National enhanced services - a positive step for Wales

If recent reports in the trade press prove to be accurate then Wales could be on the verge of agreeing a handful of national enhanced services delivered through community pharmacies. The speculation is that these could be smoking cessation, sexual health, MURs and needle exchange services.

This would be a welcome step forward not only for the profession, but also for patients and the NHS in general. It would be further recognition that community pharmacy occupies an important and arguably unique role among primary healthcare practitioners in terms of its ability to reach target groups and deliver results in a cost-effective manner.

When you compare Scotland with England, there is ample evidence that for certain services, such as smoking cessation, a centrally agreed, nation-wide approach is the most effective way to deliver results. Scotland has a nationally agreed service whereas England leaves it up to each PCT to commission their own individual smoking cessation service with the result you see patchy provision across the country with varying degrees of effectiveness.

Of course I agree with the mantra that local Health Boards or PCTs should take the lead in identifying local needs and ensuring those are met. Nonetheless, it strikes me that there are certain enhanced services which you would expect all Health Boards, regardless of where they are in Wales, to require from community pharmacies: in which case the argument for nationally agreed services becomes irrefutable.

I hope this potential development does not become a victim of budget cuts which, whilst they originate from Westminster, the devolved governments will invariably have to make.

Community pharmacy will need to redouble its efforts to ensure that Ministers and officials understand that these services have the potential to save the NHS money. There is a consensus that early, effective primary care interventions, be those healthcare and lifestyle advice or screening, are far more cost-effective for the NHS overall than treating people once they have become seriously ill. There is, however, a historic psychological bias towards GPs and secondary care as though the patient journey begins and ends at the GP practice and hospital.

In my view we need to achieve a fundamental shift in NHS thinking from treating illness to preventing it arising in the first instance. In which case, community pharmacy is not an optional add on, rather it is at the very heart of the solution to deliver sustainable healthcare outcomes.

If you accept that is the case, then Health Departments should be considering national-level services for conditions such as diabetes. It is estimated that there are over 500 thousand people with diabetes who are currently undiagnosed. The recently published National Diabetes Audit found there has been a 25% increase in the number of people with diabetes in the UK in the last six years alone and that many services are not up to scratch.

We know that if left untreated many of those people will suffer from complications including heart disease, blindness and strokes. That is a terrible human cost, but it also a huge financial cost to the NHS.

Community pharmacies are ideal locations to provide diabetes advice and testing services. I hope that when the Assembly Government makes its decision about national enhanced services it will be bold and consider a broader approach which encompasses a diabetes service as there is a clear and compelling case, both from the patients’ and NHS’ perspectives.