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The 8th Pharmacy Business Conference, organised by Pharmacy Business, unfolded a dynamic narrative around the theme of 'Pharmacy of Tomorrow', highlighting the trajectory of innovation, adaptation, and the evolving landscape of pharmaceutical services. Attended by over 200 pharmacy owners, industry leaders, and stakeholders, the conference served as a medium for robust discussions and the exchange of valuable insights regarding the future of community pharmacy. Amidst the persistent challenges posed by an underfunded reimbursement system and negotiations with governmental bodies and the NHS for the new community pharmacy contractual framework 2024/25, the conference pivoted towards investing in staff, adapting to change by investing in new technology, and optimising commissioning as pivotal strategies. "Pharmacy professionals are playing increasingly important clinical roles in both primary and secondary care," shared David Webb, Chief Pharmaceutical Officer (CPO), NHS in a video message. He highlighted the NHS's commitment to empowering community pharmacy, with plans to expand services and deprescribe to align with the NHS's focus on preventive healthcare.

The Department of Health and Social Care's (DHSC) response to the 2019 consultation on community pharmacy drug reimbursement reform has paved the way for the second phase of consultation with the pharmacy negotiator. The second round of the consultation will focus on eight proposals: Changes to the way Category A prices are set Changes to how medicine margin is distributed in Category M drugs Changes to how Category C prices are set for drugs with multiple suppliers Inclusion of non-medicinal products in the Drug Tariff Changes to the way prices of drugs in non-Part VIIIA are set Changes to arrangements for reimbursement and procurement of 'specials' Changes to reimbursement of generically prescribed drugs and appliances dispensed as 'specials' Changes to the discount deduction scale The Pharmaceutical Services Negotiating Committee has been discussing these proposals with the DHSC and the outcome was featured in the final package of the 'Community pharmacy in 2016/17 and beyond' document.

Pharmacies across Northern Ireland are in financial turmoil, reporting that they are dispensing prescription medicines at a loss due to inadequate reimbursement from the Department of Health (DoH). This crisis has led to the closure of almost a dozen pharmacies over the past 18 months, with many others struggling to stay open. Siobhan McNulty, who runs Melvin Pharmacy in Garrison, County Fermanagh, described the dire situation. "We're dispensing medicines at a loss," she said. "The reimbursement rates don't match the cost of the drugs, and we're left to cover the gap." McNulty relies on sales of non-pharmaceutical products to keep her business running.

"If the Government does not support community pharmacies with the relevant funding, then we will see a massive number of closures," warns Dr. Leyla Hannbeck, chief executive of the Independent Pharmacies Association (IPA). The Fight4Pharmacies campaign, led by the IPA, is urging prime minister Rishi Sunak to address a critical £1.2 billion funding shortfall that threatens the survival of independent pharmacies across the UK. This urgent plea comes as 1,000 community pharmacies have closed since 2019 due to rising operational costs and insufficient reimbursements. On May 21, supporters of the Fight4Pharmacies campaign, along with 50 MPs including prominent figures like Priti Patel and Gavin Williamson, delivered a petition to Downing Street. The petition, Prescription to Save Our Pharmacies outlines how independent community pharmacies can be supported to ensure smooth running of pharmacies.

harmacists in the town of Barnoldswick in Lancashire are reportedly suffering from various problems including a lack of medicines and the movement or loss of pharmacy staff. Problems, including delays with supply of insulin, were reported at a recent Pendle Council West Craven meeting. And this week the head of one pharmacy chain, Whitworth, highlighted a range of issues faced by his teams including supply chains, costs, loss of staff and NHS reimbursement for contractors. In Barnoldswick, queues have formed inside and outside pharmacies as people attempt to get prescriptions. Some said they had to wait for days to get what they needed, had made repeat-visits to pharmacies and were unsure when medicines might arrive. They also said the number of pharmacies in the area have fallen over the years. Two town centre pharmacies, Whitworth and Well, are located opposite each other, close to a doctors' surgery. Standing in one queue outside Whitworth was Marilyn King. She said: "I have been waiting seven days to get my prescription for blood pressure and some other medicines. This week, I've come back time after time. But the staff say sorry, they have not got it in because nobody has delivered it. "I came here on Saturday, when there was a queue. But the pharmacist was not here. I came again on Tuesday and then Wednesday. Then finally, just when I reached the front of the queue, they asked me to come back in an hour…

Dr Bharat Shah CBE regrets that neither community pharmacists nor pharmaceutical wholesalers in the UK have any control over how Category M reimbursement prices in Part VIII A of the Drug Tariff are determined. The co-founder and chief executive of Sigma Pharmaceuticals was speaking at a conference organised by Avicenna in West London on Sunday (March 6). Introduced into the Drug Tariff in April 2005, Category M is used to set the reimbursement prices of over 500 drugs. The Department of Health and Social Care makes the final decision on the amount of reimbursement (cost of drugs and appliances supplied against an NHS prescription form) and remuneration (fees paid as part of the NHS community pharmacy contract for the provision of a service).

The Department of Health and Social Care (DHSC) has introduced new arrangements for the application of discount deduction to community pharmacy payments which will be implemented in six financial quarters beginning in October 2022 and concluding in January 2024. Under the new discount deduction system, the current single scale will be split into three groups: one each for generic medicines, branded medicines, and appliances. Separate fixed deduction rates have been determined for each group. This will provide all pharmacies the same rates of deduction applied to their reimbursement for the three different groups, regardless of the total value of that reimbursement. Fin McCaul, PSNC member and independent community pharmacy contractor, said: "The discount deduction scale has been a point of contention for contractors for many years, and PSNC has long been pushing to remedy this. "The incoming changes are designed to both improve equity of access to margin and manage the distortions presented by branded medicines, which just don't have the same level of discount available as generics.

The recruitment of pharmacists in Primary Care Networks (PCNs) has exacerbated a general shortage of pharmacists, revealed an independent review of Integrated Care Systems (ICSs) published on Tuesday (4 April). The review, Rt Hon Patricia Hewitt, highlighted the impact that the Additional Roles Reimbursement Scheme (ARRS) roles for pharmacists are having on the community pharmacy sector. "Contracts with national requirements can have unintended consequences when applied to particular circumstances. For instance, the national requirements and funding of Additional Roles Reimbursement Scheme (ARRS) roles for community pharmacists within PCNs, has on occasion exacerbated the problem of a general shortage of pharmacists, with some now preferring to work within primary care rather than remain in community pharmacies or acute hospitals, compounding the problem of community pharmacy closures and delayed discharges." It set out to consider the oversight and governance of ICS in England and the NHS targets and priorities for which Integrated Care Boards (ICBs) are accountable, including those set out in the Government's mandate to NHS England. As part of this work, Hewitt and her team engaged with a wide range of stakeholders representing various local health and social care settings, including LPCs.

In many cases, a pharmacy's most valuable asset is its NHS contract. This is what buyers are paying for - the right to provide pharmaceutical services commissioned by the NHS and be reimbursed for the medicines dispensed. However, a pharmacy consists of more than just an NHS contract and when buyers look for a pharmacy to buy, they will also examine these other areas - the pharmacy's customer base, its staff, the property it operates from - to name a few - because these are all also crucial to a successful pharmacy. In this day and age, another important consideration is the pharmacy's intellectual property (IP) i.e. the pharmacy's rights to certain types of information, ideas, and forms of expression. At the most basic level, this includes the trade mark in the name of the pharmacy, because all pharmacies will have a name by which they distinguish themselves from other pharmacies. The more well-known the name, the more valuable this form of IP is - mention 'Boots', for example, and most will have an instant association with the largest pharmaceutical retailer in the UK.

The Challenges There cannot be anyone working in or with community pharmacy that either feels or sees the pain that emanates from the current operating climate. Pharmacy closures; increased workload and operating costs; increased patient and commissioner expectations; and, more fundamentally, an inadequate, undervalued and poorly structured remuneration and reimbursement contractual framework. As important as they are, we will not focus on these points here as they are not in the control of pharmacy owners and managers. They are the responsibility of those organisations that represent them at a national and local level who must deliver a better outcome as difficult as that may be. However, there are matters which are in the control of pharmacy owners and managers. These include their premises, their team, their systems and processes, their relationships with other healthcare providers and the broader community, their NHS and private service offer, and how they promote and deliver them to give the best patient experience. In order to create the head space to develop and implement a business plan, pharmacy owners and managers must make time to work on their business as well as in it. Then it requires the capacity and capability within their team to deliver the services and that excellent patient experience.

The Department of Health and Social Care (DHSC) will introduce new arrangements for the setting of Drug Tariff Category A reimbursement prices from April 2024. Driven by ministers, DHSC's decision aims to equalise access to margin on Category A medicines and it's part of a series of drug reimbursement reforms proposed by the department following a public consultation in 2019. Currently, prices of medicines in Category A are subject to monthly adjustment. From 1 April 2024, these will be updated quarterly based on sales and volume data obtained by DHSC under the Health Service Products (Provision and Disclosure of Information) Regulations 2018. The transition will conclude in July 2025 when the reimbursement prices will be exclusively determined by the new method. Advance notice for contractors regarding the 'new arrangements' has been outlined on the NHSBSA website. However, Community Pharmacy England (CPE) did not support the introduction of the changes at this time as pharmacies are currently grappling with "wider challenges" and there is uncertainty about the potential impact of these changes on the already "turbulent" medicines supply chain

There has been a lot of coverage in the national and pharmaceutical press of the prices being charged to pharmacy owners for certain medicines. Leaving aside the reasons for steep price rises, I have been asked on social media and elsewhere whether pharmacy owners can refuse to supply prescribed medicines if they would make a significant financial loss. Legal obligation The first thing to point out is that the National Health Service Act 2006 imposes a legal duty on the Secretary of State and NHS England to make arrangements for people to receive sufficient prescribed drugs. These arrangements involve the publication of the Drug Tariff. The Drug Tariff includes reimbursement prices or a method for determining prices. Various factors can be taken into account in determining reimbursement prices. The Drug Tariff does not provide a pound for pound reimbursement for medicines that pharmacies supply on NHS prescriptions.

The Pharmaceutical Services Negotiating Committee (PSNC) has developed a webtool to help community pharmacy contractors estimate the impact on their payments under the new discount deduction system. The calculator aims to illustrate the changes to discount deduction that a pharmacy could experience during the transition to the new arrangements from October 2022 to January 2024, when the new system will be fully in place. PSNC's calculator requires contractors to input information about their individual pharmacy dispensing mix (i.e. split of reimbursement by appliances, brands and generics) to provide an estimate for the level of impact the new discount deduction system will have. "The impact on individual pharmacies cannot be estimated without using dispensing mix data, meaning that any estimates which do not take this into account will not be reliable," said PSNC. For years many contractors have been frustrated by how discount is applied to their accounts and have often raised concerns about the blanket nature of its application to PSNC.

The Company Chemists Association (CCA)'s workforce finding showed that by 2024 eight years' worth of growth of the pharmacist workforce will have been funnelled away from community pharmacies. "In 2019, when NHS leaders realised they were unable to find enough GPs to meet the public's needs, they hastily decided to recruit pharmacists and other healthcare professionals to fill the gaps. This was implemented without any corresponding efforts to increase the supply of pharmacists, creating huge shortages," said CCA. "The bulk of the NHS's recruitment drive was paid for using additional money ringfenced by the NHS - the £2.4bn Additional Roles Reimbursement Scheme (ARRS). We estimate over the life course of ARRS funding (2019-2024), the equivalent of eight years of growth in the number of pharmacists in England will have been funnelled directly into primary care at the expense of other sectors. At the current rate, CCA estimate that community pharmacy will have experienced the equivalent of three fallow years by 2024. To ensure the pharmacy network is protected and able to take pressure off other parts of the NHS, there are several urgent measures which must be implemented. Countering the impact of primary care recruitment: Community pharmacists should be commissioned to provide 'packages of care' on behalf of GPs, rather than taking pharmacists away from accessible high street settings.

National Pharmacy Association (NPA) urged the NHS England to make local impact assessment a key requirement prior to any recruitment into Primary Care Networks (PCNs) and Clinical Commissioning Groups (CCGs), to help tackle workforce crisis. With inputs from LPCs, PCNs and CCGs should consider the impact of the creation of new roles on all health care providers in the area and on their ability to deliver their objectives on behalf of the NHS, it said. The NPA believes that creation of the Additional Roles Reimbursement Scheme (ARRS) programme is impacting community pharmacy services in some areas and contributing to the ongoing workforce shortage. In a letter addressed to Ed Waller, director of Primary Care for NHS England, NPA chief executive Mark Lyonette highlighted the challenges emerged following a shortage of pharmacists and other members of staff.

The regulators have added 10 new products to the 'Drugs for which Discount is Not Deducted' (DND) list from Thursday (01 June). Community Pharmacy England on behalf of its members had made further applications to the Department of Health and Social Care (DHSC) and the NHS Business Services Authority (NHSBSA), resulting in the inclusion of 10 new products in the DND. More than 610 products are granted DND status following checks made by Community Pharmacy England's dispensing & supply team over the past 3 years to ensure fair reimbursement for our members. The DND list is updated monthly by the DHSC and includes grouped and individual items. Individual items are separately listed in Part II of the Drug Tariff. Any items covered by the 'Group Items' heading are not listed again individually in Part II. "We will continue our work to assess whether other drugs and appliances fulfil the current DND entry requirements under either the 'Group' and 'Individual item' criteria and make applications to NHSBSA and DHSC, on behalf of our members accordingly," said Community Pharmacy England.

The primary responsibility of community pharmacists is taking care of their patients but to do that they also need to learn how to run the business. It is one thing to be au fait with profit and loss statements, reimbursement models, budgets analysis, business planning and so much more but quite another when one is hard pressed on everything - time, resources and cash flow. Bas Vorsteveld - the new vice president and general manager in Great Britain & Ireland for Haleon, a new company 100 per cent focussed on consumer healthcare - has witnessed first-hand how "time poor" pharmacists usually are and is committed to helping ease their burden wherever possible. "They can be drowning in work at all times throughout the day. If I happen to spot a community pharmacy while I am out shopping with the family, I almost always pop into the store, with obviously a lot of questions in my head. If the pharmacist has the time, I ask them a few questions and once we start the conversation and they find out that I'm the general manager for a company that provides them with some of their big brand products, I often get a look of total surprise on their face, especially as I've come to visit their store and take the time to speak with them personally. I've really seen first-hand what a busy bunch they are! "I often want to know how the shop front is presented? What does the pharmacy look like from inside? Is there a big queue? What kind of advertisement the pharmacy has in place? How are our products merchandised?

Any prescription for Promethazine hydrochloride 10mg tablets x 56 submitted for payment to the NHSBSA for July 2022 will be reimbursed at the new price of £17.77 not as per the price concession of £13.45 announced in the 4th concessions update published on 29 July 2022, said the Pharmaceutical Services Negotiating Committee (PSNC). In July 2022, PSNC received several reports from contractors unable to obtain Promethazine hydrochloride 10mg tablets (56) at the published Drug Tariff price of £4.24. Therefore, it submitted a request for a price concession, which was granted and subsequently published but this was later withdrawn after confirmation from the Department of Health and Social Care (DHSC) that due to the price change mechanism, the reimbursement price for Promethazine hydrochloride 10mg tablets has increased from £4.24 to £17.77 for July 2022. PSNC said, "Following the price change mechanism rules, for generic drugs (excluding drugs in Category M), a price change up to and including the 8th of the month takes effect for prescriptions dispensed in that same month. Any price change after the 8th takes place in the following month."

The NHS Business Services Authority (NHSBSA) has published the Drug Tariff Category M price list for July which reflects an increase in reimbursement level of approximately £5m per quarter. An adjustment of -£23.8m was announced, in light of the results of the margin survey (latest result up until end of December 2022), and the phasing down of the additional £100m agreed across years 4 and 5 as part of the Community Pharmacy Contractual Framework and uplifts for underlying market prices (between January - March 2023). Community Pharmacy England has agreed the adjustments based on the analysis of margin delivery and on current projections for 2023/24. It said: "The objectives are to ensure full delivery of agreed margin and smooth delivery as much as possible. As always, the impact on individual pharmacies will vary depending on dispensing mix."

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."