Pharmacies should help diagnose cancers within five years, says report

More community pharmacies should be contributing towards early cancer diagnoses by 2028, two influential think tanks have recommended.

The King’s Fund and the Nuffield Trust were commissioned by Community Pharmacy England to develop a ‘vision’ for community pharmacy that will underpin a strategy for the sector.

In their report published today, they recommended more community pharmacies should play a role in improving early cancer diagnosis and ensuring 75% of cases of cancer are diagnosed at stage 1 or 2 by 2028, with the services rolled out to all pharmacies within 10 years.

In June last year, it was announced community pharmacies in England would be asked to spot early signs of cancer and be able to refer patients directly for scans as part of an NHS pilot.

They also addressed primary care recovery plans for pharmacy to ease pressures on other areas of primary care, such as prescription medicine directly from pharmacists without the need for a GP appointment.

The think tanks pointed out barriers to making this workable including:

• ‘insufficient resource across primary care as a whole, with new models of care reliant on shifting resource from one part of primary care to another, rather than overall investment
• ‘finance and contracting arrangements that inhibit new models of pharmacy, with complex funding flows, atomised commissioning and fragmented contracts that are hard to manage
• ‘perverse incentives that prohibit a shift away from dispensing
• ‘poorly developed local relationships between professionals, which have continued to inhibit both integration and wider engagement
• ‘insufficient management capacity and capability within community pharmacy and within ICBs
• ‘a lack of patient data and interoperability to allow pharmacy staff to see, document and share clinical information about patient care with the clinical records held by other health care professionals
• ‘the need to improve evidence on effectiveness, particularly cost-effectiveness
• ‘some mistrust between primary care professionals, which can create a barrier to trust and collaboration
• ‘public and patient expectations of community pharmacies that are limited to the dispensing of medications and retail.’

The think thanks said that consideration should be given to applying the same model for NHS funding of GP premises to community pharmacies, for the space required to deliver clinical services.

They also said that ‘a minimum level of access’ to patient records should be agreed to enable provision of the primarily acute minor ailment services under the core national contract, requiring a level of interoperability with GP record systems.

‘More extensive access – with or without associated patient registration – could be trialled in pilot sites offering more advanced services as this will be required for management of long-term conditions,’ they said.

The report also pointed out there was ‘strong agreement’ that the way in which GP and community pharmacy national contracts are constructed in particular causes ‘unhelpful tension and competition’, and ‘disincentivises collaboration’.

It added: ‘There was consensus that incentivising collaboration within primary care, and between pharmacies, will require investment to build capacity across the primary care sector, rather than moving money from one part of the sector to another.’  

The report’s authors said: ‘From our starting point in 2023, we can see that there is clearly significant  variation within the sector in terms of capacity and capability.

‘In developing this vision, we have sought to design an approach which is deliverable by most community pharmacies, as we believe that this will mean that implementation is likely to be more successful.’

Community pharmacists will also be able to access and add to patient records currently maintained by GPs by the end of this year, under changes announced as part of NHS England and the Government’s long-awaited GP recovery plan.

Under the plans, NHS England said that GP access will be improved by enabling patients to get prescription medicine directly from pharmacists for seven common conditions, under the Pharmacy First scheme, which would launch by the end of this calendar year.

But GPs told Pulse that while pharmacists will need to see patients’ records when they are given further prescribing powers, this will need to be rolled out taking into account patient confidentiality.

And a Pulse analysis of the recovery plan found that while many of these initiatives may go some way to ’empower patients’ in getting access to health services, it is unclear whether they will help ease pressure on GPs.

Note: This article was updated to reflect that the report suggested all pharmacies should diagnose cancers within 10 years, while an optional service should be rolled out more widely within five years.