Making integrated neighbourhood working real, not just policy

A structured relationship, not a referral scheme

Most GP-pharmacy working is informal. A practice refers when it remembers to, a pharmacy delivers when a patient turns up, and nothing connects the two beyond goodwill.

Capacity+ replaces that with structure. Patients are identified from the practice list, invited, booked into pharmacy clinics, and outcomes are returned to the practice record. Every referral and every outcome is visible to both organisations.

Every quarter, the practice and the pharmacy meet to review how the pathway is performing and where they can extend it. That standing review is what turns two separate organisations into one working team, and it is what makes this an integrated neighbourhood pathway rather than a service one party happens to buy from another.

Hypertension as the operational backbone

Hypertension case-finding is the starting point because it is recurring by design. Patients need re-checking, ABPM needs re-running, and cohorts need re-reviewing every year. That recurrence is what keeps the practice and pharmacy connected month after month, rather than for the length of a campaign.

It also sits directly on the cardiovascular prevention agenda. The 10 Year Health Plan commits to a modern service framework for cardiovascular disease aimed at reducing premature deaths from heart disease and stroke by 25% over the next decade. Blood pressure detection and control is the most immediate primary care lever available against that ambition, and community pharmacy has the physical capacity that general practice does not.

Recovering unnecessary NHS spend

Alongside hypertension case-finding, Capacity+ is developing an independent appliance review model. Stoma and catheter prescriptions are checked against published fair-usage guidance to identify waste that accumulates through auto-ordering, accidental issue, and bulk repeat requests. Unlike medicines, appliances are rarely reviewed at all, so this spend builds up unchallenged.

In the St Giles pilot, approximately £2,000 in unnecessary spend was identified across a 90-day review period.

Capacity+ is building a partnership with CQC-registered clinical nurses to deliver these reviews independently, sitting entirely outside the companies that supply and dispense the appliances being reviewed. That independence is the point: an organisation that profits from dispensing volume has no reason to reduce it. Capacity+ has no such conflict.

Designed to scale, not to stay a pilot

The model is built for PCN and ICB level from the outset.

A single practice proves the pathway works. The value for a commissioner is in replication: the same referral structure, the same governance, the same reporting, running across a neighbourhood with visible activity and outcome data at every site.

Practice-by-practice adoption requires three things to align at once — a willing practice, a willing pharmacy, and access governance. Commissioning at neighbourhood level resolves all three together.

Clear clinical responsibility

Capacity+ coordinates the pathway. Community pharmacy delivers clinical activity under NHS service specifications, with independently indemnified clinicians. Diagnosis, prescribing, oversight and liability remain with the GP practice.

Capacity+ does not diagnose, prescribe or deprescribe, and does not hold clinical responsibility for patient care.

Early evidence from a practical starting point

Results from the single-site St Giles pilot in South East London, serving approximately 8,000 patients in year one:

• 150+ ABPMs delivered
• Approximately 75 GP clinical hours released
• 51 of 52 patients managed without GP involvement
• Approximately £8,000 NHS revenue generated for the partner pharmacy*
• Approximately £2,000 unnecessary appliance spend identified across a 90-day review

This is what one practice looks like. Pilot results are site-specific and are not a guarantee of future outcomes.

* Activity delivered under existing national NHS service specifications. This is not additional commissioner spend; it is existing NHS funding drawn down against activity that would otherwise go undelivered.