I’m old enough to remember PIANA. The Pharmacy in a New Age initiative from the old RPSGB, which ran between 1995 and 1998 was the largest exercise in professional engagement for a generation. More than 5,000 pharmacists contributed to it, and its vision for the profession included elements that the incoming Labour Government of 1997 picked up, including prescribing rights for pharmacists, and a community pharmacy contract that started to reward different types of roles. Marcus Longley, now Professor of Applied Health Policy at the University of South Wales, but at the time a facilitator for PIANA, wrote a look back at PIANA for the PJ in 2006. Seen 10 years on, he said the programme had raised the profile of the profession, helped convince people that pharmacy wanted to make a contribution to the broader agenda, and provided politicians with some practical solutions to the problems facing them – such as relieving pressure on other parts of the NHS. Sound familiar?
We published “Community Pharmacy Forward View: Making it Happen” three weeks ago. As the sector considers what it wants to do next with the vision and implementation framework for what we, collectively want to see happen to crystallise pharmacy’s contribution to better healthcare, Marcus’s 2006 “lessons for the future” bear a look. So, I’ve interpreted his words to develop some advice for the current context:
- Since we consider the CPFV to be vitally important for the future, it needs to be a high priority for the organisation(s). Visions are pointless unless they are bought into, and strategies useless unless they are followed through. So, next steps for CPFV: we need a cross sector Steering Group to develop plans for ownership, allocate actions and follow through on them. This must have genuine support and commitment of all our leadership bodies.
- The CPFV should be given the profile it needs. There can’t be lots of high priority items, so if the top one is to work with the NHS on developing a shared alternative to the current approach, then everything needs aligning to make that the case.
- The infrastructure at community pharmacy’s disposal should be used as a platform for engagement, internally and externally. This means aligning the leadership, across companies and national organisations, nationally and locally to a common purpose. The campaign has shown how community pharmacy can be engaged in exploiting its contacts to a purpose. The same approach needs to be deployed now to ramp up the CPFV message to best effect.
- Making the CPFV happen should be supported by dedicated resource, including a central secretariat staff and a suitably trained and equipped field-force of facilitators, who can stimulate and further the agreed approach.
- All CPFV communications should be attractive, and simple, but not simplistic. The CPFV vision and plan has to have wide appeal – it needs to look and feel doable, to front line pharmacists and their teams and to interested outside parties. The 26 page NUMSAS service specification is an object, or should that be abject, lesson in how not to make something sound and feel simple.
- Messages must be consistent. Key messages or questions must be worked out in advance, reduced to their essence, and used consistently in all communications, by all who are communicating. For this to resonate the sector needs to speak with one voice. That’s not a joke. That can be usefully reinforced by common branding.
- Other interests across the sector need to be considered. This one might have had more application in the mid-90s, and the partnership working that created the CPFV should mean that the main interest groups are already bought in. Partnership, collaboration, co-production are the buzz words of today, in the NHS and for pharmacy alike. We need to stop treating primary care and secondary care pharmacists as the enemy. The NHS is working across pathways, and is breaking down the silos. It ain’t easy, but you need to look like you mean it.
- The hard to reach should be recognised and engaged. The CPFV will fail if it does not reach the parts other implementations haven’t reached. For some inside the NHS, non-compliance with core elements of the community pharmacy contract provide those arguing for new services with additional hills to climb. Engaging people in discussions requires a forum to suit people’s circumstances. A variety of approaches is therefore desirable. This will require legwork. The alternative needs to be clear to all, but the laggards cannot hold back those who want to move forward.
- Think about the end game. The CPFV has raised expectations, particularly on the other side of the table. From our conversations across the country there is a desire to think about the future differently among many. Regular feedback on progress, and the creation of ongoing opportunities to get involved, will be vital. The CPFV will come to life when new pharmacy-based models of care start up, get tested, and grow. This needs feeding; pharmacy champions needs to be created, and success celebrated.
- Stick with it. It can take many months of effort to raise awareness, get people up to speed, and allow them to contribute ideas and builds. We should all be prepared for a long haul.
My own recollection of PIANA is of excitement and energy, and great debate. Marcus highlighted in 2006 the achievements as he saw them at 10 years, largely in terms of profile raising and ideas that were taken up by a new Government determined to invest in what it saw as an underfunded NHS. But, as we know a further decade on, the early impetus for pharmacist prescribers then stalled, and contract development did too. I’d say the last phase of PIANA – “Over to You” was where things went wrong. Now prescribing skills are being invested in by Health Education England, and across the NHS community pharmacy is suggested as a solution by those trying to deal with the current multiple crises. Even many STPs have a mention for community pharmacy, even if they appear to have little clue about what that means. Those charged with taking forward the Community Pharmacy Forward View need to learn those lessons this time.
The blueprint is there. It has its flaws, but no-one seems to be dissenting from its broad message. The real work starts with “how”, and it will take a vision of a different kind to make that happen in the way.
Marcus Longley’s article can be found online at http://www.pharmaceutical-journal.com/news-and-analysis/pharmacy-in-a-new-age-start-of-a-new-era/10001940.article
The Pharmaceutical Journal, Vol. 277, p256 | URI: 10001940
The Community Pharmacy Forward View and Making it Happen can be viewed here: https://cpfv.info/