England's chief pharmaceutical officer (CPhO) David Webb has promised his "wholehearted support" for the community pharmacy sector at the board meeting of the National Pharmacy Association (NPA) on 28 June in St Albans.
After hearing the CPhO at the meeting, NPA chair, Andrew Lane, later declared: "David is someone we can do business with."
Webb thus listed his priorities as head of profession: integration of independent prescribing as part of pharmacy practice by 2026; promotion of inclusive pharmacy
practice for all pharmacy professionals; assurance of post-registration practice; developing the role of pharmacy technicians; support for Integrated Care Systems
and Primary Care Network pharmacy teams (including community pharmacy); medicines optimisation; and strengthening of professional leadership for community pharmacy.
He also reported that NHS England had recently increased its team of regional pharmacy integration leads from seven to 14, creating seven new senior posts.
Webb told NPA board members: "I want sincerely to thank community pharmacy teams for everything they are doing and to say that you have my wholehearted support. I believe in the importance of community pharmacy and will listen and engage as I've already demonstrated.
Nestled in the heart of a bustling high street and a housing estate, at Lincoln Pharmacy, part of Mildcare Ltd Group, in Tower Hamlets in London, the scene
is a testament to resilience and innovation, where queues of people seek aid from a pharmacy technician stationed behind a glass window-a symbol of the enduring
impact of the pandemic.
Amidst the array of modern amenities at the pharmacy stands Atulkumar Patel, the proprietor and Independent Prescriber (IP) at Lincoln Pharmacy, whose vision has
propelled the establishment into a beacon of progressive healthcare.
Owner of two Pharmacies, Patel's team of 20 dispenses an average of 20,000 prescriptions monthly, maintaining an NHS/OTC split of 80/20.
Recipient of the prestigious Independent Prescriber of the Year award at the Pharmacy Business Awards 2023, Patel reflects on the pivotal moment when his
pharmacy pioneered the rollout of COVID-19 vaccine jabs within the community.
"When doctors' doors closed, pharmacy was the only place where people could get help and care," Patel recounts, emphasising the pivotal role pharmacies played
during the crisis.
Patel's dedication during the pandemic extended beyond mere service provision; it was about showcasing the untapped potential of pharmacies.
Achieving the community pharmacy vision necessitates legal adjustments and additional funding beyond recent boosts, the pharmacy vision document published
by Nuffield Trust and The King's Fund has revealed. It says community pharmacies in England must adapt to changing population needs amidst unprecedented health
and care challenges.
Commissioned by Community Pharmacy England, the report titled 'A Vision for Community Pharmacy', published on Sept. 19, is a result of almost a year of research
and extensive consultation with the sector and wider stakeholders, advocating for community pharmacy. The think tanks detail a shift in the community pharmacy
sector, highlighting how pharmacies can contribute to crucial policy objectives regarding population health, prevention, and the increasing demand in primary care.
"The health and care needs of the population are evolving, and pharmacies in England, like all components of the health and care system, must adjust to address
these changes," said Helen Buckingham, Director of Strategy at Nuffield Trust.
Wales has begun the rolled-out of a community pharmacy prescribing service as part of reforms agreed by the Welsh health minister last December.
Eluned Morgan approved wide-ranging changes following re-negotiation of the Community Pharmacy Contractual Framework with Community Pharmacy Wales, the
representative body for community pharmacies in Wales.
The roll out will allow appropriately trained community pharmacists to treat an extended range of conditions that currently require people to visit their GP.
Initially pharmacist prescribers will be able to prescribe medicines, including antibiotics for acute illnesses like urinary tract and upper respiratory tract infections, and also prescribe routine contraception.
The first of its kind in the UK, the service is being rolled out progressively across Wales, building on local schemes which are already in place.
As we transition in England through yet another NHS organisational change, I ask myself what does this mean for community pharmacy? I would like to think that
this change will bring about opportunity and a chance for community pharmacy to showcase and continue the excellent work that was carried out during the height of
the pandemic and is still ongoing today.
I hope that it allows community pharmacy to be regarded as part of the NHS rather than sitting on the side lines. This change has to lead to better funding for
community pharmacy, without sufficient funding we will see more pharmacies close.
We are hearing a lot about winter pressures but this year it feels like all year round pressure. What I have seen, whilst the NHS is under such pressure, is North
East London (NEL) CCG transitioning to an integrated care board (ICB) almost seamlessly.
I have seen people transitioning into new roles, whilst working hard to ensure that all plates are still spinning, which at the moment is no mean feat. I spent a
day out recently visiting pharmacies with the chief medical officer of NHS NEL, Dr Paul Gilluley.
The visits were positive, we felt listened to and understood. The feedback was great, it was recognised that community pharmacy is often the informal front door to
the NHS and that we have so much to offer in terms of ill health prevention.
Community pharmacy can offer a total solution as long as we have the tools to do so, which can save so much time and money. An example is the GP CPCS service, which
has launched well across NEL.
The NHS England has introduced a training programme for 1000 staff to broaden their community pharmacy roles, thereby improving patient access to services.
Among them, 500 pharmacy staff will be trained to supervise pharmacists during prescription training, while the remaining 500 will provide support for various
training, including pre and post-registration programmes for pharmacists and pharmacy technicians.
According to the NHSE, pharmacist and pharmacy technician roles are rapidly evolving due to healthcare changes and increased demand for clinical services in
community pharmacy. "There are 3,000 independent prescribing training spots available for 2023/24. Educational supervision is a crucial part of this to enable the
ongoing transformation and skills development of the growing pharmacy workforce."
The NHSE-funded training, scheduled to begin next month, will ensure that those involved in educational supervision, including Designated Supervisors (DSs),
Pre-registration Trainee Pharmacy Technician education supervisors and Designated Prescribing Practitioners (DPPs), can effectively support learners.
The fusion of the unique in-depth understanding of medicines by pharmacists together with the competence to prescribe offers will improve access to care and
increase capacity in the health system, said the Royal Pharmaceutical Society (RPS) Director for England Ravi Sharma to Parliament at the Health and Social Care
Select Committee's inquiry on workforce on Monday (May 23).
However, he also stated that a new workforce strategy must support and harness the skills of pharmacist independent prescribers in clinical care with investment
in training, both for new and existing workforce; access to supervisors; protected learning and development time; and commissioning of services to make best use of
independent prescribers across care settings, supported by appropriate prescribing budgets in community pharmacy.
"We're about to see new generation of pharmacists independent prescribers that will make a huge difference to the clinical role of pharmacists to support patient care, but this must be underpinned by protected learning time and a more ambitious approach to commissioning new services to use their skills," Ravi said.
He spoke to MPs in Parliament at the Health and Social Care Select Committee's inquiry on workforce, highlighting the vital contribution of pharmacy teams during
the pandemic and called for action to support the current and future workforce.
Some of the key issues highlighted in the parliament included, the risk of burnout and the need to help boost staff retention; staff wellbeing, including a zero tolerance of abuse from the public; the importance of professional development and protected learning time to enhance patient care and support rewarding careers; the potential of new pharmacist independent prescribers and the need for investment in the current workforce and the need for better workforce data and a pharmacy workforce strategy.
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.
Preet Kaur Gill, Shadow Minister for Primary Care and Public Health, has paid a recent visit to a community pharmacy in Staffordshire to personally experience
the services it provides to patients, while staying updated on the latest sector developments.
Her visit to Eason's Pharmacy in Tamworth on September 22nd marked her first since assuming new responsibilities for pharmacy policy matters within Labour's health
team. Gill was also joined by a member of the National Pharmacy Association staff.
The Minister received a comprehensive briefing on Eason's Pharmacy from its third-generation owner, Kieran Eason (R). He outlined the NHS services, which include
the New Medicines Service and blood pressure monitoring, and showcased two consultation rooms and an operational dispensary.
"It's great that Preet came to learn firsthand about the challenges we face and the substantial potential of community pharmacies nationwide," Eason said. "As an
independent prescriber, I have the expertise to provide even more convenient care, but the current funding levels severely limit our contribution."
The pharmacy inquiry will explore issues impacting different types of pharmacy, with a particular focus on community, primary care and hospital pharmacy
services.
It will also consider current challenges around funding, workforce and the digital infrastructure.
Planned developments within the profession will enable future pharmacists to be independent prescribers from day one of registration, giving them a greater role
within primary care teams.
Health and Social Care Committee Chair Steve Brine MP said: "It is clear that pharmacy has a central role to play in the future of the NHS. With a greater focus on
personalised and patient-centred healthcare, we will be asking what more must be done to make sure that the profession is in the best shape to meet demand.
"Better use of the pharmacy workforce would reduce pressures on general practice and hospitals. However, this will not happen without a planned workforce with the
funding, supervision and training to support it.
"At the end of the inquiry, the committee will be making recommendations to the government on what action needs to be taken to ensure the potential of pharmacy is
realised.
The Royal Pharmaceutical Society (RPS) and National Pharmacy Association (NPA) have both urged the new health secretary Steve Barclay to back the 'pharmacy first'
approach in England as mentioned by his predecessor on numerous occasions.
"Sajid Javid recognised the vital role of community pharmacy and the potential of a 'Pharmacy First' to support patient access to care. I would urge the new Health
Secretary to see this through to completion," said chair of RPS in England Thorrun Govind.
Thorrun hopes the new health secretary will engage with pharmacy leaders about how we can make the most of our health and care workforce to support the NHS recovery,
including reducing health inequalities, managing the growing cost of long-term conditions, and utilising the enhanced skills of Pharmacist Independent Prescribers.
Commenting on the new appointment, she said: "This is a crucial time for the future of health and care - with continued pressures on teams, changes to NHS structures
and organisations, and the need for long-term investment in the workforce.
"With a 'refresh' of the NHS Long-Term Plan and the Government's workforce plan expected later this year, these must support a more ambitious approach to advancing
the clinical role of pharmacists across the NHS to better meet changing patient demand, backed by investment in pharmacy education and training.
Professor Harry McQuillan has said community pharmacists in the UK must change their focus from an 'accuracy of supply' to a 'safety of supply' model when it
comes to dealing with patients.
"The main take away message from tonight's lecture is for pharmacy professionals to really challenge themselves about whether they are focused on accuracy of supply
or safety of supply," he said at this year's UCL School of Pharmacy Lecture in London on Thursday, 15 June.
"For our community pharmacists it must be about safety, including prescribing, and ensuring patients and citizens get the maximum benefit from prescribed medicines.
"To deliver this, we need to invest in our teams - harness technology and always be willing to take the next step in a more clinical future."
The Chief Executive Office of Community Pharmacy Scotland, however, noted that at a time when the UK was grappling with an unprecedented national debt crisis
exacerbated by severe cost of living and spiraling inflation, community pharmacy will need to make a "compelling case" of where the priority should be in the sector.
Expanding on the financial woes of the country, he compared the current national debt of the UK, which stood at a staggering 270 percent of GDP in September 2022,
with the previous record-breaking national debt of 250 per cent at the end of WWII.
Data crunched by an online pharmacy delivery company paints a concerning picture for the pharmacy sector in England.
Gophr's 'Prescription For Pressure' initiative reveals a challenging time for the sector and is supported by separate analysis by the BBC showing that the number
of pharmacies in England is at its lowest since 2010.
In addition, new powers being introduced for pharmacists to prescribe common prescription drugs and perform routine tests create an even greater workload for already
overstretched pharmacists.
Gophr's data reveals that:
* Each pharmacy in England serves an average of 6,078 people.
* In 2022, pharmacists dispensed 1.043 billion prescriptions, 26.3 million more than 2021.
* A single pharmacy in England dispensed 248 prescriptions a day on average in 2022.
Based on the most up-to-date statistics from the Office for National Statistics, NHS England and Statista, Gophr's calculations show that pharmacists have around 116
seconds to dispense a prescription, which is less time than the 180 seconds it takes to make a Quarter Pounder at McDonald's.
Using innovation and technology is the best way for pharmacies to boost income and ensure efficiency in services, said tech-savvy independent prescriber and community pharmacy contractor Amish Patel.
Patel has invested heavily in technological refurbishment at his pharmacy and installed the first dispensing robot of its type in the UK.
Highlighting the downward trend in pharmacies' income, he said: "We know for the last five years plus, pharmacy income, pharmacy services - they have just been reducing…
"We are still very heavily dependent on dispensing, and dispensing fees, and profit margins with the supply chain they have been ever reducing.
"This (using technology) has been a new way of generating new income. But again, just to highlight it is just enjoyment of pushing the boundaries what I can do personally."
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.
Jonathan Burton will receive the 2022 RPS Charter Award for his outstanding work for the Society and the wider profession in promoting the interests of pharmacy.
The award will be presented by the President at a future meeting of Fellows and Members to take place at the Society's Edinburgh office on 22nd March 2023.
Jonathan's main role is as a practising, patient-facing pharmacist within the community in NHS Forth Valley where he uses his advanced practice skills and independent
prescribing qualification to assess and treat acute ENT, dermatology, and respiratory conditions.
He was one of the first community pharmacist prescribers in Scotland and has always been at the forefront of innovation and service development.
Jonathan has demonstrated outstanding commitment and passion for the pharmacy profession throughout his career. He has excelled as a pharmacist in the Right Medicine
Pharmacy group, on local and national committees, in advocacy for the pharmacy profession and as a local and national leader who is highly regarded as an exceptional
role model for the profession.
Sobha Sharma Kandel wants community pharmacy teams up and down the country to be super responsive to emerging needs of their patients - by always being
pro-active rather than reactive.
"We know that every patient benefits from our proactive approaches - listening, asking questions, providing information and making clinical interventions when
appropriate.
"At a time when general practice is overstretched, community pharmacy must be relied upon as the frontline of the NHS when it comes to providing diagnosis,
treatment and continuous care in our communities to promote health and wellbeing of our patients."
Sobha believes Covid-19 has helped shift public perception of community pharmacies from being a place where one goes to collect a prescription to a hub where one
can access a range of healthcare advice and services.
"We are way more than just a shop where you can collect your medicines," she said, giving examples of how her interventions have helped reduce medication errors,
prevent harm and subsequently reduce cost of care.
She once saved a baby from getting overdosed with omeprazole when they had issues with gastroesophageal reflux. On another occasion, she managed a lady's high blood
pressure by finding equivalent medications to a combination dose prescribed by her doctor in another country.
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.
The 14th Community Pharmacy Conference by Sigma Pharmaceuticals has been timely, prime minister Rishi Sunak said, noting that it coincided with the launch
of Pharmacy First, a new initiative that enables patients to receive treatments for seven common conditions directly from a pharmacist without the need for a GP
appointment or prescription.
"We are all grateful for the tremendous contributions that pharmacists make to our NHS. The fantastic work you do is critical to the success of Pharmacy First and
many other initiatives," Sunak said in a written message.
The conference was organised from 25-29 February at Sun City in Johannesburg, South Africa, under the theme 'community pharmacy in an integrated NHS'.
In a recorded video address to the Sigma Conference, shadow health secretary Wes Streeting said community pharmacies are 'critical' to the Labour party's mission to
make the NHS 'fit for the future'.
"You should be playing a much more significant role. Labour's reform agenda will get pharmacists working to the top of their licence. We want community pharmacists
to play a greater role in healthcare, with more focus on their expertise in prescribing and medicines management," he said.
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.