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A harsh funding regime that hasn't adapted to changing macroeconomic realities means the viability of large parts of the pharmacy sector is at risk unless the model changes. Very simply, across the sector, revenue has remained largely fixed while costs have increased significantly, making it impossible for many pharmacies to sustain their business models. The sector has seen the closure of more than 1,500 community pharmacies since 2015, with 700 of these closures occurring since 2021. Larger pharmacy operators such as Lloyds, Boots, and Rowlands have seen the biggest decline in numbers, with smaller businesses operating between one and five pharmacies now accounting for almost 50% of the sector. Despite rising inflation and business costs, the NHS pharmacy funding model has remained fixed. Over the period of the current Community Pharmacy Contractual Framework (CPCF) - 2019-2024 - pharmacies have experienced a 30% real terms cut in core funding leading to an annual shortfall of over £750 million, equivalent to £67,000 per pharmacy in England. The current CPCF is due to end in 2024, and there is still no arrangement in place for future funding, leading to delayed and inefficient spending decisions and hampering the ability of the sector to plan and attract much-needed investment.

The All-Party Parliamentary Group (APPG) on Pharmacy published a new report on Monday (January 23) that calls for "urgent action" to relieve funding pressure so there are "opportunities" for community pharmacy teams to deliver even more for their patients. The report highlights the need for a new "strategic vision" for pharmacy and highlights opportunities for the network to be empowered to deliver even more for patients. However, the manifesto also underlines that there are the very real risks that this opportunity may be lost if significant and ongoing pressures are not addressed. The recommendations are based on written and oral evidence gathered from frontline pharmacists, GPs, professional bodies and healthcare experts. To harness the potential of pharmacy, the report recommends the Government must take urgent action to relieve the funding pressures on the community pharmacy sector in the short term and review the long-term funding model for pharmacy. It also suggested the Government must harness the power of pharmacy to help the NHS deal with the COVID-19 backlog and the UK's growing healthcare challenges. It further recommended that future commissioning and funding must recognise that community pharmacy is the front door to the NHS for many patients.

The Parliamentarians have called the government to urgently consider the short-term funding to stabilise the community pharmacy sector. 39 MPs and Peers from across the political spectrum have signed letters to the Health Secretary, Steve Barclay MP and raised their growing concern about the pressures facing England's community pharmacies and the risks this poses to patient care and safety. "Steve Barclay MP received correspondence from 23 Opposition MPs, with six Peers also signing a letter. Separately, 9 Conservative MPs also wrote to the Health Secretary and up to 10 others have signalled their intention to write to the relevant Minister," said the Pharmaceutical Services Negotiating Committee (PSNC). The Parliamentarians acknowledged that pharmacies have the potential to do more to support the NHS and they called for the government to urgently consider a commitment to working with the sector to create a fair and fit for purpose future funding model that ensures sustainability and properly funds pharmacies for what they do. All signatories also called for the introduction of a fairly-funded Pharmacy First service.

The current funding and contractual framework for community pharmacy is not fit for purpose, the Health and Social Care Committee report has concluded, recommending a complete overhaul to reduce its complexity. Published today, the report highlighted the necessity for a new framework to ensure adequate funding and to prevent damaging cross-subsidy between clinical services and prescription dispensing, as is presently observed. The report revealed that community pharmacy funding has fallen by over 30 per cent in real terms since 2015, resulting in an annual shortfall of at least £67,000 per pharmacy for individual owners. More than 1,100 community pharmacies have closed since 2015, of which were serving the most deprived areas, it said. MPs on the committee have urged the government to address medicine shortages, warning that they could undermine flagship initiatives such as 'Pharmacy First' by eroding public confidence in pharmacists. "People living with type 2 diabetes, ADHD, epilepsy and cystic fibrosis, and those experiencing the menopause, have faced challenges accessing the vital medication they need. Many others are facing similar experiences.

With the government gearing up and pushing community pharmacies in England to adopt the hub and spoke dispensing model, stakeholders of the sector and industry leaders analyse the pros and cons related to the new concept. The model rose to prominence in 2015 in community pharmacy and the medicine supply chain in the UK, and has undergone a few consultations and reviews at the professional and governmental level since then. From a broader perspective, the industry agrees that the model will bring in efficiency to the system, much needed amid community pharmacy's flat funding settlement in England, at the same time highlighting some real challenges. The National Pharmacy Association (NPA) has so far released three reports on this matter and a review of the challenges and enablers of the hub and spoke in the UK in 2016. Besides, a review of international evidence and the report of a roundtable meeting was brought together in the supply chain with government and regulators in early 2020.

Chief executive of the Pharmaceutical Services Negotiating Committee Janet Morrison has said government ministers are looking at the future of community pharmacy in England in a "bigger way" and have a vision to go "beyond the Scotland model". "I think they believe they're going beyond the Scotland model," she said, in her closing keynote at the 7th Annual Pharmacy Business Conference held in London on Sunday (May 14). Giving her views on the latest government funding - worth £645 million - for community pharmacy, the head of pharmacy negotiator, added: "Their thinking is for the future in a bigger and a more forward-thinking way." She added it was for the first time that community pharmacy has been seen "as part of primary care in a really fundamental way that gives us hope for the future". Morrison said the new funding uplift was effectively "for five quarters of activity," arguing that the common condition service won't start before December or early in the New Year due to the time it would take to get the IT systems up and running to support the rollout.

The Department of Health and Social Care (DHSC) today (19 October) issued its official response to an evaluation conducted by an independent expert panel from the Health and Social Care Committee (HSCC) regarding government commitments in the pharmacy sector. The joint agreement between DHSC, NHSE, and CPE (Community Pharmacy England) under a five-year plan commitment to review the funding model, however, the current status is "continue to monitor and discuss progress". The government has claimed that the panel's rating has "not been met" and still "requires improvement". However, the funding "remains subject to affordability and consultation with the sector on the activity that can be delivered within that funding envelope".

Community Pharmacy England (CPE) is aiming to reach an agreement with the Department of Health and Social Care (DHSC) and NHS England (NHSE) on negotiation with regards to expanded services and payment model in the pharmacy sector. Chief Executive Janet Morrison, said: "We are working at pace in negotiations with DHSC and NHSE. The process remains on track with the Government's original timescale - i.e. aiming for agreement in July, with cross-government clearance later in July, and implementation from July through to September." CPE is involved in working groups on service expansion of Hypertension Case-Finding and the Pharmacy Contraception Scheme and service design for the Common Conditions Service; and are in in-depth negotiations on Payment models. These discussions critically look at the balance between funding core capacity and activity payments, how the funding streams will be distributed and how CPE will measure delivery and impact. NHSE has been leading on the development of the PGD pathways for each of the 7 conditions, with external medical, pharmacy and other experts feeding into the process - pharmacy owners from the Community Pharmacy England Committee have also been involved but the discussions are clinically led to ensure they comply with NICE principles and concur with Antimicrobial Stewardship policy.

Recently, the English Health Secretary has talked about introducing a 'Pharmacy First' model similar to that which exists in Scotland. This would be a win-win outcome providing people with better access to essential healthcare support, advice and treatment whilst relieving strain on other parts of the NHS, not least GPs and A&E. It is a no-brainer and yet despite a few media headlines there are still no firm proposals on the table to make this a reality. It surely cannot be right that you can receive a broad range of patient care services in Scotland which are not available in England. It works well in Scotland, Wales is keen to develop more pharmacy-based services and Northern Ireland, leaving aside the current funding dispute, has had a minor ailments service for many years. If the English Health Secretary is sincere in his interest in adopting an English version of the Scottish model, then there are critical aspects he needs to consider. Firstly, start with the patient journey through the healthcare ecosystem from illness prevention through to long-term condition management. What is the role of community pharmacy and how do we guide people to seek support from the most appropriate healthcare professional? What is the vision for community pharmacy delivering patient care in the next decade? The lesson from Scotland is that the government needs to sit down with the sector and map that out together. There are no quick fix overnight solutions. This needs to be a long-term commitment backed by adequate funding. Supervision regulations need to change and there needs to be a thought through workforce strategy which avoids community pharmacy shortages as that does nothing to deliver improved patient outcomes.

The Royal Pharmaceutical Society (RPS) Scotland the BMA's Scottish GP Committee has called for improvements to the pharmacotherapy service. The joint statement released by the organisations on Friday (13 January), has recognised that much progress has been made but states that further improvements are needed to fully maximise the benefits of the service. It highlighted the need for better use of skill mix, including more clearly defining roles and responsibilities; improved IT enablers to reduce administrative burden; and further developing a tandem model of working comprising hubs with in-practice activity The two organisations state that inadequate funding and workforce shortages are a real threat to the pharmacotherapy service. They have urge Scottish Government to reconsider its recent decision to reduce funding for training pharmacy technicians. Clare Morrison, RPS Director for Scotland, said: "In the statement, we stress that the use of pharmacists' clinical skills must be maximised.

As the general election campaign heats up, major political parties - including Labour, the Conservatives, the Liberal Democrats - have released their manifestos, detailing their plans and visions for the future of community pharmacy. While the Conservative Party promises to expand Pharmacy First initiative, Labour pledges support for small businesses, with plans to overhaul the business rates system. The Liberal Democrats' election manifesto commits to developing a fairer and more sustainable long-term funding model for pharmacies. Announcing their plans recently, Prime Minister Rishi Sunak stated that they are investing in community care services to secure the future of the NHS and make healthcare more accessible. The Conservatives plan to fund these initiatives by cutting NHS managerial positions back to pre-pandemic levels and halving the government's management consultancy expenditure.

MP Steve Brine, the chair of the health and care committee, said that the healthcare in the UK "doesn't work without pharmacy". The inquiry focuses on addressing current issues, particularly around the "funding model, digital infrastructure and workforce recruitment, training and retention." Brine said at the Sigma annual conference on Sunday, that he wants to "focus on the sector", and "drill down into some of the challenges and potential" that lies ahead. "The Health and Social Care Committee, we think about much of our work through the lens of pharmacy, what role it plays, the quality of care that it delivers, and the potential for it to do more," said Brine. He further said that he wants to "build on the groundwork" and to "cover as many of the different pharmacy services within the pharmacy sector as we can, so pharmacy in our communities, in hospitals and general practice".

A group of 20 MPs from the different political parties, including Dame Priti Patel and Judith Cummins, have written a joint letter to health minister Andrea Leadsom, calling for urgent action to address the pressures faced by community pharmacies. Taking note of rising pharmacy closures, they have highlighted the need for more investment and support from the government. Recent NHS figures showed that around 1,400 pharmacies have closed permanently since October 2016, and many more are withdrawing services or reducing their opening hours, particularly in deprived areas. The MPs have urged the pharmacy minister to commit to making essential changes including a fair and sustainable core funding model, an effective implementation of the Pharmacy First service and an expansion into other clinical service areas.

With the UK General Election set for 4 July, pharmacy bodies are actively engaging with all political parties to secure support for the community pharmacy sector. They are pressing parties to address urgent issues such as pharmacy closures and medicine shortages. "The upcoming general election is a critical opportunity for us to strengthen supporters of community pharmacy in readiness for the new Parliament," said Janet Morrison, chief executive of Community Pharmacy England (CPE). She stressed the need for unity within the sector in advocating for community pharmacy and raising awareness of the issues with election candidates from all parties. As the general election approaches, CPE has called upon all political parties to support pharmacies by "introducing a long-term sustainable funding model and reviewing the medicines supply chain, including much-needed short-term relief measures."

Pharmacy First has demonstrated the enormous value of community pharmacy in providing accessible front-line care. However, pharmacists continue to face several challenges in delivering the service. "Pharmacy First is a success, but it needs proper support to reach its full potential," said Numark chairman Harry McQuillan. In the first year alone, community pharmacies in England delivered an incredible 2 million consultations, highlighting the vital role pharmacists and their teams play in supporting the NHS. "This significant number shows the high demand for accessible healthcare and the trust patients place in their local pharmacy teams. It's clear that when empowered, community pharmacy delivers," McQuillan told Pharmacy Business. Key challenges in providing the service While Numark members have embraced Pharmacy First, McQuillan pointed out several challenges that persist: "Workforce capacity continues to be a concern, with patient demand sometimes outpacing available resources. "The administrative burden, particularly around IT interoperability, data capture, and reimbursement processes, adds complexity." "Additionally, some geographical areas are still struggling with public awareness, meaning more work is needed to ensure patients understand when and how they can access Pharmacy First."

Speaking at the SIGMA Conference 2023, Dr Leyla Hannbeck, CEO of the Association of Independent Multiple Pharmacies (AIMp), spoke about the increasing number of prescriptions, lack of funding and other existing challenges. Leyla explained how the pharmacy sector is facing immense challenges which are disrupting the delivery of services as well as impacting its growth. She further spoke about the hub and spoke model, and how it is unable to solve the issues. "Community pharmacies are clogged with prescription volume, and this is preventing them from supporting the wider NHS as well as offering services," she said. She said that the prescription volumes have rocketed, while the number of pharmacies in England has declined from 11, 522 in the year 2021-22 to 11, 414 in 2022-23. When it comes to Company Chemists' Association (CCA) pharmacies, there has been a loss of 1055 branches from 2022 to 2023.

...there are layers of telehealth program development to unpack. Core considerations for rural telehealth program development include: state telemedicine rules and regulations, language and terminology, state parity laws, staffing and teleconsultation models, funding, broadband access, and benefits to rural communities.

Health Education England (HEE) has developed funded training offers for community pharmacists, including locums aiming to become independent prescribers. Almost 3000 independent prescribing training places will be available to pharmacists from March 2023. This training enables pharmacists to support patients from diagnosis to prescribing, and to provide advice and follow-up - while also helping them to feel confident and prepared for the new challenges of their role. Courses will be available between April 2023 and March 2024, with several universities offering multiple dates for cohort intakes. Start dates will depend on the university provider. Training will enable the provision of new models of care: supporting patients from diagnosis to prescribing, providing advice and follow-up, and preparing pharmacists to provide clinical care, as pharmacy services become more widespread within emerging clinical pathways.

The UK Health Security Agency (UKHSA) and The Pirbright Institute have launched a new collaboration to develop vaccines against henipavirus, a genus of viruses that includes Nipah virus. Funded by the Medical Research Council, this research aims to develop a vaccine that provides cross protection against the whole genus, addressing the threat of outbreaks from new or emerging henipaviruses and strengthening epidemic preparedness. Scientists at UKHSA will evaluate the protective efficacy of vaccines developed by The Pirbright Institute by using use a model of Nipah virus disease, which mimics the infection in humans. Professor Isabel Oliver, chief scientific officer at UKHSA, stated that the study would improve understanding of henipaviruses and enhance efforts to protect health from this "current and future global health threat." "The work will also make a vital contribution to the 100 Days Mission - an important initiative to make sure the world is better prepared for the next pandemic by accelerating the development of diagnostics, therapeutics and vaccines," he added.

All 42 integrated care boards (ICBs) in England have signed memorandums of understanding for the NHS Independent Prescribing Pathfinder programme, the first nationally-funded prescribing service in the country. Anne Joshua, interim deputy director of pharmacy commissioning at NHS England, made the revelation during the 'Chief pharmaceutical officer bi-monthly webinar' held on 7 March 2024, as reported by The Pharmaceutical Journal. In the initial phase of the programme, 210 community pharmacies across all ICBs will trial independent prescribing, ahead of establishing a commissioning framework for the service. Giving an update on the pathfinder programme, Joshua confirmed that 164 of these potential pathfinder sites had registered for the programme as of 29 February 2024. Additionally, she announced the clinical models to be followed by the participating pharmacies and presented a graph showing an overview of the services they will provide.