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The General Pharmaceutical Council (GPhC) has published updated guidance on online pharmacy services in Great Britain, introducing additional safeguards to prevent unsafe supply of high-risk medicines, including weight loss injections. Under the new rules, medicines used for weight-management and medicines requiring physical examination before a prescribing decision is made have been added to the list of high-risk medicines. When prescribing these medicines, prescribers can no longer rely solely on online questionnaires. Instead, they must independently verify patient information, either through timely two-way communication with the person, accessing the person's clinical records, or contacting the person's GP, their regular prescriber, or a third-party provider. These measures aim to prevent individuals from providing false information to obtain medicines that may not be clinically appropriate for them, reducing potential harm. The pharmacy regulator updated its guidance in response to concerns identified relating to unsafe prescribing and supply of medicines online.

Proprietary Association of Great Britain, PAGB - which represents manufacturers of branded over-the-counter (OTC) medicines, self-care medical devices and food supplements - on Tuesday (12 December) celebrated 40 years of reclassification of medicines. Expanding self-care for common ailments and minor injuries will not only help ease pressure on primary care services, but also provides significant potential savings for the NHS, the consumer healthcare association highlighted during the event. Nurofen (ibuprofen) and Imodium (loperamide) were the first medicines to go through Medicines and Healthcare products Regulatory Agency (MHRA)'s switch process in 1983 to make them available over the counter - OTC. Other reclassified medicines which were once available on prescription only include Voltarol (diclofenac dimethylammonium), Canesten (clotrimazole), Nexium (esomeprazole), Nicorette, Nicotinell and Niquitin (nicotine replacement therapies), Regaine (minoxidil), Viagra Connect (sildenafil), Cialis Together (tadalafil) for erectile dysfunction and Gina (estradiol hemihydrate) for the treatment of postmenopausal symptoms such as vaginal dryness.

In response to a recent Parliamentary question regarding pharmacy reimbursement, pharmacy minister Stephen Kinnock stated that pharmacies were permitted to retain £850 million from the medicine margin for 2023/24. The medicine margin represents the difference between the product price reimbursed by the National Health Service (NHS) and the price at which pharmacies buy them. Rebecca Smith, the Conservative MP for South West Devon, inquired about the number and proportion of community pharmacies that had dispensed medications at a loss over the past three years. Kinnock replied that they do not hold this information, and explained that community pharmacy reimbursement arrangements "do not aim to ensure that every pharmacy is paid as much or more than it paid for every product, but aims overall to reimburse as much as they were bought for, plus the allowed medicine margin." Additionally, the minister highlighted that as part of the Community Pharmacy Contractual Framework (CPCF) for 2023/24, pharmacies are allowed to retain "£850 million from the medicine margin, on top of what they are paid for the medicines they purchase as part of providing NHS services."

Community Pharmacy England (CPE) has notified pharmacy teams that starting 1 August 2024, three Hormone Replacement Therapy (HRT) medicines will be discontinued and will no longer be covered under the NHS HRT Prescription Prepayment Certificate (HRT PPC) scheme. These are Bedol® 2mg tablets, Climanor® 5mg tablets and Clinorette® tablets. Since Climanor® 5mg tablets have been discontinued, Medroxyprogesterone 5mg tablets will also be removed from the HRT PPC list, as this generic product is no longer available as a licensed HRT medicine. The CPE also noted that Provera® 5mg tablets, being an unlicensed HRT medicine, are not covered by the HRT PPC. Pharmacy staff are advised to check the NHS Business Services Authority (NHSBSA) website for the most current list of HRT medicines covered by the HRT PPC. The CPE has updated its HRT PPC medicines list to reflect these changes, which will also be updated in Part XVI of the August 2024 Drug Tariff.

Pharmacist supervision has been the subject of debate for as long as I can remember. Strikingly, no one is sure what supervision requires. The Human Medicines Regulations 2012 say it is a criminal offence to sell or supply Pharmacy medicines or Prescription Only Medicines unless a pharmacist makes the sale or supply or, if the transaction is carried out by a non-pharmacist, that person acts under the supervision of a pharmacist. Over the years, some people have argued that supervision requires a clinical check. Others say it requires an accuracy assessment. Yet others have asserted that it requires a final check before a medicine leaves the pharmacy. Things are made more uncertain by the NHS terms of service which require prescription medicines to be supplied under the direct supervision of a pharmacist. No one knows what the word "direct" adds. The wording of the Human Medicines Regulations is not identical to the wording of earlier legislation. In particular, on the only occasions when the courts have been called upon to interpret the requirement for supervision, the Pharmacy and Poisons Act 1933 was in force. In cases decided in 1943 and 1953, the courts decided that a pharmacist who was upstairs when a supply was made could not have been supervising; and that a sale was supervised by pharmacist standing at the cash desk because the pharmacist could intervene if a sale would not be appropriate.

A new report has highlighted that the public places a higher value on medicines for severe medical conditions, such as terminal cancer, than the thresholds currently used by the National Institute for Health and Care Excellence (NICE). The study, conducted by the Office of Health Economics (OHE), found a misalignment between NICE's current 'severity modifier'-which determines whether a medicine is recommended for coverage on the National Health Service (NHS)-and the UK public's preference for prioritising health gains for more severe diseases. The research, commissioned and funded by the Association of the British Pharmaceutical Industry (ABPI), also indicated that the public is willing to pay more for medicines used to treat patients with severe disease. Titled 'Understanding Societal Preferences for Priority by Disease Severity in England and Wales,' the report suggested that NICE's current severity modifier may be limiting access to innovative treatments for NHS patients. The ABPI has called on the government and NICE to adopt a more flexible approach when assessing medicines for severe conditions.

The large majority of adults in the England knew that flu jabs are available in many pharmacies, just over half were aware of the GP Community Pharmacist Consultation Service or the New Medicine Service, according to a new survey by the National Pharmacy Association (NPA). The new survey revealed the need to raise the public awareness of key NHS services such as the New Medicine Service. According to the survey, 56 per cent of those asked believed that pharmacies in England offer NHS consultations for people newly prescribed a medicine for a long-term condition. While 48 per cent believed that many pharmacies in England offer blood pressure monitoring (NHS or private). 51 per cent believed it to be true that GPs can formally refer patients for same-day clinical advice from their local pharmacist about minor ailments.

The growing issue of medicine shortages is posing significant challenges for both patients and pharmacy teams across the UK. According to new data from the Office for National Statistics, 20 per cent of adults who used pharmacy prescription services in the last 28 days experienced delays in receiving their medications. The survey, Experiences of NHS healthcare services in England, revealed that over 13 per cent of patients had to return to the same pharmacy at a later time to obtain their prescriptions. Many patients were forced to visit multiple pharmacies or seek alternative services such as a GP or urgent care due to medicine shortages. Pharmacy teams were added with extra burden to manage and resolve these issues. Despite these challenges, 85 per cent of patients expressed satisfaction with pharmacy services, reflecting the dedication and value of pharmacists and pharmacy teams in the community.

The recent announcement that Royal Mail will be partnering with distance selling pharmacy (DSP) giant pharmacy2U highlights how standards of regulatory enforcement are being ignored to accommodate the DSP model. The brunt of these double standards hinges around the levelling down of temperature enforcement standards by the Medicines and Healthcare products Regulatory Agency (MHRA) which demands mapping must be audited from the point of dispensing to the patient. The MHRA has a well recognised duty to ensure medicines reach patients in a safe condition. The current anomaly appears to turn a blind eye to this step in the supply chain at the point the wholesaler releases goods to the pharmacy hub. Equally the training on delivering medicines safely and effectively direct to patients should apply fully to all hubs including DSPs. Why is it that DSPs are being treated differently to bricks and mortar pharmacies? It's essentially the same patients receiving the same medicines from the same wholesalers. A further regulatory disparity exists around how parcels must be "tracked and signed for" to be reasonably certain medicines are delivered into the hand of the intended recipient, as per existing regulations. Clearly an untracked, unsigned package cannot be guaranteed to finish in the hands of the intended recipient. There is a very real possibility that such omission could lead to community pharmacy closures which will, in turn, lead to unemployment and a reduction in the care services. At a time when integrated care systems have just gone live, the removal of vital support services leading to further inequalities is the wrong message for both providers and patients alike.

Boots UK in association with Macmillan Cancer Support and the NHS has launched a Palliative Care Service in its pharmacies to provide easy access to vital medicines and specialist pharmacist advice and support to patients. As part of the new service, Boots has created a list of recommended medicines most used by terminally ill patients. It has committed to maintain stock of these medicines, or formulary, at over 2,000 of its pharmacies with an NHS contract. To further support the launch of the new service, all 4,200 Boots Macmillan Information Pharmacists (BMIP) have received additional training on palliative care, including a range of cancer-related advice and side effects of medication. Marc Donovan, chief pharmacist at Boots said: "Discussing end-of-life care is never easy, but it is very important. At this extremely difficult time for patients and their families and carers, ease of access to medicines and support can make a big difference.

The Royal Pharmaceutical Society (RPS) is refreshing its Professional Standards for Homecare Services and will be shared for consultation in August to allow comment and input on the updated content. The final version is expected to be completed in the autumn. The standards were originally published in 2013 and are a framework to support teams providing and commissioning homecare services. Homecare medicines services deliver medication, and any necessary associated care, direct to the patient's home with their consent. The standards help patients experience a consistent quality of homecare services, irrespective of provider, will protect them from avoidable incidents and help them get the best outcomes from their medicines. Jennifer Allen, The Chief Pharmaceutical Officer's Clinical Fellow leading the refresh at RPS said: "It has been 10 years since the first set of Homecare Standards were published, so it is important that they are reviewed and brought up to date to reflect current service design, medicine pathways and delivery models to ensure patients receive safe and effective medication supply and associated care."

A PAGB report has emphasised the need to empower the public to practice self-care and improve access to over-the-counter (OTC) medicines to alleviate pressure on GPs and reduce NHS costs. Launched at the Labour Party Conference today, the PAGB's State of the Nation report explores the current state of self-care and OTC medicines. The report outlines 11 recommendations for the government to consider as part of its strategy to build an NHS fit for the future. It highlights that each year, at least 25 million GP appointments and 5 million A&E visits are used for self-treatable illnesses, which can be effectively managed through self-care. The report suggests that empowering individuals to utilise OTC medicines could save the NHS at least £1.7 billion per year in costs. Furthermore, it says that eliminating these appointments could save the economy an additional £350m per year, as employees would not need to take time off work for unnecessary treatments. PAGB welcomed the government's manifesto commitments to take pressure off GP surgeries by "improving access to services and treatment through new routes" and to expand the role of pharmacists.

A recently published report on medicines optimisation highlights the urgent need for transformative changes across all pharmacies to unlock their full potential in delivering integrated care. The report by Public Policy Projects (PPP) is first of the four in the series that emphasises the significant benefits that medicines optimisation can bring to integrated care systems (ICSs). This includes reducing health inequalities and improving population health. Pointing to the "untapped opportunity" that medicines optimisation presents for ICSs facing financial challenges, the report underscores the vital role of pharmacies in enhancing patient outcomes. The launch of the Pharmacy First services has already demonstrated the essential contribution of pharmacies to the health and care system. With "medicines being the second highest cost to the NHS," the report recommends ways "to achieve better value for money while improving patient outcomes".

The Pharmaceutical Services Negotiating Committee (PSNC) has expressed its concerns over sustained pressures on medicines supply that are having a very serious impact on community pharmacy teams and their patients. It has asked contractors and their teams to continue using its regular reporting tools to help them demonstrate the scale of the problems to the Department of Health and Social Care (DHSC) and to support escalations as needed. The committee said: "The sustained increases in price concessions that we have seen so far in 2022 - with more than 100 concessions being granted in some months - show no signs of abating, and we know that many pharmacies now find themselves in a critical situation trying to source medicines in timely manner and facing significant financial risk due to greater uncertainty around expected reimbursement prices for a large number of medicines." "We know that some concessions being imposed by the Department do not match contractors' experience on the ground, and we would ask all contractors to continue reporting pricing issues to us on a regular basis to support our representations: Report product over Drug Tariff price."

New amendments to the Human Medicines Regulations will soon allow registered pharmacy technicians to supply and administer medicines under Patient Group Directions (PGDs). Laid before Parliament at the end of May, the legislative changes will come into effect from June 26, 2024, the Community Pharmacy England (CPE) announced today. The introduction of this new legislation follows an announcement made by the Department of Health and Social Care (DHSC) earlier this year. The regulatory adjustments provide the legal framework for pharmacy technicians to engage in the supply and administration of medicines under PGDs in the course of their professional practice. However, there will be no immediate change in the provision of community pharmacy services, the CPE noted

Increased cooperation between countries is needed to ensure better regulation of online pharmacies, said authors of a new report - 'Online pharmacy operations and distribution of medicines', published by the International Pharmaceutical Federation's (FIP) Community Pharmacy Section. The report presents findings of a global survey of pharmacy organisations covering various aspects, such as type of medicines supplied by these pharmacies in different countries, how the authenticity of online pharmacies can be verified, and the usage of e-prescriptions and shared patient health records. Of the 79 countries responding to the survey, 51 per cent acknowledged that no regulation of online pharmacies exists. A quarter of the respondents reported cases of irresponsible self-medication by consumers who had purchased medicines through online pharmacies. A lack of regulation creates "an avenue for illegal pharmacies and may impact the overall quality of medicines and services offered to consumers," authors of the report said. Lars-Åke Söderlund, immediate past president of FIP's Community Pharmacy Section and co-editor of the report, said that the pandemic has increased preference for online services, including in the pharmacy sector.

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 Community Pharmacist Consultation Service (CPCS) will be expanded to enable urgent and emergency care settings to refer patients to a community pharmacist for a consultation for minor illness or urgent medicine supply from Monday (15 May), the DHSC and NHSE said. The service builds on the progress made in GP referrals via the CPCS and hospital referrals under the Discharge Medicine Service. It was originally planned to launch in March, and fee for this service will be the existing CPCS fee of £14, as per the agreement for both year 4 and year 5 of the Community Pharmacy Contractual Framework (CPCF) 2019 to 2024 5-year deal. In an update on the CPCF, published today (12 May), the Department of Health and Social Care (DHSC) and NHS England (NHSE) has also committed to the 4 October 2023 launch date for the Tier 2 of the Pharmacy Contraception Service, subject to a positive evaluation of the pilot. The Tier 1 of the service was launched on 24 April, delayed by over three months. This new service enables community pharmacists to provide ongoing management, via a patient group direction (PGD), of routine oral contraception that was initiated in general practice or by a sexual health clinic. The fees for this service are as follows: a fee for each consultation of £18; and a set-up fee of £900, paid in instalments. The Tier 2 will "enable community pharmacists to also initiate oral contraception, via a PGD, and provide ongoing clinical checks and annual reviews," Alette Addison, deputy director for pharmacy, dental and optical at the DHSC and Ali Sparke, director for dentistry, community pharmacy and optometry at the NHSE, said in a letter.

People who use pharmacies in parts of Pendle have suffered shortages or delays in buying prescription medicines such as insulin, councillors have been told. In the Barnoldswick area, a number of pharmacies have been impacted and some councillors hope a new regional NHS organisation might look into the problems. However, pharmacies in the neighbouring town of Nelson are facing shortages with other medicines. A pharmacists in Nelson Pharmacy told Pharmacy Business that he was struggling to meet local demand for children's paracetamol due to ongoing shortages. Pendle Council's West Craven Area Committee heard about the issues at its latest local meeting, held in Earby. An agenda for the committee stated: "Pharmacy provision in West Craven. It is reported that there is an acute problem with people being unable to get prescriptions filled, with Whitworth chemists suffering a breakdown in service. Previously, Well chemists has suffered similar problems." Speaking at the meeting, Lib-Dem Coun David Whipp said: "It's quite an appalling situation where people are queuing 30 minutes to get a prescription filled but when they get to the counter they are told it's not ready. They have to go home and come back at 5pm. It's an ongoing problem. "It includes insulin, which is critical for people with diabetes. I know several people who have failed to get insulin, It's a very serious problem." He added: "I think the committee should contact the local integrated care service. I think they are responsible for primary care which includes pharmacies. We need to find out what's happening and improve things in future. "

The Pharmaceutical Services Negotiating Committee (PSNC) has raised concerns over the impact that high medicine price rises are having on contractor. Recently, the Department of Health and Social Care (DHSC) has granted the final list of price concessions for December 2022. The latest additions bring the total number of concessionary prices granted for the month of December to 198, surpassing the previous record of 159 granted in September 2022. PSNC has heard from hundreds of community pharmacy contractors who are paying inflated prices for antibiotics used for the treatment of Strep A and who have rightly been concerned about the lack of certainty around the final reimbursement prices for these medicines. It added: "We welcomed the involvement of the Competition and Markets Authority (CMA) to look into the pricing of antibiotics. But the number of reports we are getting from contractors about medicines price rises are just not acceptable and this goes far beyond the antibiotic crisis."