The future of community pharmacy in cancer care

Community pharmacy plays an essential role in the care of patients with cancer, with contact throughout the pathway from prevention and treatment to living with and beyond cancer. Such pharmacies provide an accessible place for patients to get not just treatment, but key advice and support. The importance of community pharmacy in oncology continues to grow, with an increase in the number of oral anti-cancer therapies that can be dispensed, as well as improvements in therapy leading to more patients living with cancer as chronic condition.

Another important development is the digitalization of medicines, with the potential to improve efficiency, transparency, and the coordination of care between services, to name just a few of the benefits.

To get a better insight into these areas, we spoke to Nishali Patel, Clinical Lead of Digital Medicines and Pharmacy at NHS Digital, and Cancer Services Pharmacist at University College London Hospitals NHS Foundation Trust, London, UK. She is also the British Oncology Pharmacy Association (BOPA) Community Pharmacy Subcommittee Co-Chair.

What services does community pharmacy provide for cancer patients?

By 2020, nearly half the population in the UK will be estimated to get cancer at some point during their lifetime – that’s 50% or more of all patients walking through the doors of a community pharmacy. For this reason alone, it is imperative that the community pharmacy sector is prepared and empowered to support these patients where possible.
We know there is a high demand and pressure across the healthcare system – the long-term plan emphasises the importance of shifting care where appropriate to the primary sector to improve patient experience and outcomes.

What we have is a significantly large group of suitably qualified healthcare professionals with the ability to take on more specialist knowledge in order to facilitate delivery of optimised and integrated cancer care in the community. It’s a no brainer – the community pharmacy sector is a key asset to the system.

Currently there is no formal contractual commissioning for community pharmacists to support patients through provision of a cancer specific service. However, we have seen some great services established through local, research or joint pharma funding initiatives in the UK. An example of some of these are: red flag referral schemes, minor ailment services tailored to cancer patients, structured medication use reviews for cancer patients, and infusion clinics set up in pharmacies to administer cancer treatments closer to home.

The new community pharmacy contract alludes to closer engagement with primary care networks to support earlier detection, so we will see how this progresses over the coming months.

How can the integration of community pharmacy and cancer care be improved?

Education and training: providing up-to-date, relevant training to community pharmacists will form the foundation of building cancer specialist knowledge to support service delivery. Education also needs to be delivered publicly to other healthcare professionals and patients to increase their understanding and awareness of the services community pharmacies can offer.

Service models: having service models with clear reimbursement mechanisms for cancer care provision by community pharmacies is essential. These could be co-designed locally or at national level depending the demand for the service in question. There are a variety of services that could be delivered by community pharmacies to address: early detection and prevention of cancer, management of chemotherapy related toxicities through provision of OTC treatment and advice, screening oral chemotherapy, treatment counselling for patients on chemotherapy, and well-being services for patients living with and beyond cancer.

Collaboration: collaboration between community pharmacies, patients and other sectors of the healthcare service is a key enabler to managing care effectively. The delivery of care needs to become a seamless joint responsibility as the patient moves from one healthcare sector to another – this is only achieved through citizen-centric collaboration.
Engagement and leadership: it’s our job as clinical cancer specialists to engage and support our community pharmacy colleagues. It is the job of the community pharmacy sector to maintain engagement, own and lead the vision of cancer care integration in the community to fruition.

What work is the BOPA Community Pharmacy Subcommittee doing in this area?

The subcommittee’s vision is to act as a support network for community pharmacists to enable the provision of safe, effective and quality care to cancer patients in the community. There are three workstreams that the subcommittee is focussed on to achieve this:

1) Engage and maintain professional networks with key stakeholders and the community pharmacy sector.

2) Utilise clinical expertise to advise on the creation of and/or endorse content produced by other accountable bodies for cancer care in community pharmacies.

3) Share best practice of services/initiatives in community pharmacy relating to new models of care in cancer.
The subcommittee is currently exploring joint working opportunities with charities such as Macmillan and Pharma companies who are creating education and training packages, apps and services to support cancer care integration in community pharmacy. We are also keen to promote the growing area of academic interest through research and fellowships to understand how community pharmacies can best support cancer patients.

What are the barriers to this integration, and how can they be overcome?

For me, there are three key barriers that need to be overcome in the wider healthcare system to enable this:

Interoperability: enabling the receipt and sending of referrals, communication and access to clinical information and prescriptions between the community pharmacy sector and other organisations/healthcare sectors is key – this doesn’t just require a change in technology, but an operational and culture change in how we work together across sectors and organisations to support citizens in our community with a shared responsibility.

Funding: community pharmacies need to be valued financially by the NHS for providing cancer support services. The current climate for community pharmacies is challenging, with funding cuts to dispensing services and an emphasis on more clinically focussed services. This makes it difficult, particularly for independent pharmacies, to stay afloat and find the resource to transition their business models. Clinical services will not be sustainable anywhere in healthcare unless adequate funding is provided, and community pharmacy is no exception to this.

Influence: community pharmacies are already delivering impactful clinical services to patients. The whole sector needs to own the space as a clinical resource in primary care and continue to change society’s traditional perception of community pharmacy.

Can you tell us about your work around digital medicine at NHS Digital?

Over the last year as a Clinical Lead in the Digital Medicines and Pharmacy programme at NHS Digital I have been responsible for overseeing the final enhancements to the electronic prescription service (EPS) in primary care: schedules 2&3 controlled drug prescribing and phase 4 – where all prescriptions will become electronic by default – and expanding EPS utilisation into integrated urgent care settings. I am also involved in the CCIO7 structured medicines work, supporting medicines interoperability use cases in secondary care through the receipt and sending of FHIR messages.

What developments are there in digital medicine?

We are moving towards integrated and data-driven healthcare, and the technology sector is moving with it: we are likely to see greater transparency of healthcare information and records for providers delivering patient care, more effective utilisation of medicines data, true interoperability between providers, and increased ease of patient access to healthcare and healthcare information. Technology has the potential to solve a lot of the systemic issues within the NHS, however it is not an effective solution alone. It requires an understanding of the benefits, rapid adoption by users, openness to change the way in which the system operates, and co-producing health and care with patients where appropriate.