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A winter NHS crisis is inevitable unless the government acts now to reverse the worrying decline in community pharmacies. Years of government underfunding could see 3,000 pharmacies in England - around a third of the network - having no option but to shut their doors to patients in the next few years. That figure is based on independent assessments from Ernst & Young and UCL/LSE healthcare professors: it is not scaremongering - it is the reality the country faces. Fifty per cent of pharmacies are already in financial distress because government funding has been falling in real terms since 2019 and that figure is predicted to rise to 75 per cent within the next two years. The government needs to act now and invest in pharmacy or sleepwalk into a healthcare disaster as we have seen with access to dentistry care. Prescription volumes have risen consistently year-on-year by roughly 2 per cent which means fewer pharmacies doing more work and under greater pressure than a decade ago. Ten years ago around 11,200 pharmacies in England were dispensing roughly 79,000 prescriptions; nowadays around 11,500 are dispensing roughly 89,000 prescriptions. The secretary of state recently asked pharmacy to do more to avoid a winter NHS crisis and at the same time said there will be no new money to pay for those additional services. This at a time when the network is in decline with random unplanned pharmacy closures - 640 closures since 2016 - and pharmacy staff face huge workload pressures as prescription demand is increasing year-on-year. The government's approach to pharmacy literally does not add up: the pharmacy contract is not fit-for-purpose now let alone dealing with a NHS winter crisis.

Community pharmacy representatives and MPs from across all political parties discussed the impact of winter pressures on pharmacies in England during a parliamentary drop-in event held on Tuesday (5 December). As many as 34 MPs attended the event, including Bradford South MP Judith Cummins, who hosted the event. Members of the Community Pharmacy England (CPE) Policy Team and LPC leaders briefed the politicians about the current winter pressures that all NHS community pharmacies are grappling with, and asked them to help get more support. CPE Chief Executive Janet Morrison said: "Community pharmacies play an active role to support their patients throughout the winter period, but the sector needs fair and proper funding to enable its vital services to be delivered in the long term. This event came at a key moment for the sector as we work towards implementing the Pharmacy First service and negotiations begin for the 2024/25 Community Pharmacy Contractual Framework (CPCF).

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.

In a recent interview with The Telegraph, health secretary Steve Barclay stated that he has asked his officials within DHSC to look at a "pharmacy first" approach to alleviate pressures on A&E departments in order to avoid the widely predicted NHS winter crisis. On the face of it, this a welcome if long overdue recognition that community pharmacy is an essential part of our national healthcare infrastructure alongside our GP and A&E colleagues. But let's not get carried away - we have had lots of praise from politicians in the past which have not then been backed by firm commitments for a sustainable future for the network. Could this be a turning point? I hope so, but I am not confident it will be. I fear this may turn out to be another emergency stop-gap measure which does nothing to secure the long-term viability of the sector in England. The role of community pharmacy during the recent Covid pandemic demonstrated clearly how important we are to ensure people have easy access to essential healthcare support, advice and services. The NHS winter crisis can only be avoided or at least mitigated if the potential of the community pharmacy network to provide more patient care services is unlocked and that Barclay requires you to end pharmacy funding austerity and start investing. The Treasury will no doubt say there is no more money, but what then the alternative other than a NHS winter crisis? And, of course, treating people in secondary care settings is far more costly than community pharmacy based interventions.

The Royal Pharmaceutical Society (RPS) has urged people across Scotland to be kind to their pharmacy teams this winter through its campaign called 'Be Kind'. The pharmacies are facing lot of pressure and challenges during winter, RPS has heard from its members that abuse towards pharmacy teams, particularly those in community pharmacy, has 'unfortunately' risen. The campaign has been running throughout December, to promote 'be kind' message to the public at a time when pharmacy services are particularly stretched by winter pressures and other factors, including the recent shortages of antibiotics. "Throughout December, leading figures have provided a series of powerful videos, which all encourage the public to be kind to their pharmacy teams. The campaign has highlighted personal video messages from many figures including Jason Leitch, Scotland's National Clinical Director, Maree Todd, Minister for Public Health, Women's Health and Sport, and Andrew Carruthers, RPS Scottish Pharmacy Board Chair," said RPS.

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 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.

Community pharmacy teams in England have broken all previous records by a distance and delivered nearly five million flu jabs in the past season. They have administered over 2.08 million more flu vaccinations under the national programme during 2021-22 than the previous year, which is a a 75 increase, the Pharmaceutical Services Negotiating Committee has reported. According to latest data published by the NHS Business Services Authority in its Advanced Service Flu report community pharmacy has administered 4.85 million vaccinations under the national Flu Vaccination Service in 2021-22. The total number of vaccines administered in community pharmacies in 2020-21 was 2.77 million. Commenting on the end-of-season figures, PSNC chief executive Janet Morrison said: "I am thoroughly impressed to hear it confirmed that community pharmacy has had another record-breaking year of flu vaccination provision. The ability of pharmacy teams to deliver the healthcare services that communities need, despite the challenges and pressures this winter, is simply phenomenal.

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.'

The Department of Health (DoH) Northern Ireland is reminding the public to think Pharmacy First this winter to stay well and reduce demands on other parts of their health service. Under this new advanced service, a local pharmacy can provide treatment and advice on a range of health conditions including common colds, stomach upsets, ear aches, diarrhoea, head lice, mouth ulcers and thrush. Pharmacies will also directly provide emergency contraception and advice and treatment for uncomplicated Urinary Tract Infections (UTI) for women aged 16 to 64 years without the need for a GP appointment, the department said. Further the public are informed that 42 community pharmacies across the country will be providing a sore throat service this winter, involving advice, testing for infection and treatment, if necessary.

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.

The Department of Health and Social Care has updated the list of community pharmacies eligible for the Pharmacy Access Scheme (PhAS) and approved 43 cases out of 63 applications, bringing the the total number of eligible pharmacies in England to 1,445. Earlier this year, NHS England and NHS Improvement (NHSE&I) invited community pharmacy contractors to apply for a review if they believed there were any inaccuracies in relation to pharmacy premises addresses or unforeseen circumstances affecting access, such as a permanent roadblock. Submitted applications were reviewed by the relevant NHSE&I regional pharmacy contract team, and determined by the relevant pharmaceutical services regulations committees (PSRC). Due to the workload pressures seen over winter, the review deadline was extended, giving contractors applying for a review two full months to complete their applications. This also pushed back the announcement of the outcome of the review, but where an application has been successful, PhAS payments will be backdated to the start of the scheme.

The Pharmaceutical Services Negotiating Committee (PSNC) has launched a four point plan at its parliamentary drop-in event for MPs and peers hosted on Tuesday (15 November). The event lasted for two hours, during which MPs had the opportunity to drop-in and have their blood pressure measured by pharmacists with experience of working on the front-line and were briefed on the urgent need for action to address the pressures on the sector. Outline of the four-point plan: Resolve the funding squeeze: Community pharmacy needs an immediate funding uplift to prevent large-scale pharmacy closures, as well as emergency business relief to get through this winter. Tackle regulatory and other burdens: Pharmacies must be protected from medicines market shocks, supported to help them weather the workforce crisis, helped to free up capacity and freed from red tape that does not enhance patient care. Help pharmacies to expand their role in primary care: Pharmacies could do more to support the delivery of primary care for example through offering clinical services for long-term conditions - like hypertension, diabetes and respiratory disease, supporting people to adopt healthier lifestyles and prevent the development of long-term conditions, medicines optimisation, and a much wider variety of NHS vaccinations.

The Pharmaceutical Services Negotiating Committee (PSNC)'s members are seeking immediate rescue packages for the sector to help with energy bills and to ease capacity constraints. In a meeting held on 14th and 15th September, the committee members expressed their anger and frustration on the reluctance of NHS England and government to fund pharmacy sustainably. The meeting was held to consider practical steps to ease the pressures on the community pharmacy sector, and to oversee the progress of negotiations on the Community Pharmacy Contractual Framework (CPCF) and other work. Committee members, as pharmacy contractors, shared their experiences of the current pressures on all contractors, including the inability to deliver some services and to maintain core service levels; the capacity and workforce crises facing the sector; the critical need for funding support this winter; and the urgent need for Government to adapt the Price Concessions system to meet the needs of contractors. "The Price Concessions system is no longer working for contractors in the current volatile medicine supply environment and PSNC is clear this is not acceptable," said the committee.

The Pharmaceutical Services Negotiating Committee (PSNC) has rejected Department of Health and Social Care (DHSC) and NHS England's proposal on price concessions reform and relief measures to ease pressure on pharmacies. The Committee called the proposal 'insufficient' to meet the sector's needs considering the impact of the current crisis, reflecting on the economic pressures that accelerated through the autumn and winter. The Ministers and other decision-makers have shown their interest in the potential role of community pharmacy, particularly in using a Pharmacy First approach and making use of PGDs and the skills of independent prescribers. But the Committee had made clear to them that without new money this is all a pipedream. "We need an urgent injection of funds into the sector, otherwise we will continue to see a degradation of services and eventual collapse of the network. The Committee is clear that there is no further place for warm words while pharmacy collapses," said PSNC. The Committee reflected that the 5-year CPCF agreement had been based on working together to create the capacity and context necessary to deliver the shift towards greater service delivery. Not only has that capacity-release not happened due to slow progress by Government, but pharmacies have also been burdened with these additional, and insurmountable, challenges.

The new Smoking Cessation Service (SCS) will commence on March 10, 2022, allowing community pharmacy contractors to register to provide the service on the NHS Business Services Authority's (NHSBSA) Manage Your Service (MYS) portal from March 1, 2022. This is the second of the two new Advanced services to be introduced this financial year, after the Hypertension case-finding service, which were agreed outcomes from negotiations for Year 3 of the Community Pharmacy Contractual Framework. Since the service is an Advanced service, contractors are free to decide if they wish to provide it, as most would be busy completing work for the Pharmacy Quality Scheme 2021/22 alongside winter-related workload, the Pharmaceutical Services Negotiating Committee said. Therefore, those who decide to start this service should consider the likelihood of receiving sufficient referrals to make provision of the service worthwhile, the PSNC said.

Leading pharmacy bodies and associations are looking forward to working with 'reappointed' Secretary of State for Health and Social Care, Steve Barclay, on 'future roles' and 'funding' for the community pharmacy. The Royal Pharmaceutical Society (RPS) England Country Board Chair, Thorrun Govind, hopes that the ministers will now be able to focus on addressing the key challenges facing the health service and the country. "This means not just getting through the winter, but planning for and investing in the future." She added: "It will be crucial to use the skills of all our health professions to support the NHS recovery, reduce health inequalities, manage the growing cost of long-term conditions, and deliver best value from medicines.

The new data from NHS England has revealed that more than 100,000 patients were treated for minor illness by their high street pharmacist in just one month. According to new NHS figures, in June, 118,123 people with minor illnesses such as a sore throat or constipation, or those in need of medicine urgently, received a same-day consultation with their local pharmacist after calling NHS 111 or their GP practice - an increase of more than four-fifths (83%) on the number in the same month last year (64,512). The data comes alongside expanded roles for community pharmacies ahead of winter, announced at the NHS England board meeting today. "From this week, NHS 111 online can directly refer people to their high street pharmacist for a same-day consultation, rather than patients needing to call the phone line," said NHS England. Amanda Pritchard, NHS chief executive, said: "Our local pharmacies ensure hundreds of thousands of people every week get the support and medication they need and today's figures show that in just one month, over 100,000 patients have also had consultations with their local pharmacist for minor illnesses - this means patients are getting the care they need quickly but also in a convenient way that can fit in with their busy lives.

The Pharmaceutical Services Negotiating Committee (PSNC) has challenged price concessions imposed by the Department of Health and Social Care (DHSC) on some of the medicines. It has raised concerns on the process for setting price concessions to senior government officials responsible for medicines supply, warning that the system is not working in the current environment from a community pharmacy contractor perspective. "When a new government takes over next week, this will be one of several urgent topics being raised by PSNC to new ministers, alongside the fuel price crisis, inflationary pressures and winter pressures on pharmacy businesses," said PSNC. The final update to August price concessions was announced yesterday taking the total concessions granted to a record 138 for August. PSNC said: "Of those, 99 were in line with PSNC requests, but prices for 39 lines were imposed by the Department of Health and Social Care (DHSC): those impositions do not match the purchase prices reported by contractors and the evidence of market prices which we passed on to DHSC. In particular, the final imposed prices of Apriprazole and Temazepam tablets has generated a lot of concern amongst contractors due to the large variation between their reimbursement prices and purchase prices during the month of August."

Community pharmacists in England have slammed the government's latest decision to reduce the number of people who get a free winter flu jab in the 2022-23 flu season, as concerns related to Covid-19 still exist. This follows a letter from the NHS England and NHS Improvement (NHSE&I) to clinicians, which stated that the flu vaccination service in 2022-23 will be offered to patient groups eligible in line with pre-pandemic recommendations. The eligibility was widened significantly after the pandemic struck in 2020 to help reduce the death toll from the Covid-19. With the change in place people aged 50-64 and schoolchildren aged 11-15 will not be eligible to receive the free jabs on the NHS next winter, pushing millions of people to pay for their jabs privately. It further recommended that vaccination for frontline healthcare workers and social care workers should be provided by employers as part of the organisation's policy to prevent the transmission of infection.