The NHS 10-year plan:

What does it mean for pharmacy?

Contents

1. Introduction
2. Hospital to Community
3. Analogue to Digital
4. Sickness to Prevention
5. System operation
6. Workforce
7. Other areas impacting on pharmacy
8. Share any feedback, best practice or case studies

Introduction

The NHS 10-year plan: Fit for the Future sets out a vision of where the NHS will be in ten years’ time, but with limited detail on how to get there.

Pharmacy and medicines are mentioned throughout the document and are seen as an enabler of the 10-year plan. There is a particular focus on pharmacists working in the community, but there is less attention on areas such as hospital pharmacy. At the same time, while there is a clear recognition of pharmacists’ key role in the NHS of the future, this comes alongside significant cuts to Integrated Care Boards, changes to national bodies, and uncertainty as to the structure of pharmacy system leadership at national, regional and local levels. These will need to be carefully managed to avoid destabilising the overarching system that supports medicines optimisation and ensuring best value from medicines.

Our joint report with The King’s Fund made clear how pharmacists across healthcare are central to reducing health inequalities, managing the rising burden of long-term conditions, and delivering best value from the nearly £20 billion spent annually on medicines. But success hinges on critical enablers; robust workforce planning to secure a sustainable pipeline of pharmacists to meet demand, smarter deployment of skill mix within pharmacy teams, and urgent investment in digital infrastructure, particularly IT and patient records.

Over the last two decades, the expertise of pharmacists has increasingly been used to deliver better use of medicines, support for public health and more clinically focused care to people. Our vision document for pharmacy professional practice in England demonstrates how pharmacists and their teams can lead in the field of pharmacogenomics, support and utilise digital therapeutics, and develop and be part of new care models.

Hospital to Community

Neighbourhood Health Centres (NHCs) and a focus on primary care

The 10-year plan talks about the establishment of neighbourhood health services and centres, although there is little detail about where they will be sited or how they will operate. We would expect a national framework to be shared to support the establishment of the NHCs.

Community pharmacies are already sited in neighbourhoods and are well placed to be part of NHCs and deliver patient care. The NHC must include all of primary care to fully realise the potential for better patient outcomes and to make the most of the opportunity to strengthen integrated, place-based care. Pharmacists must be included in the discussions at both national and local level from the outset, as NHCs are established. The community pharmacy contractual framework needs to evolve to support and commission pharmacist independent prescribing services as part of clinical pathways. All primary care should be represented in the Place partnerships and Neighbourhood Health Teams, and community pharmacy will play an important role. This is dependent on local relationships and how community pharmacy organises to enable involvement with Places.

The plan intends to increase the capacity in primary care which could mean more practice pharmacists working alongside other colleagues in primary care teams. GPs will be encouraged to lead wider neighbourhood providers, which means pharmacists working in general practices will also be part of larger neighbourhood teams. There is no clarity as to how NHCs and Primary Care Networks (PCNs) will work together or replace each other. Whilst there is a draft ICB model blueprint there is still debate on where certain functions, such as medicines optimisation, will sit.

Medicines are the biggest intervention in the NHS, so it is essential that medicines are optimised across systems and that they are used appropriately and safely to prevent unwanted admissions into secondary care. This means that pharmacists, as the experts in medicines and their use, should be embedded in NHCs and Integrated Care Boards (ICBs).

As more care is provided in primary care, more funding will be invested in primary care and reduced in secondary care as funding will follow the patient. It is not understood what impact this will have on secondary care services, and we are concerned about reduced investment in hospital pharmacy services. Secondary care teams could potentially provide more outreach services within neighbourhood health centres and work more closely with primary care colleagues to support specialist care. There are concerns that specialist hospital services such as aseptic units, which are essential to the delivery of the ‘Life Sciences’ plan, may not get the funding they need to operate and develop services.

Hospital pharmacy services play a critical role in supporting specialist care and ensuring the delivery of the recently published Life Sciences Plan, particularly in relation to clinical trials. Hospital pharmacists ensure that patients are discharged back into their community safely, in terms of medicines. Investment in systems is required to support communication and better and safer transfers of care.

The 10-year plan talks about two new primary care contracts for both single and multi-neighbourhood providers. As part of the primary care team, we expect to see pharmacists included within these primary care contracts. We would also like to see these contracts encourage collaboration between primary care providers, so they are all working together to deliver the best outcomes for patients.

Integrated Care Boards (ICB) will also have the ability to contract with a wide range of providers to deliver care in neighbourhoods, and this includes Foundation Trusts. With the current reforms at ICB level we have concerns that there will be a lack of strategic oversight and understanding of medicines optimisation and pharmacy leading to increased spend on medicines with a negative impact on patient outcomes.

There will be dedicated mental health emergency departments and mental health neighbourhood teams. Specialist mental health pharmacists must be involved in both of these.

Analogue to Digital

Digital transformation underpins the delivery of the 10-year plan. There needs to be good data flow between all care providers, which means that systems used by different providers need to be interoperable.

Single Patient Record (SPR)

Community pharmacies are mentioned as getting access to the Single Patient Record. It is critical that pharmacy is considered and included in the design discussions as the structure of the SPR is being decided. The SPR will hold all the health data about the individual person and the patient will be able to access it and add data themselves, for example from wearables. All clinicians will be able to access the SPR to prevent people having to relay information all the time. The SPR will, over time, contain a summary of the patient’s clinical history and legislation will be introduced that places a duty on every health and care provider to make the information they record about a patient, available to that patient. Pharmacists will need to ensure they record relevant data into the SPR and that they make clear and robust clinical records.

System and technology suppliers must also be given sufficient time to include the SPR within their development roadmaps. The right methodology needs to be used to ensure that both technology providers and end users can engage with the technology, and this will help to ensure widespread adoption as the delivery of clinical healthcare evolves.

NHS App

The NHS App will become the gateway to the NHS. There is a role for pharmacists and their teams in supporting people to access and navigate the NHS App, especially as its functions become more complex, they could become NHS App Ambassadors, as mentioned in the 10-year plan. Whilst the Government aims to make the NHS App the default entry to NHS healthcare, consideration should be given to other approaches to drive innovation into this market and may help the uptake of citizens becoming "digital health citizens" via the platform of their choice.

Patients will be able to book certain appointments using the App and be able to self-refer in certain circumstances, pharmacists may have a role in directing them to do this and also using this functionality in their delivery of clinical services from pharmacies.

The NHS App will evolve to include AI functionality that will provide online advice to patients. The My Medicines function of the NHS App will make it simple to manage repeat prescriptions for delivery or collection. Medicine regimes can be complex and hard to remember, so this tool will remind patients what they need to take and when. In the longer-term, My Medicines will be able to guide patients on drug interactions, using scientific advances like pharmacogenomics, and help avoid adverse drug reactions. Pharmacists will need to be involved in the development of this, and other functions, of the app to ensure the advice provided around medicines is up to date and robust.

Functions in the NHS App will enable patients to see wait times and outcomes, choose providers and leave public feedback so pharmacists will also need to understand the functionalities of the App and support patients in using it.

Developments in this area should be driven by patient and clinician need, and not just a "digitisation" of processes. This provides opportunities to look at current processes and see if they can be re-imagined with the support of technology.

There are also concerns about digital inequalities and the need to support those people who may not have access to, or want to use, digital applications to access and use healthcare.

Artificial intelligence (AI)

Artificial Intelligence (AI) is a key enabler of the 10-year plan. There are plans to use AI to take on some of the administrative work such as working as AI scribes using ambient voice technology. AI could also assist pharmacists in their roles, such as taking consultation notes, providing referrals and supporting remote consultations. AI-enabled digital tools, such as those used in dermatology, could be used by pharmacists to capture high quality images of suspicious skin lesions which AI can then support in triaging.

The use of AI to support clinical decision making and automation of tasks is prominent within the 10-year plan and pharmacy needs to consider how AI is best utilised for pharmaceutical care. The safety aspects of AI must be at the forefront of pharmacy professionals use of any form of this technology. RPS have developed artificial intelligence policy to support members in this area (https://eu-health-news.info/recognition/all-our-campaigns/policy-a-z/ai%29.%3C/p%3E

The 10-year plan says that all hospitals will be fully AI enabled during the lifetime of the plan. In secondary care, automation can be used in staff rostering and procurement; AI to support reporting in radiology and pathology; remote monitoring to support virtual care of patients at home; and predictive models to predict need and manage hospital flow. However, we would like to see more support for the basics such as an upgrade to digital systems in hospital pharmacy, overcoming the delays to electronic prescribing which have held back productivity for far too long. There needs to be clarity as to how hospital pharmacies will be supported to upgrade their digital systems, implement electronic prescribing, and then integrate AI-enabled tools. As systems are developed, hospital pharmacists need to be included in these discussions from the outset.

Pharmacy professionals need to be supported with learning and understanding of the technologies, to ensure they are deployed and utilised effectively.

Digital equality

There are a number of apps already available for professionals and patients to access but the government have committed to building a HealthStore which will enable patients to access approved health apps to manage or treat their condition. This will also be helpful for pharmacists when recommending apps to patients and the public. There may also be opportunities for pharmacists to develop apps to support medicines optimisation and ensure medicines safety.

Digital health inequalities is a major concern as the NHS App is set to be the new way to access and use the health service. Individuals will need to be supported to access and use the NHS App effectively.

An overriding concern for all pharmacy professionals will be safeguarding those unable or unwilling to become digital natives. We must ensure that credible, non-digital routes remain for those patients to access the care and information they need

There is a commitment to introduce single sign-on for NHS software to remove the duplication currently experienced by staff. We hope this commitment extends to those providing NHS services such as community pharmacies and general practices.

Sickness to Prevention

Pharmacogenomics

The plan has a strong emphasis on pharmacogenomics and genomic data which has the potential to revolutionise personalised and predictive care. Pharmacists are well equipped to play a lead part in the development of pharmacogenomics and translating genomic science into clinical practice and they should be empowered to do so through investment in infrastructure and by leading clinical pathways. One ambition of the plan is for all babies to have a genomic test at birth to provide information of a child’s future health. Patient genomic data will be integrated with clinical data to form a unified genomic record.

RPS is supporting all prescribers in developing a pharmacogenomics competency framework resource. This work aims to accelerate the safe and effective integration of pharmacogenomics into everyday prescribing practice across all professions. Ensuring the pharmacy workforce is equipped to deliver on the promise of pharmacogenomics now depends on investing in the right tools, training, and support. As the area of personalised medicines develops through the accumulation and utilisation of genetic data, there will be a need for clinical systems that can “consume” and produce meaningful outputs in terms of preventing harms from prescribed medications. Just as systems now alert users to interactions between medications, newer systems will need to alert the clinician to an interaction between the medicine and the genome.

Pharmacists could become genomic champions, encouraging uptake of genomic testing and supporting people to understand and act on the results. The plan mentions using pharmacogenomics to optimise medication effectiveness and prevent adverse drug reactions, so pharmacists must lead this work both nationally and locally.

Healthy living

The 10-year plan mentions the three initial focus areas on prevention which are vaccination, screening and early diagnosis. For pharmacists working in primary care, including community pharmacists, there are significant opportunities to deliver this prevention agenda. Community pharmacists could also be more involved in the supply of PrEP to support the Government’s aim to end new HIV transmissions in England by 2030.

The plan encourages the NHS to take more of an active role in secondary prevention, and this is a good fit for pharmacists, providing advice on lifestyle and medicines that can support in this area.

Community pharmacy is a natural place to receive preventative health interventions including stop smoking, weight management and exercise advice. They are also easily accessible on high streets to support the delivery of weight loss treatments and services. All community pharmacies in England are healthy living pharmacies so they have a good understanding of the prevention agenda, and their pharmacy team includes a health champion. The Healthy Living Pharmacy should be one of the starting points for any patients journey into healthcare access.

People need to have easy access to and be able to self-refer into pharmacy services provided in the community, rather than relying on another healthcare professionals to make a referral.

In terms of digital, data for wearables could be utilised by pharmacy teams to help focus advice for patients. The NHS has initiated a Digital Health Check to try and engage patients with early engagement and early identification of potential future health issues; pharmacy should play a part in delivering these to the community.

System operation

Patient safety and medicines safety

The 10-year plan has a strong focus on neighbourhood health centres supported by strategic direction and standard setting from the centre and regions. The cuts to Integrated Care Boards seems to be at odds with the ambitions of the plan.

There needs to be strong pharmacy leadership across the system to support the development of new services, ensure the best use of resources and deliver savings where possible. ICBs must continue to have pharmacists as leaders within their organisation to lead on the delivery of medicines optimisation, ensuring the best value from medicines, as well as to provide knowledge and guidance around the strategic commissioning of community pharmacy services. Leadership in medication safety provided by Medication Safety Officers in Integrated Care Boards and NHS Regions, can save lives and generate a return on investment of 228% by driving improvement activity towards high-risk populations and high-risk medication.

Continuously improving safer care and medicines optimisation, are operational functions of providers and neighbourhood health. However, medicines optimisation, as an activity of strategic commissioning, is a function of Integrated Care Boards

The scale of medication use, and its complexity results in a large opportunity for error and associated harms. Recent estimates are that 237 million medication errors occur at some point in the medication process in England annually¹. In 2022 it was found that 1 in 15 urgent admissions was a result of an avoidable adverse drug reaction and that these accounted for £0.9bn in NHS costs, each admission using 6 bed days². Harm is inequitably distributed across the Core20Plus inclusion groups, particularly for the elderly and people with a learning disability.

Prescribed medicines are the most common intervention used in the NHS to treat and prevent ill health and in 2023/24 the total cost was £20.6bn³

The opportunities offered by shift from hospital to community and the adoption of new models of care based around neighbourhood health represent a rebalancing of risk in relation to medication use, reducing risk in secondary care and increasing it in primary care and community settings as clinical roles change. Pharmacy leadership will be needed to ensure medicines safety and management of these risks as they emerge.

An example of cost-effective interventions delivered in England include the large scale roll out of PINCER which demonstrated a mean incremental cost-effectiveness ratio (ICER) of - £3936 per QALY compared to prescribing feedback. This shows PINCER to be cost effective at the £20,000/QALY ceiling⁴.

Medicines safety is a constantly dynamic field of practice that requires management at provider, system and national scales. Leadership in medication safety has been a long- established imperative to safeguard patients from. Investment in leadership in medication safety has been shown to save lives, reduce serious harm and reduce health utilisation.

There is a focus on making the quality of care more transparent and although the national guardian role is likely to disappear, all organisations will be required to have mechanisms to enable staff to raise concerns and have freedom to speak up.

Finances

It is good to see a change to multi-year budgets and a focus on outcomes rather than input and activity. However, it is unclear how this will translate into practice. There is a clear steer that any investment must result in better outcomes.

There is also a desire to change payments as block contracts to a model where budgets are linked together across providers. RPS has long called for primary care contracts that support and incentivise collaboration across primary care providers.

Foundation Trusts will be reinvigorated and eventually, all hospitals will become a foundation trust. FTs have more autonomy how the finances are spent which could mean more, or less, investment in clinical pharmacy services. Medicines optimisation services and ensuring patient safety should be key areas of investment for foundation trusts.

The 10-year plan encourages a plurality of providers from within the NHS, the voluntary sector, the independent sector or social enterprise. Pharmacies need to consider how they fit into these new systems and how they can form partnerships with other providers. It also mentions that patient will have a say as to whether or not the full payment of their care is paid to the provider, or if some of it goes into an improvement fund. Further clarity is needed on how this might relate to pharmacy.

Single National Formulary

The government will move to a Single National Formulary (SNF) for medicines within the next two years. Whilst this may save duplication of effort at local and regional levels the impact on medicines shortages needs to be considered due to vulnerabilities in the supply chain, as well as any impact on locally commissioned services focused on specialised medicines. The Single National Formulary will need to provide clear and consistent guidance on whether medicines are to be initiated or supplied in primary versus secondary care to support safe and equitable implementation across ICS boundaries. With a decrease in the number of ICBs and uncertainty around strategic pharmacy leadership, the implementation of the SNF across local systems is at risk.

Workforce

The government have committed to publishing a 10-year workforce plan later this year, potentially with a view to revising down projected workforce numbers set out by the 2023 workforce plan, alongside an emphasis on automation and supporting multidisciplinary working.

Pharmacists, as the experts in medicines and their use, play a significant role in providing care closer to home, tackling long-term conditions earlier, and helping the NHS deliver the best value from medicines. Consultant pharmacists play a significant role in the development and implementation of clinical pathways and this needs to be recognised and supported.

Pharmacists, like other healthcare professionals will need to have digital capability skills as the NHS moves from analogue to digital. The 10-year plan talks about changes to education and training which includes updated curricula for undergraduates, but we need to also ensure the current workforce are upskilled and confident in their digital skills. There needs to be investment in training, development, and retention of pharmacy professionals to ensure a robust workforce supply in the future.

Skill mix is encouraged and with more pharmacists becoming prescribers they will be taking on new roles within the system. The commitment to pharmacist independent prescribing must be matched with investment in service redesign and commissioning.

The plan also mentions that professionals and staff within the NHS will be trained to task rather than trained to role. This will help to break down boundaries across professions but their needs to be clear demonstrations of competencies to deliver those tasks.

As part of the workforce plan, we would like to see protected learning time made available for pharmacists in all care settings and areas of practice. This is briefly mentioned for clinical educators but needs to be equitable and available across all professions working in the NHS.

The 10-year plan mentions changes to the NHS workplace to make the work environment better for staff including flexible working options and protection from bullying and harassment. We support this as our annual workforce wellbeing surveys have consistently shown a high level of burnout amongst the pharmacy profession. However, the standards and implementation details are yet to be clarified. We welcome the need to make the work environment better for staff protected from bullying and discrimination as outlined in our commitment to improving inclusion, diversity and equity within the profession. The NHS PWRES data supports inclusive workforce planning.

A diverse and inclusive pharmacy workforce better reflects the population it serves—and is more effective at delivering equitable healthcare. To create environments where everyone can thrive, regardless of race or ethnicity. Ensures talent is not lost or overlooked due to systemic or structural bias

Other areas impacting on pharmacy

All people with complex needs will have care plans and the NHS App will support people to book appointments, communicate directly with professionals and view and add to their care plans. Pharmacists need to be involved in all the aspects of care plans that involve medicines including undertaking regular medication reviews.

Hospital at home will continue to be supported but there is not much detail in the plan. We will continue to advocate for pharmacist’s role within hospital at home teams alongside the interim standards we have developed (link). There needs to be dedicated funding to support the role of pharmacy staff within these virtual teams to ensure best use and understanding of medicines.

There will be a continued focus on sustainability and achieving net zero. Pharmacies can use the RPS Greener Pharmacy Toolkit⁵ to help support them in doing this.

There will be increased involvement of pharmacies in research and clinical trials and pharmacists will need to be supported to enable this.

There is also reference to ensuring that best value medicines are consistently adopted everywhere by modernising the supply chain. There will be increased use of robotics in pharmacy as well as automation and use of AI to enable medicines optimisation.

Overprescribing and frailty receive limited attention in the 10-year plan. given the importance of getting the best value from medicines and ensuring people living well at home. RPS and RCGP have worked together to develop and publish a repeat prescribing toolkit to support GP practice teams in reviewing and assessing patient taking medicines on a repeat basis⁶. The Nimbuscare Improved triage and navigation in York example included in the 10-year plan demonstrates how patients with frailty can be better supported in the community. And predictive tools, alongside clinical knowledge and expertise, can help to predict falls.

Share any feedback, best practice or case studies

If you want to share any views about the 10-Year Plan, opportunities, challenges, or perhaps how you are developing services in your areas, please contact the team at [email protected]

If you have a case study you would like to share, please complete this online form.

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