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The Department of Health and Social Care (DHSC) announced on Monday (November 22) that it would integrate NHS Digital, NHSX and Health Education England into NHS England and Improvement (NHSE&I) as part of major workforce planning and technology reforms. The merger is part of the government's long-term strategy for the recruitment, training and retention of healthcare staff coupled with a digital transformation of working practices. The overhaul is based on recommendations made by NHS Digital chair Laura Wade-Gery who led a government-commissioned review to improve patient care, centralise the NHS workforce and accelerate digital delivery. Commenting on her recommendations, Wade-Gery, said: "In the rest of our lives, digital has really changed how we live and we must now make this true in healthcare. The goal of my review is to equip the national centre with the right capability to support Integrated Care Systems to deliver better citizen health. We need to have the culture, operating model, skills, capabilities and processes to put data, digital and technology at the heart of how we transform health services."

The Association of the British Pharmaceutical Industry (ABPI) has welcomed the new research guidance published by NHS England for the integrated care systems. The guidance is said to reflect the benefits of delivering research, for patients, staff and healthcare system performance, including the economic benefits for the NHS. Jennifer Harris, ABPI's Director of Research Policy, said: "This guidance is clear on what good research practice looks like and it's great to see it out and available for the NHS to use. "A research-active NHS delivers huge value to patients, staff and the system itself. We hope that putting this guidance into action will help Integrated Care Systems realise the huge benefits that research can offer, and help make the UK once again a destination of choice for developing the medical breakthroughs people need."

Dr Amanda Doyle has been appointed as NHS England as director of primary and community care. Prior to her new role, Amanda had joined NHS England and NHS Improvement as North West Regional Director on 2 August 2021 and previously she was the Chief Clinical Officer for West Lancashire Clinical Commissioning Group (CCG), Blackpool CCG and Fylde and Wyre CCG. Amanda was also the Integrated Care System Lead for Lancashire and South Cumbria, leading a large health and care transformation programme across the patch. She has been a GP for more than 20 years, practising in a large practice in a deprived area of Blackpool, which, in addition to primary medical services, provides a range of urgent care services for patients across the Fylde Coast. Amanda was the Co-Chair of NHS Clinical Commissioners from 2013 to 2018. She was Senior Responsible Officer for the primary care component of the Long Term Plan and was involved in the leadership of the health inequalities, prevention and personalisation elements.

Lack of staffing and increased demand from patients is mounting unsustainable pressure on the NHS, putting patient safety and care at risk, a new poll of NHS leaders by the NHS Confederation revealed. NHS leaders in England warned that the service has reached a "tipping point" with nearly 88 per cent saying "the demands on their organisation are unsustainable." The survey, published ahead of the monthly performance figures for the NHS England, covered leaders across hospitals, ambulance services, mental health providers, community services, primary care and integrated care systems. It highlighted primary care, urgent and emergency care as greatest areas of concern, with record levels of demand on A&E departments and increasing bed occupancy rates.

Now is the best time for community pharmacy to integrate its model of NHS representation and support to ensure better outcomes for contractors, said James Wood, director of Contractor & LPC Support, Pharmaceutical Services Negotiating Committee (PSNC). It is important for the sector to adapt to the new landscape and address challenges such as workforce, digital data, integration of pharmacy services, and medicines optimisation, he said during the first session of the sixth annual Pharmacy Business Conference held online on Tuesday, September 21. Under the new system, every part of England will be covered by integrated care systems (ICSs) from April 2022. ICSs have been created to bring about big changes in how health and care services in England are planned, paid for and delivered. They are a key part of the direction of travel for the NHS as outlined in the NHS Long Term Plan.

The Pharmacists' Defence Association (PDA) is supporting pharmacists in England whose employment has been impacted by the creation of new NHS structures. As a result of the 2022 Health and Care Act, Integrated Care Systems (ICSs) were established in England, and Clinical Commissioning Groups (CCGs) were closed on 1 July 2022. Each of the ICSs includes two key parts: an Integrated Care Board (ICB) and an Integrated Care Partnership (ICP). The association said: "The previous structures in England, established by the Health and Social Care Act 2012, originally had over 200 clinical commissioning groups. This number had reduced over recent years via mergers." "However, this latest shift to just 42 commissioning entities means a significant change to significantly larger geographies and populations covered by each ICS. Although each ICS and its activity can be subdivided into 'places', and within places into 'neighbourhoods', it is at the ICS level that the employer is formed." "Whereas CCGs previously employed many local health professionals, including pharmacists, the new arrangements mean that ICBs are now that employer. The PDA is supporting members who have contacted its Service Centre about the impact of these changes."

The Local Pharmaceutical Committees (LPCs) has rebranded to be known as Community Pharmacy to present a strengthened and unified identity to the local NHS, local government and other stakeholders, as the local voice of community pharmacy. "There are now 58 LPCs in England. The number of LPCs has reduced from 69, with further consolidation expected by April 2024 to a network of 48 local organisations," said Community Pharmacy England. "The changes mean there will be better alignment between LPCs and the 42 NHS Integrated Care Systems in England, who have taken on the responsibility for commissioning pharmaceutical services delegated by NHS England." "This marks a significant milestone, as similar to Community Pharmacy England, LPCs have been undergoing changes to respond to the Review Steering Group (RSG) recommendations on pharmacy representation. The sector voted in favour of the RSG proposals in the summer of 2022, and since then progress has been made on many of the changes at both local and national level as part of the Transforming Pharmacy Representation (TAPR) Programme."

Keith Ridge, who retired from the role of England's chief pharmaceutical officer this month, has written to the NHS regional directors regarding a package to empower community pharmacies to implement clinical services in their integrated care systems. Though details about this letter are not available, Malcolm Harrison, chief executive officer of the Company Chemists' Association, welcomed the move saying: "It is a positive step towards the greater integration of community pharmacy care into the NHS. "It is vital for the NHS that patients can benefit from the clinical care services set out in the Community Pharmacy Contractual Framework." Harrison, however, highlighted that while pharmacies are being pushed to do more, the efforts to introduce new clinical services should be supported with "sustainable funding and material actions to increase workforce numbers in the sector." "We are concerned that without the funding and people in place, the desired volume of necessary services cannot be delivered, no matter how well coordinated."

The NHS Confederation and the Association of the British Pharmaceutical Industry (ABPI) has published a report that demonstrated the importance of the collaboration between industry and the NHS to improve patient outcomes across the UK. Analysis from the report has shown a significant variation in access to innovative medicines for patients across the UK and showed that uptake of new treatments in these areas continues to be below the average of similar countries in Europe. The report, 'Transforming Lives, Improving Health Outcomes', has highlighted four initiatives where effective partnerships between the NHS, patient organisations and industry have helped to tackle unwarranted variation in the uptake of innovative medicines. Transforming Lives, Improving Health Outcomes also called for a systemwide secondary prevention strategy covering all parts of the health system creating a barrier to wider and consistent uptake of innovative medicine. It also noted that newly created Integrated Care Systems have the potential to improve preventative treatment. The report data also showed a 51% variation of uptake of three types of medicines related to diabetes between NHS Trusts in England.

NHS England has commissioned the Royal Pharmaceutical Society (RPS) to develop guidance that helps community and hospital pharmacy teams across Britain to reduce the impact of pharmacy services, pharmaceutical care and medicines on the environment. The RPS said the Greener Pharmacy Guidance will enable pharmacies to self-assess their impact against the standards, benchmark and improve through evidence-based activities and actions. "I'm delighted our strong commitment to helping pharmacy reduce its environmental impact can now be taken to the next level through developing guidance and accreditation for pharmacy teams," RPS president Professor Claire Anderson said. "Medicines account for 25 per cent of carbon emissions within the NHS and this initiative underscores our commitment to promoting sustainable healthcare and supporting the NHS's goal of achieving 'net zero' emissions by 2040." Peter Morgan, medicines assistant director at NHS England, commented: "Pharmacy staff are involved in the purchasing and dispensing of almost every medicine used in the NHS and the new Greener Pharmacy Guidance and Self-accreditation scheme will provide support for pharmacy professionals by outlining clear actions to deliver more environmentally sustainable pharmacy practices." The RPS said the guidance and digital self-assessment toolkit will integrate with carbon calculator tools to help pharmacy teams to measure their carbon footprint, action plan to reduce use of carbon and improve sustainability.

The Department of Health and Social Care (DHSC) made a recent announcement that the Incubator for Artificial Intelligence (i.AI) and NHS England (NHSE) have joined forces in a groundbreaking move by signing a Collaboration Charter on AI. This pivotal partnership aims to equip the NHS workforce with the tools and resources to leverage AI technology for enhancing patient care, improving staff experience, and driving operational efficiency. The Charter, endorsed by Minister Burghart, Parliamentary Secretary for the Cabinet Office, and Lord Markham, Parliamentary Under Secretary of State at the DHSC, signifies an important step towards integrating AI into the fabric of the NHS. Under this collaboration, the i.AI team, comprising elite technical experts within the government, will identify opportunities where AI technology can be deployed responsibly to support the NHS. This initiative is expected to streamline processes, optimize resource allocation, and ultimately enhance patient outcomes.

The Integrated Care Systems (ICSs) provide an opportunity to break the silo mentality in the health and care sector, National Pharmacy Association (NPA) chair Andrew Lane told MPs. While giving evidence to the Health and Social Care Select Committee on 6 December about the effectiveness of ICSs, Lane also poured cold water on newspaper reports that community pharmacists will be drafted in to break the NHS strike, as he reiterated the call for a "properly costed and funded environment." "We've been in different silos historically and ICSs are an opportunity to pull all systems together for the benefit of patients," he told committee members. Lane pointed to dementia-trained pharmacy delivery drivers and the Discharge Medicines Service as instances where the influence of community pharmacy already stretches beyond primary care into hospitals and social care. "We've seen pharmacists prescribe and get UTIs off doctors' desks, so we are starting to release capacity [in the system] and we're on that clinical journey. We welcome that, but it has to be with the right level of funding," he added.

As we transition in England through yet another NHS organisational change, I ask myself what does this mean for community pharmacy? I would like to think that this change will bring about opportunity and a chance for community pharmacy to showcase and continue the excellent work that was carried out during the height of the pandemic and is still ongoing today. I hope that it allows community pharmacy to be regarded as part of the NHS rather than sitting on the side lines. This change has to lead to better funding for community pharmacy, without sufficient funding we will see more pharmacies close. We are hearing a lot about winter pressures but this year it feels like all year round pressure. What I have seen, whilst the NHS is under such pressure, is North East London (NEL) CCG transitioning to an integrated care board (ICB) almost seamlessly. I have seen people transitioning into new roles, whilst working hard to ensure that all plates are still spinning, which at the moment is no mean feat. I spent a day out recently visiting pharmacies with the chief medical officer of NHS NEL, Dr Paul Gilluley. The visits were positive, we felt listened to and understood. The feedback was great, it was recognised that community pharmacy is often the informal front door to the NHS and that we have so much to offer in terms of ill health prevention. Community pharmacy can offer a total solution as long as we have the tools to do so, which can save so much time and money. An example is the GP CPCS service, which has launched well across NEL.

Community pharmacy contractors are likely to receive more referrals from NHS 111 for the Community Pharmacist Consultation Service (CPCS) following a review of the NHS Pathway algorithms, NHS England and NHS Improvement (NHSE&I) announced on Friday (January 14). The review, conducted by an expert group of Integrated Urgent Care clinicians and pharmacists, led to inclusion of more minor illness symptoms for referral to the CPCS from NHS 111. The reviews based on data from 2021, showed it could generate 275,000 additional referral opportunities annually. With the introduction of changes, three new condition types (scratches and grazes, teething, sinusitis) and general health information requests will be added.

David Webb, the Chief Pharmaceutical Officer for England, acknowledged that the "pressure in the system is high", but urged everyone to "keep our eye on the design" of the NHS plan, adding that the "the objective is to bring the different parts of primary care together" in the patient interest. Speaking during the opening keynote session at the the National Pharmacy Association (NPA) conference held on Thursday (13 October), he added that the NHS plan intends to bring different parts of primary care together to help patients. He said the new integrated care boards (ICBs) are a key strategic framework as they provide the "potential to form partnerships to deliver integrated services across larger populations". "ICBs will want to work with Local Pharmaceutical Committees to plan for the local population and the new community pharmacy clinical leads in ICBs, who have been funded by NHS England, are there to advise." He explained that once an ICB takes over the commissioning of pharmaceutical services (which they are all due to do by April 2023), it could use its funds to commission a local enhanced service as an add on to an advanced service. For instance, a CVD risk assessment could be added to the blood pressure check service.

NHS England and NHS Improvement published on May 26 the findings of the Fuller 'stocktake' - setting out how primary care can work with partners across health and care to best meet the needs of their local communities. Dr Claire Fuller's report lays emphasis on the essential role of primary care and the potential of integrated neighbourhood teams in reducing the burden of ill health and tackling health inequities. It commends community pharmacy for keeping "its doors open to the public throughout" the pandemic whilst being "among the most recognisable of a multitude of dedicated staff delivering care around the clock in every neighbourhood in the country". The report highlights "recruitment and retention challenges across the wider primary care workforce" including in community pharmacy. Stressing the importance of community pharmacy teams in urgent care and prevention, including early diagnosis of cancers, the report points out that pharmacists could play "a more active role in signposting eligible people to screening and supporting early diagnosis, building on a number of successful pilots such as those from the Accelerate, Coordinate, Evaluate (ACE) programme".

The recruitment of pharmacists in Primary Care Networks (PCNs) has exacerbated a general shortage of pharmacists, revealed an independent review of Integrated Care Systems (ICSs) published on Tuesday (4 April). The review, Rt Hon Patricia Hewitt, highlighted the impact that the Additional Roles Reimbursement Scheme (ARRS) roles for pharmacists are having on the community pharmacy sector. "Contracts with national requirements can have unintended consequences when applied to particular circumstances. For instance, the national requirements and funding of Additional Roles Reimbursement Scheme (ARRS) roles for community pharmacists within PCNs, has on occasion exacerbated the problem of a general shortage of pharmacists, with some now preferring to work within primary care rather than remain in community pharmacies or acute hospitals, compounding the problem of community pharmacy closures and delayed discharges." It set out to consider the oversight and governance of ICS in England and the NHS targets and priorities for which Integrated Care Boards (ICBs) are accountable, including those set out in the Government's mandate to NHS England. As part of this work, Hewitt and her team engaged with a wide range of stakeholders representing various local health and social care settings, including LPCs.

All 42 integrated care boards (ICBs) in England have signed memorandums of understanding for the NHS Independent Prescribing Pathfinder programme, the first nationally-funded prescribing service in the country. Anne Joshua, interim deputy director of pharmacy commissioning at NHS England, made the revelation during the 'Chief pharmaceutical officer bi-monthly webinar' held on 7 March 2024, as reported by The Pharmaceutical Journal. In the initial phase of the programme, 210 community pharmacies across all ICBs will trial independent prescribing, ahead of establishing a commissioning framework for the service. Giving an update on the pathfinder programme, Joshua confirmed that 164 of these potential pathfinder sites had registered for the programme as of 29 February 2024. Additionally, she announced the clinical models to be followed by the participating pharmacies and presented a graph showing an overview of the services they will provide.

Since the introduction of the 2019 NHS Long-Term Plan, several policy commitments have surfaced, presenting a definitive 'blueprint' for community pharmacy in England. The Company Chemists Association has identified four crucial commitments that, when integrated, hold the potential to revolutionise patient care through community pharmacies. "Each commitment is like a crucial piece of a puzzle," CCA said. "For the transformation of patient access through community pharmacy to be successful, all these pieces must come together harmoniously. Otherwise, the picture will remain incomplete." The four major pieces of the puzzle coined by CCA include: * Building on education and training reforms to increase the size and capability of the workforce. * Expanding the number of clinical services commissioned and delivered in community pharmacy. * Introducing digital enablers which underpin service delivery. * Introducing legislative changes to increase capacity and allow the delivery of more patient-facing clinical care.

As part of a new blueprint for primary care, the government today (May 9) announced an investment of £645 million over two years to expand community pharmacy services in England. In a statement, NHS England said: "For the first time ever, patients who need prescription medication will be able to get it directly from a pharmacy, without a GP appointment, for seven common conditions including earache, sore throat, or urinary tract infections." Prime minister Rishi Sunak hopes that the measures will help end the "all-too stressful wait on the end of the phone for patients" by freeing up 15 million slots at doctors' surgeries over the next two years. "We will end the 8am rush and expand the services offered by pharmacies, meaning patients can get their medication quickly and easily," he said Almost half a million women will no longer need to speak to a practice nurse or GP to access oral contraception and will instead be able to pop into their local pharmacy for it, according to the government announcement. Blood checks for people suffering from moderate risk of heart attack or stroke conducted in community pharmacies will more than double from 900,000 last year to 2.5 million next year. NHS chief executive Amanda Pritchard said the "ambitious package" would help transform how care is provided within the health service "with pharmacies playing a central role in managing the nation's health including providing lifesaving checks and medication for common conditions for the first time.