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Community pharmacy is stuck in a vicious circle. Pharmacies are closing at an alarming rate whilst the government is talking about moving care away from hospitals and into the community to focus on preventative care. While the government talks about this vision for the future, the stark reality is that pharmacies are already struggling to meet the current Pharmacy First thresholds. And now we discover that one of the key components that could create capacity in pharmacy to deliver more clinical services has been put on hold…indefinitely. The recently published Darzi review, which was commissioned after the new government came to power to assess the state of the NHS, praised the value of community pharmacies and preventative services. But it recognised the level of pharmacy closures across the country and warned pharmacy access could be 'at risk'. Community pharmacy is ideally placed to deliver the government's vision of preventative care in the community. But let's all be clear, moving preventative services into community pharmacies has, so far, been nowhere near as successful as it could have been due to the current climate pharmacies find themselves in. The Pharmacy First scheme is a testament to this. Just this week it was announced that consultation thresholds for the Pharmacy First scheme have been reduced from 30 consultations to 20. It's the second time in three months that the thresholds have been reduced and it follows an intervention from Community Pharmacy England who wanted to "save many pharmacies from missing out on a vital payment this month." In June alone, 3,269 participating pharmacies failed to meet the threshold - that's almost a third of all community pharmacies in England.

The leading pharmacy bodies have come together to launch the 'Save Our Pharmacies' campaign which highlights the pressure and untapped potential of the sector. Pharmacy bodies- Association of Independent Multiple Pharmacies (AIMp), Company Chemists' Association (CCA), National Pharmacy Association (NPA) and Pharmaceutical Services Negotiating Committee (PSNC) have agreed to work together on a programme of activities to lobby for fair NHS funding for pharmacies in England, including co-ordinating efforts to mobilise public support. The campaign will focus on highlighting both the pressures that pharmacies are under and the huge untapped potential of the sector - including to offer a Pharmacy First service - if appropriate resourcing is made available. Mark Lyonette, NPA Chief executive, said: "Together we will be cranking up the noise to persuade Government and NHS to make the right choices and back the community pharmacy sector with decent funding. Maintaining patient and public support is critical to our campaigning success, so this will be a key focus in the months ahead. Our joint message is very clear: pharmacies can help get the NHS back on its feet, but not while the sector itself is on its knees." The pharmacy bodies will develop shared resources for effective parliamentary lobbying and mobilising public opinion, in the face of chronic underfunding that threatens further pharmacy closures. They will also work hard to show off the value of pharmacy and to continue pushing for a fully funded Pharmacy First service.

In celebration of World Pharmacy Technician Day today, we have gathered some significant achievements from this year that highlight the growing recognition of pharmacy technicians as integral members of the pharmacy team. During the Association of Pharmacy Technicians UK (APTUK) Conference in September, NHS England's Chief Pharmaceutical Officer, David Webb, announced 530 apprenticeships for community pharmacy pre-registration pharmacy technicians (PTPs) for the 2024/25 period. "This announcement shows a real investment in pharmacy technicians. It will impact all areas of practice, not just within community pharmacies," said Nicola Stockmann, APTUK President, in an exclusive interview with Pharmacy Business. In August, the Centre for Pharmacy Postgraduate Education (CPPE) was allocated funding to offer 80 NHS England-funded places in its Accuracy Checking Pharmacy Technician (ACPT) programme. This 3-12 month course is designed to help pharmacy technicians develop a range of competencies, ensuring they can deliver safe and effective patient care. Up to 10 NHSE-funded spots will be available each month on a first-come, first-served basis for pharmacy technicians working in community pharmacies, NHS hospitals, and health and justice settings. The funding will remain available until all 80 places are filled or until March 2025.

Community Pharmacy England (CPE) is inviting community pharmacy owners to share their insights and views about increasing Pharmacy First thresholds and the effects of GP collective action on their pharmacies. This feedback will be discussed at the upcoming Community Pharmacy England Committee meeting in September. During the meeting, the Committee members will also discuss urgent matters including the 2024/25 negotiations, collaboration with the new government, and their ongoing strategies. A key point of discussion will also be the effects of GP work-to-rule action on community pharmacies. CPE has raised concerns that many pharmacies might face challenges meeting the scheduled increases in the monthly Pharmacy First payment threshold, noting that pharmacy owners are already considering their options if they start failing to meet the threshold. In response to concerns from Community Pharmacy England, Ministers have recently agreed to lower the August threshold from 20 to 15.

In response to concerns raised by Community Pharmacy England (CPE), ministers have decided to lower the October threshold for the Pharmacy First service to 20. This decision addresses a major worry for pharmacy owners who have struggled to meet the required number of clinical pathways for monthly Pharmacy First payments, especially as the October increase to 30 pathways approached. CPE has been actively engaged in discussions with the Department of Health and Social Care and NHS England over the past few weeks to address this issue. Commenting on the decision, Janet Morrison, CEO of Community Pharmacy England, said: "It is great that ministers have responded to our concerns about another increase to the Pharmacy First payment threshold: this decision will save many community pharmacies from missing out on a vital payment this month." Morrison added that CPE will continue to monitor service data and, if needed, make further representations to ministers about future months. She also emphasised the need to find a long-term solution, which involves "NHS England marketing Pharmacy First effectively and ensuring that GPs are actively referring people to the service."

EMIS Pinnacle, the leading Pharmacy First IT supplier, has begun implementing the GP Connect Update Record feature to all community pharmacies in England that use PharmOutcomes. Starting June 28, this new feature was made available for use with the Hypertension case-finding service and the Pharmacy contraception service, as announced by the Community Pharmacy England (CPE). The GP Connect Update Record will enable community pharmacies to securely share "structured" information with GP practices regarding consultations conducted under the Pharmacy First programme, which includes minor illness and clinical pathways, along with Hypertension Case Finding and Pharmacy Contraception services Live testing is underway with EMIS Pinnacle for Pharmacy First minor illness and clinical pathways. There are plans to expand the system in the future to include updates for urgent supply of medicines under the Pharmacy First service. EMIS Pinnacle is the third CPCF IT system supplier to offer this functionality, following Cegedim's Pharmacy Services system and Positive Solutions' HXConsult system.

In response to concerns raised by pharmacy owners, the government has decided to adjust the August threshold for the Pharmacy First service from 20 to 15 clinical pathways. The ability of pharmacy owners to achieve the thresholds for the monthly Pharmacy First payments has been a topic of great concern. Community Pharmacy England (CPE) has been actively discussing this issue over the last few weeks with the Department of Health and Social Care and NHS England. Ministers have now decided to adjust the August threshold for the Pharmacy First service to 15, CPE announced today (July 31). Commenting on this decision, Janet Morrison, CEO of Community Pharmacy England said: "We are pleased that Ministers have listened to our concerns and acted quickly to make an adjustment so soon after coming into office."

NHS England announced at the Pharmacy Show this morning that Ministers have decided to amend the Pharmacy First thresholds for the remainder of the year. This decision follows concerns raised by Community Pharmacy England (CPE) regarding difficulties faced by pharmacy owners in meeting the required number of clinical pathway consultations for monthly Pharmacy First payments In response to CPE's representations to the Department of Health and Social Care (DHSC) and NHS England, the threshold was earlier reduced from 20 to 15 in August, and from 30 to 20 in October. At the Pharmacy Show on Monday, Ali Sparke from NHS England announced the revised thresholds, setting them at 20 for November and December 2024. Starting in January and February 2025, the number of clinical pathway consultations needed for the monthly Pharmacy First payment will rise to 25, with a further increase to 30 in March.

Analysis by IQVIA revealed that over the past four years, from May 2020 to May 2024, the average number of prescriptions processed by pharmacies has risen by 8 million per month. However, this is happening against the backdrop of a declining number of pharmacies. During these four years, nearly 900 pharmacies have closed in England, with almost 500 of those closures occurring in the last 12 months. Carol Alexandre, vice president at IQVIA, presented the data at the recent SIGMA UK Community Pharmacy Conference 2024, where she shared insights into the dynamics of the UK market, the pharmacy sector, and the Pharmacy First initiative. As of August 2024, there were just 10,059 community pharmacies (excluding distance-selling pharmacies) in England, 1,589 less than in March 2015, when the number stood at 11,647 (source: NHS BSA). There has been a significant shift in the distribution of pharmacy ownership, with independents (single pharmacies and chains with 1-5 stores) and regional chains (pharmacy chains with 6-200 stores) growing at the expense of managed chains.

Community Pharmacy England (CPE) is gearing up to conduct a vital Pharmacy Advice Audit, calling on pharmacy owners and their teams to help measure the increasing reliance on pharmacies within communities. With years of financial strains impacting the sector, despite the much-needed £645 million recovery plan funding, the sector finds itself on the edge. The launch of Pharmacy First sparked a notable surge in people seeking advice from community pharmacies, both within and beyond the funded service, as revealed by recent sector polling. To accurately assess this trend and advocate for sustainable funding, CPE is initiating an audit to gather data crucial for showcasing the extent of unfunded care provided by community pharmacies. Scheduled to commence this week, the Pharmacy Advice Audit will entail pharmacy teams documenting informal healthcare advice dispensed over a single day.

To maximise the benefits of the Pharmacy First service for patients, the NHS, and community pharmacies, Community Pharmacy England (CPE) has advised the community pharmacists to to establish a robust relationship between community pharmacies and local general practices. The news comes after several reports highlighted issues regarding GP referrals for the seven minor ailment conditions under the Pharmacy First services. According to the reports, many pharmacists claimed that "many GPs in England are not sending patients to them to be treated - and that some are refusing to participate at all in the "groundbreaking" Pharmacy First scheme". In response to foster better relationship with the GPs, CPE has said that strong local collaborations will enable general practice teams to confidently refer patients to the Pharmacy First and other community pharmacy services where appropriate. Moreover, the organisation emphasised implementation of long-term changes in practice will take time. The current focus on integrating GP referrals to Pharmacy First will likely require sustained effort over several months or longer.

'Community pharmacy is far too important to be allowed to wither away' desc-Thousands of pharmacies took part in the second day of the 'Save Our Pharmacies' protest organised by the National Pharmacy Association (NPA) on Thursday. Similar to the first day of protest in June, pharmacies carried out several symbolic actions, such as blacking out windows, to warn of the threat of future closures. Meanwhile, NPA chief executive Paul Rees led a delegation of pharmacy leaders to deliver a 350,000-strong petition to No 10 Downing Street, calling for "immediate, fair and sustained funding to safeguard NHS pharmacy services and ensure local pharmacies have a future." The delegation included NPA Chair Nick Kaye; Janet Morrison, CEO of Community Pharmacy England (CPE); Malcolm Harrison, CEO of Company Chemists' Association (CCA), and Gerard Greene, CEO of Community Pharmacy Northern Ireland (CPNI). Steve Race MP, who is the new chair of the All-Party Parliamentary Group on Pharmacy, and Sadik Al-Hassan, one of only two pharmacists in the House of Commons, also joined them.

Shadow Health Secretary Wes Streeting outlined his plans for NHS reform on Friday (21 April), where he also mentioned a desire to see pharmacies take on more workload and pharmacists' clinical skills to be better utilised. In his speech, he also expressed concern at warnings from the pharmacy sector and pharmacy closures. The Company Chemists' Association (CCA) appreciated Shadow Health Secretary's desire to enhance pharmacies' role in primary care reform but also stated that the sector is in urgently needs a funding injection. Dr. Nick Thayer, Head of Policy at the Company Chemists' Association (CCA) comment: "We are pleased to see the Shadow Health Secretary recognise the enhanced role that pharmacies should play in primary care reform. Mr Streeting wants to see care brought closer to people's homes and more front doors into the NHS. With 89.2% of the population located within a 20-minute walk of a pharmacy, pharmacies do just that. They are essential to realising his vision of a 'neighbourhood health service'. Pharmacies could free up over 42m GP appointments annually, including 10m vaccination appointments. Urgent same-day appointments for minor conditions in pharmacies will immediately benefit patients by increasing GP access. The first step is for the Government to immediately commission a fully-funded Pharmacy First service in England.

The national pharmacy bodies has created 'Save Our Pharmacies' campaign website to give new focus to calls for fair pharmacy funding in England. The newly launched site contains key messages for public, politicians and stakeholders, and hosts campaign resources to be used by pharmacy teams. The pharmacy bodies encourage members of the public and pharmacy teams to show their support for the campaign on social media, as well as signing the petition and contacting their local MPs about fair funding. A further resource in the form of a window poster is being printed and will shortly be mailed out to all community pharmacies in England. It is the latest output of a joint programme of work being coordinated by PSNC, CCA, AIM and the NPA.

The Pharmaceutical Services Negotiating Committee (PSNC)'s 2022 Pharmacy Advice Audit revealed that more than 1.2 million consultations a week - or 65 million a year - are now being carried out by community pharmacy teams in England. This is an increase from 2021, when the audit results suggested that in total pharmacies were providing 58 million consultations per year. PSNC has published the findings of the audit of over 4,000 community pharmacies carried out earlier this year. During the audit, 82,872 informal patient consultations were recorded, with the average pharmacy completing 19 consultations per day. This suggests that more than 1.2 million informal consultations are taking place in community pharmacies in England every week. The audit helped to quantify the number of informal referrals being made to pharmacies by GPs and NHS 111, with 7,774 informal patient referrals into pharmacy coming from these routes; grossed up to a national level that means 117,000 cases per week. These are all referrals that could and should have been made by the NHS Community Pharmacist Consultation Service (CPCS).

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."

A recent report from Healthwatch England has highlighted that while people highly value the accessibility of community pharmacies, both in terms of location and prompt service, they also encounter challenges in getting the most out of their pharmacy care experience. The report titled 'Pharmacy: What People' is based on the research conducted by the organisation in November last year, involving 1,650 people who shared their experiences of pharmacy services in England. It showed the country's notable dependence on community pharmacies, with 72 per cent of respondents saying they have used a community pharmacy in the past three months. Usage of online pharmacies is considerably lower than community pharmacies, with only 18 per cent of individuals having used an online pharmacy in the past three months, according to the report published on Tuesday (30 April).

A group of 20 parliamentarians has written to health secretary Wes Streeting MP, calling for urgent government action to address the growing financial crisis facing community pharmacies. In the cross-party letter, supported by Community Pharmacy England (CPE), the MPs warned of a real risk of more pharmacy closures, with one in six pharmacy owners saying that they are unsure if their pharmacy will survive the year. They have urged the Department of Health and Social Care (DHSC) and NHS England (NHSE) to prioritise long-term planning for pharmacies, including the implementation of the Community Pharmacist Prescribing Service. The MPs have also highlighted the need for more effective marketing for Pharmacy First to increase both walk-ins and referrals to this critical service. CPE chief executive Janet Morrison welcomed the support of 20 cross-party parliamentarians and recognising the vital role pharmacies play in the local community. She stressed the urgent need for immediate government intervention to ensure the survival of the sector and to maximise its potential in providing accessible care.

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.

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.