacy services, carried out by Professor David Wright, was published alongside the report.

The next steps

NHS England stated that it intended to use the recommendations from the review to inform its approach to the commissioning of community pharmacy services, once the recommendations had been properly considered. It also said the Pharmacy Integration Fund would support these changes and to help transform how pharmacists and community pharmacy will operate in the NHS.