A fundamental shift in the digital capabilities of community pharmacies is opening the door to a new era of record sharing and shared care, Rewired keynote speaker Rahul Singal tells Digital Health News

The launch of Pharmacy First at the end of last month means high street pharmacists in England can supply prescription only medicines for seven common health conditions. On the face of it, NHS England’s initiative is entirely predictable. After all, community pharmacists have been moving towards a more clinical role for some time, and people often go to their local pharmacist first for advice when they have a common health condition such as a sore throat or earache. (The other conditions on the Pharmacy First list are sinusitis, infected insect bite, the bacterial skin infection impetigo, shingles and uncomplicated urinary tract infections in women). Now they will be able to get the treatment they need without making another trip to the GP for a prescription.

But NHS England’s chief pharmacy and medicines information officer Rahul Singal says the “critically important” expansion of the pharmacist’s role signalled by Pharmacy First is on a different level to previous efforts to make better use of pharmacists’ skills, which have mainly focused on secondary care.

“For community pharmacists this is a watershed moment. Over the years you have been able to go to community pharmacists and get various clinical services, but it has been a bit sporadic. What is different is the digital capabilities of community pharmacies are fundamentally going to shift. They’ll have access to the record and be able to update it which hasn’t been done before in any kind of meaningful way. They’ll be able to contribute structured information that the GP system can consume. We’ll be able to do record sharing, which we weren’t [able to do] in the past.”

To go live, Pharmacy First achieved a minimal viable product so the service could run safely. “But over the next two or three months we’ll be enhancing the capabilities,” says Singal. “At the moment, pharmacists can see the patient’s record and get paid for their activity. The bit that needs to happen next is updating the GP record through structured medicines information. That will probably be in the next month.”

Information that flows

Under the current system, pharmacists’ updates are sent as a pdf or message which someone in the GP practice has to open and then input the information. “The capability that is being worked on at the moment will mean such information can flow into the record,” says Singal. “You won’t have to rely on the clinician at the other end to open the pdf.”

Singal says a “huge amount of work” has gone on to prepare pharmacies for the new system, including training. The four existing approved IT system suppliers – Cegedim, Emis Pinnacle, Positive Solutions and Sonar – upgraded their systems to prepare for the go-live on 31 January, so their community pharmacy customers would have Pharmacy First screens to support clinical pathways and send data for payments and monitoring to NHS Business Services Authority.

More than 10,000 pharmacies have joined Pharmacy First, over 95% of those in England. But is the public ready to embrace the new service? Singal says public trust in pharmacists in high but admits that “variation in services and reliability” might be an issue for some people. “If you go into a pharmacy and don’t quite get the service you expected, that has an impact on trust.”

Close the episode of care

He’s confident that the service will appeal to pharmacists and patients. “What pharmacists are already saying is helpful, is that with Pharmacy First they can close down the episode of care. Before it used to be ‘you have an ear infection. Go and see your GP and get a prescription’. Now you can say ‘you have an ear infection – here are your antibiotics’. That will not only give the clinician more satisfaction it will change the public perception [of the high street pharmacy]: ‘I got the problem resolved here’.”

The range of conditions seen under Pharmacy First will “hopefully” be extended over time, he says. “What we are trying to do is move [community pharmacists] away from tasks to do with the dispensing and preparation of medicines into a clinical facing role.”

Taking pressure off GPs “is a side benefit” rather than, as is sometimes assumed, the whole point of expanding pharmacists’ role. “This is more about improving patient access to care in the most convenient way and utilising professionals’ skills across the workforce”.

Releasing community pharmacists’ potential also has implications for hospitals. As things stand, there isn’t a mechanism to send a prescription safely from a hospital to a community pharmacy – something that is being worked on. “There will be a whole series of implementation challenges to do that because it fundamentally changes the pathway of how we issue medicines.”

It will involve getting the national electronic prescription service currently used in the community adopted in hospitals. “What that requires technically is hospital EPRs to integrate with EPS. So if you prescribe something in hospital it would give the ability to send that to the high street pharmacy and give the patients’ choice. There are all sorts of complexities but it’s a significant opportunity.” Importantly, linking hospitals to community pharmacies would smooth discharge processes and reduce reliance on hospital pharmacies. “Lots of hospitals are keen to pursue it,” says Singal.

There is also a “really significant piece of work” underway to improve the transfer of information from hospitals to GPs (similar to the improvement in record sharing between community pharmacies and GPs), so information enters the GP’s workflow “in real time at the point of discharge”.

The “final bit” of work will give patients more transparency and flexibility via the NHS App. “What patients have told us they really want is to know when their prescription is ready – that will stop phone calls and anxiety. By September, we should have tracking capability so patients can see where their medicines are.”

Digital will make the biggest difference

Singal will be a keynote speaker on the Digital AHP and Pharmacy stage at Rewired in March. Other highlights on this stage include innovation case studies.  He is looking forward to having “face-to-face time” with suppliers and frontline clinicians. “Opportunities to do that now are fewer and fewer, so it is hugely valuable. It gives us an opportunity to make ourselves accessible.”

For the keynote session, he’ll be discussing “the maturity of digital medicines – where we are heading to. We have a unique ability to look at the whole pathway. Medicines are the most common intervention that happens to patients, it’s the thing that changes the most.”

If you get medicines right, the benefits for patients and the NHS are huge. “It’s a ‘win win,’ isn’t it?” says Singal. “The NHS spends £16bn a year on medicines – you want to get good value for that, so that patients get the medicines they need that are doing more good than harm.”

A message he’ll be getting across at Rewired is that digital is at the heart of getting medicines right.

“At a tech conference you expect people to say ‘it’s the single [most important] thing’. But when I look at what we need to do, I think it’s the thing that will make the biggest difference next.”

Put simply, providing a “clear record” on medicines opens the door to doing so much more around safety, appropriateness and personalisation. There is a very big question that digital can help answer: “Are these medicines right for you? I don’t think [before now] we have been able to be in that space.”

Rewired 2024 is at the Birmingham NEC, March 12-13. Find out more about the Digital AHP and Pharmacy stage, explore the programme, and register here.