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."
Community pharmacy bodies have said that the current crippling financial pressures and severe staff shortages will limit the sector from fully supporting the
new health secretary's ambition to improve patient care in England.
Thérèse Coffey announced her plans on Thursday (September 22) which would be looking to reduce the country's reliance on general practice by expanding the range of
services available from community pharmacies and allowing pharmacists more "prescribing powers".
"Pharmacists will be able to manage and supply more medicines, without a prescription from a GP. We will look to go further on enabling pharmacists with more
prescribing powers and making more simple diagnostic tests available in community pharmacy," she said in her foreword to Our Plan for Patients.
However, the National Pharmacy Association has lamented that the plan stops short of promising any fresh funding for community pharmacies to deliver patient care
and develop clinical services.
NPA vice-chair, Nick Kaye, said: "The life is being choked out of independent pharmacy businesses by the continuation of a fundamentally under-resourced contract
in England.
A survey of over six thousands pharmacies has revealed that the community pharmacy sector is buckling under growing cost and capacity pressures.
The survey conducted by the Pharmaceutical Services Negotiating Committee, which also involved two thousand community pharmacy confirms, rising costs, patient
demand and
medicine supply issues continue to grip the sector.
PSNC's 2023 Pharmacy Pressures Survey, run as a follow up to the 2022 pressures survey, provides clear comparative data showing the worsening situation across
the sector.
Govt must act now
The result of the survey indeed paints a bleak picture for community pharmacies and it is clear that without urgent action from government and the NHS this will
only get worse: more community pharmacies will either be forced to reduce the number of services they provide or, in the worst-case scenario, will be left with
no option but to close their doors for good.
The PSNC has urged the government to act now "to save our pharmacies, before it is too late for patients, the public, and the rest of the NHS".
"This year's survey clearly shows that community pharmacies are buckling under growing cost and capacity pressures," said PSNC Chief Executive Janet Morrison.
Staff shortage has begun to bite the community pharmacy sector with several high street pharmacies closing doors due to workforce crisis triggered by the NHS poaching.
More than 200 pharmacies closed last year and several are reducing their hours, posing a significant risk to patients' access to care, medicines and advice.
Many in the industry have raised concerns related to workforce crisis and warned that plans for community pharmacies to help ease pressure on GP surgeries could also take a hit.
The NHS plans to recruit a total of 6,000 pharmacists in England by 2024, equivalent to nearly three full years of new pharmacists.
Since 2019, 3,000 pharmacists have been recruited into NHS primary care networks, which accounts for around 10 per cent of the community pharmacist workforce.
Digital pharmacy app Charac has raised over £1 million in debt and equity, bringing total funding to date for the London-based startup to £2.5m.
Pharmacy Business understands while the majority of the new finance, worth about £1.2 million, comes from the National Pharmacy Association (NPA) coffer, the
remainder is put forward by a number of individual pharmacy businesses.
The pharmacy sector is in a state of crisis, experiencing nearly two closures per week over the past two years, Charac said in a statement.
According to data from the NHS Business Services Authority, there are now only 11,026 community pharmacies in England, the lowest number since 2015. The current
crisis is attributed to escalating operational costs, a shortage of staff, and diminished government financial support.
The Royal Pharmaceutical Society (RPS) has called pharmacy employers and pharmacy trade unions to come together to a round table meeting to agree on principles
for a way forward that ensures patients benefit consistently from access to high quality, adequately staffed, safe pharmacy services.
It has also urged the governments, NHS organisations and individual pharmacy teams to define clear prioritisation plans, which can be embedded in organisational
business continuity plans which set out the pharmacy services that are essential and must always be provided and can be de-prioritised at specific levels of
pressures.
The challenges for pharmacies are compounded by the escalating cost of living crisis. With unprecedented levels of burnout among pharmacists, pharmacy closures
and the potential for strike action, RPS has called for three things- 'professionalism, respect and prioritisation.'
Community Pharmacy England (CPE) has cautioned that patients in the UK will continue to encounter difficulties in accessing medicines unless the government
addresses supply problems and resolves the critical financial state of community pharmacies.
CPE Chief Executive Janet Morrison and Mike Dent, Director of Pharmacy Funding, on Monday 19 February, gave evidence to the Health and Social Care Select
Committee's Pharmacy Inquiry, highlighting the impact of ongoing medicines supply issues on pharmacies and patients.
Morrison indicated that a combination of the ongoing "financial squeeze, operational pressures, and medicines supply and pricing issues" has left pharmacy
businesses fighting for survival.
"As the NHS continues to grapple with wider challenges, this is a battle that patients cannot afford for pharmacies to lose," she said.
Morrison warned that if pharmacies continue to close, not only business owners and pharmacy teams will suffer, but patients and local communities will also
face the consequences.
Those of us who work in community pharmacy know there is a workforce crisis created in large measure by PCNs actively recruiting pharmacists and pharmacy
technicians from our sector. It is welcome, if long overdue, that this has now been officially acknowledged in a report commissioned by the English Health Secretary.
PCN hiring 'exacerbates pharmacist shortage' says DH-commissioned report, which states such recruitment has "on occasion exacerbated the problem of a general
shortage of pharmacists" which has compounded "the problem of community pharmacy closures."
We have been telling the government this for years only to be told "problem? What problem?"- but now that Steve Barclay has his own official report sitting on his
desk, he and NHSE cannot continue in denial mode. The facts are there for all to see. Time to act. No more dithering, delay or indifference. You asked if there was
a problem and you have been told there is.
In the absence of a holistic workforce strategy and cross-sector career pathways, PCNs poaching from community pharmacy is a zero sum game adding nothing to
improving patient care.
Proposed changes to a European Union pharmaceuticals law will include stronger obligations for the supply of medicines and earlier notifications of shortages,
EU Health Commissioner Stella Kyriakides said last week (January 17).
Kyriakides told a session of the European Parliament that shortages of antibiotics are a growing problem for many European countries. She said the European
Commission's proposal to revise the pharmaceuticals legislation is planned for March.
"Our objective is and remains to secure access to medicines for all patients in need and to avoid any market disruption of medicines in the EU," Kyriakides said.
Shortages of antibiotics have been reported in 26 European countries, the European Medicines Agency says.
The unseasonably early upsurge in respiratory infections in Europe this winter and insufficient production capacity are the root causes of the shortages, Kyriakides
said.
Numerous EU lawmakers speaking at the session said the shortages needed to be tackled urgently. But experts say shortages of essential generic medicines like
antibiotics are likely to be recurrent in Europe due to problems in the sector such as the gradual migration of generic manufacturing to Asia.
The National Pharmacy Association (NPA) highlighted the role played by community pharmacies during pandemic to provide urgent care and vital support to people
with long-term medical conditions at its opening remark in the Covid-19 public inquiry held on Tuesday (28 February).
NPA is the core participant in the Covid-19 public inquiry. lawyer Brian Stanton made an opening statement on the NPA's behalf which focused on three areas- health
inequalities and the needs of vulnerable patients; the impact of medicine shortages and medicine price increases and the challenge that community pharmacy faced in
responding to the pandemic and maintaining patient services following long-term under investment.
Stanton said: "The UK's community pharmacies were on the frontline of efforts to limit the impact of coronavirus and to keep people well, and as well as handling a
massive increase in demand for healthcare advice and medicines, they also continued to provide urgent care and vital support to people with long-term medical
conditions.
"However, there are now very many at risk of closure during to underfunding and when the Inquiry comes to consider its recommendations the NPA would encourage
you [the presiding judge] to think about how resilience can be built into future plans."
The statement included a compelling account of the commitment typical of so many pharmacies during the pandemic - from husband and wife Pete and Sukhi Johal, both
NPA members and pharmacists, who co-own Calow Pharmacy in Chesterfield.
The English health secretary has fumbled the opportunity to prevent a crisis in the NHS this winter. She either does not understand or value the role of
community pharmacy as the third pillar of patient access to essential healthcare.
Her announcement that she wants community pharmacy to provide more services to take the strain off A&E departments and GP surgeries comes on the same day DHSC
announces no new long-term investment to sustain the sector.
Does she not understand that as a result of years of government underinvestment in England the network is in decline with random closures across the country? Too
many pharmacies are temporarily closed every day due to workforce shortages beyond the control of pharmacy owners.
Adding a new service here and there, even with some additional funding, does not address the longer term viability of the network which needs to know which patient
services it will be expected to provide over the next 10 years - not just the next few months - and how those will be adequately remunerated.
Asking more from our sector with no new investment is a strategy which is bound to fail. The pharmacy contract remains economically illiterate. The sector's finances
need open heart surgery not a couple of paracetamol tablets.
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.
A combination of factors, including the doctors' strike, medicine shortages, and funding scarcity, indicates that this upcoming winter could be the most
challenging period for both community pharmacies and the NHS, Community Pharmacy England has said.
In a September 4 blog post, CPE Chief Executive Janet Morrison emphasised that the relentless pressures show no signs of easing. "Pharmacy businesses, like
numerous other sectors, are grappling with the challenges of staying afloat in the current economic climate, compounded by the detrimental effects of historical
funding cuts."
"The doctors' strike, despite ongoing assurances from the Health Secretary that their pay deal is final, will inevitably exacerbate the demand for both primary
and secondary care, leading people to turn to their local pharmacies for assistance," she added. "This, in turn, will heighten the pressure on community pharmacies."
"Whatever the coming winter brings I am sure of two things: that community pharmacies are going to be more critical to the health of the population than ever
before, and that your representatives here will be fighting on all fronts to get you the help that you need."
Following intermittent shortages during the holiday period and amid continued high level of demand for lateral flow tests (LFT) in pharmacies, the industry has voiced concerns over supplies.
Royal Pharmaceutical Society in England chair Thorrun Govind recently gave numerous media interviews over the issue, supporting pharmacists and reassuring the public.
She said it is 'frustrating' for pharmacy teams who are unable to access enough test kits to meet the growing demand and highlighted that placing all supplies with a
single distributor as a key issue.
Many in the sector have raised questions about the government's strategy for LFT distribution after it emerged that the sole distributor to pharmacies closed for four
days shortly after receiving 2.5 million tests.
Alliance Healthcare, from whom pharmacies receive LFTs, reportedly took delivery of the tests on Christmas Eve and then shut.
Majority of the pharmacies are facing aggression from patients due to the medicine supply chain issue, a PSNC survey has revealed.
The Pharmacy Pressures Survey by the trade body has seen nearly 83 per cent of pharmacies reporting a significant increase in medicine supply issues in the past year,
leading to extra work and additional stress for staff.
The survey of over 5,000 pharmacy premises and 1,000 pharmacy team members in England took place in early 2022.
Two-thirds of respondents said that medicines supply chain issues are a daily occurrence, with 97 per cent reporting that this led to frustration from patients.
"The results of PSNC's Pressures Survey make distressing reading for anybody in the sector - they tell a story of teams under immense pressures, and of businesses at crisis point," said Janet Morrison, PSNC chief executive.
The Company Chemists' Association (CCA)'s research has found that between 2015 and 2022 more than 40 per cent of permanent community pharmacy closures took
place in the 20 per cent most deprived parts of England.
The association has analysed the NHS data and found that between 2015 and 2022, 808 pharmacies closed permanently in England. In that period, only 138 new pharmacies
opened - a net loss of 670 community pharmacies.
It also examined where permanent closures had taken place. "41% of net permanent closures had taken place in the top 20% most deprived areas in England. Meanwhile,
only 9% of net permanent closures took place in the top 20% least deprived areas."
Although the latest figures for 2021/22 suggest that the overall rate of closures may be slowing down, the proportion of pharmacies permanently shutting in more
deprived areas has only increased.
An even larger share of pharmacies that permanently shut in 2021/22 occurred in the most deprived areas compared with the previous fiscal year: 44% of net closures
took place within the bottom two IMD deciles.
The Royal Pharmaceutical Society (RPS) England Chair Thorrun Govind has called for Government action to support pharmacy teams experiencing huge demand for
their services.
"Pharmacy teams are under immense pressure at the moment, in common with other NHS services, and working extremely hard with health service colleagues to provide
the right care for patients," said Govind.
"As winter pressures mount, pharmacies see increased numbers of patients seeking support with illness and also because they have heard other areas of the health
service are struggling to cope.
The society has also stated staffing pressures, alongside an increase in workload has created an extra burden which takes a toll on the wellbeing of pharmacy teams.
Govind added: "Issues such as medicine shortages can also take up many hours of time for pharmacy teams tracking down medicines when they could be directly helping
patients. In community pharmacies, rising costs and fairly static funding are adding to business pressures.
"However, pharmacies remain the most accessible part of the health service and provide expert advice to patients without the need for an appointment and are open
long hours and at weekends."
The Company Chemists' Association (CCA) has raised concern that pharmacies may face challenges in providing placements to pharmacy students graduating in
2025 due to shortages of designated prescribing practitioners (DPPs).
From the academic year 2025/26, all pharmacy students will be required to complete 90 hours of training with designated prescribing practitioners prior to their
registration.
However, the CCA has raised doubts regarding the availability of these healthcare professionals to provide such training.
The association said: "We are concerned that pharmacies will be unable to secure DPPs. This will result in a significant reduction in the number of Foundation
Pharmacist placements available within the community pharmacy sector.
Consequently, a significant number of graduates leaving university next year will, unfortunately, struggle to find employment in their chosen career."
As per the CCA, they have repeatedly raised their concerns with NHS England and cautioned them about the potential consequences arising from the lack of DPPs.
A new report commissioned by the National Pharmacy Association (NPA) has revealed harsh financial realities faced by community pharmacies in England.
The report by Professor David Taylor of University College London warned that 1000s of community pharmacy closure might take place by 2024 in England if the sector
was not supported with additional funds.
At the launch of the report titled 'Protecting UK Public Interests in NHS Community Pharmacy', Prof Taylor said: "There will be several 1,000s of closures over the
next few years unless we take appropriate action, which doesn't mean to pour money all over it, but it is to fund appropriately when necessary.
"At the moment, if we got a partial collapse in the pharmacy network it would disrupt medicine supply and increase health inequalities… For me, it's missing out on
the future development of better and more accessible care, which would be the tragedy of reducing, harming and damaging the pharmacy network unnecessarily."
The trade bodies and four largest pharmacy chains in England, have jointly written to the Secretary of State for Health, Steve Barclay, warning that the sector
needs urgent investment for sustainability.
The letter from AIMp, CCA, NPA, PSNC, Boots UK, Lloyds Pharmacy, Well, and Phoenix UK, warned that the 30 per cent real terms funding cuts that pharmacies have faced
over the past seven years have left many businesses in a cashflow crisis.
The letter said that the government is facing a choice over the future of the country's 11,000+ community pharmacies, with permanent closures likely and medicines
supply at risk if no urgent action is taken.
"If the funding situation is not addressed, the sector is likely to move rapidly towards many permanent closures of pharmacies."
The organisations say that once these closures start, they will be hard to stop, as the sector is now so fragile other pharmacies would struggle to pick up the slack.
