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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.

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."

"We need to fix the front door to our NHS by investing in community pharmacy," asserts Daisy Cooper as more and more pharmacies "worry about the future of their business." Reflecting on the challenges faced by pharmacists during the pandemic, she emphasised their pivotal role in launching vaccination schemes across communities and the larger role pharmacies play in complementing traditional NHS facilities. Cooper recalls her collaboration with local pharmacies in St. Albans, where she worked hand in glove with them to address challenges faced by pharmacists to obtain information from NHS England regarding protocols and procedures. She told Pharmacy Business reporter that she had to work out something "hand in glove to help them get those vaccinated schemes up and running, as pharmacies were desperate to take part in the vaccination scheme" in her constituency. Describing their unique selling point (USP), Cooper emphasised the convenience and immediacy of pharmacies located in high street areas and warned that pharmacy closures "should be a real wake up call for the government."

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).

The nationwide implementation of the Pharmacy First service is viewed as a significant development that benefits pharmacies, primary care, and the broader National Health Service (NHS). Pharmacy teams are striving to ensure its success despite challenges within the industry landscape. However, not all pharmacists are able to reap the benefits from it. Recently, two members of Numark shared their experiences of how the scheme is impacting their pharmacies. Graham Phillips, who owns Letchworth Pharmacy in Hertfordshire, revealed that patients are responding favourably to the service. "It's all good, people are just delighted to have easier access to care," he said. In its first month, Letchworth Pharmacy provided around 100 consultations, and Phillips envisions that as the service matures, they will be able to conduct an average of 200 interventions per week. "That will make it financially viable for us and mean that we're acting at scale from an NHS perspective. That's 200 GP appointments we've freed up in a week - that's a huge capability and capacity bump for the NHS," he added. Graham credits part of his success with Pharmacy First to the strong relationship he has established with local GPs in his area.

The 'SaveOurPharmacies' roundtable held on Tuesday (21 March) to discuss severe challenges faced by the community pharmacies in England witnessed the support of 15 MPs. Janet Morrison, Chief Executive, Pharmaceutical Services Negotiating Committee (PSNC); Andrew Lane, independent pharmacy owner and Chairman, National Pharmacy Association (NPA) and Ian Strachan, independent pharmacy owner and Board Member, Association of Independent Multiple Pharmacies (AIM) attended the summit, which was chaired by Stephen Hammond MP, to brief MPs on the severe challenges facing the sector. MPs in attendance were Stephen Hammond, Sally-Ann Hart, Peter Aldous, Anna Firth, Taiwo Owatemi, Bob Seely, Derek Thomas, David Rutley, Lilian Greenwood, Tulip Siddiq, Hillary Benn, Sarah Olney, Christian Wakeford, Daisy Cooper (researcher) and Victoria Atkins (researcher) The title of the event 'Community pharmacy's role in the Primary Care Recovery Plan' which is expected imminently, is set to include a variety of measures aimed at helping primary care to recover from the impact of the pandemic. PSNC has been pressing for the plan to include a fully-funded national Pharmacy First service as this is the best chance for getting significant additional funds into community pharmacies.

This year has been another turbulent year for the UK pharmacy sector. The sector continues to undergo significant transformations, driven by evolving healthcare needs, regulatory shifts, and economic pressures. For pharmacy owners, staying abreast of these trends is crucial to navigating the challenges and seizing opportunities. IQVIA, a leading global provider of clinical research services, commercial insights and healthcare intelligence, delves into the key issues, challenges, and developments shaping the sector, drawing insights from the latest industry data and reports, supported with data released by NHS England (NHSE). The community pharmacy landscape remains unsettled, with disruptive market dynamics at play. The decline in the number of pharmacies, particularly within the Managed Chains channel, underscores the volatility of the market. The number of active pharmacy contractors in England has dropped significantly, with more closures than openings each month, exacerbated by the exit of Lloyds Pharmacy from the UK market which completed at the end of 2023. In the year ending June 2024, there was a net closure of 440 sites within NHSE which equates to a 4% decline in available pharmacies1. The increase in closures from June 2023 was driven by the closures of Lloyds in Sainsburys and the ongoing divestment of the Boots estate.

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."

Patients are highly satisfied with the new Pharmacy First service, which enables pharmacists to assess and treat patients for seven common conditions, according to a survey by the National Pharmacy Association (NPA). Nearly 100 NPA members participated in the snapshot poll conducted at the end of the first full week of the service. Nine in ten respondents (87 per cent) said that "most or all patients expressed satisfaction" with the service they received. However, many independent community pharmacy owners are facing challenges in implementing the service. While 56 per cent of pharmacy owners surveyed expressed feeling "motivated" by the new service, a larger proportion (70 per cent) indicated being "under additional pressure." More than 30 per cent of the respondents found implementation of the service "harder" than they had expected.

Acknowledging the ongoing challenges in delivering the required IT systems for the scheduled launch of the Pharmacy First service on January 31, NHS England reported progress in fulfilling 'many' commitments outlined in its plan to enhance primary care access during a board meeting on Thursday. However, it noted that the digital infrastructure supporting Pharmacy First, included in the £645 million fresh funding for community pharmacy, will require additional time for implementation. "Delivery remains challenging due to changes needed in digital infrastructure, and we are working with suppliers to support January implementation," NHSE said. "A public campaign is planned for 2024." The Pharmacy First service allows pharmacists to supply prescription-only medicines for seven common health conditions (sinusitis, sore throat, earache, infected insect bite, impetigo, shingles, and uncomplicated urinary tract infections in women), eliminating the need for a GP visit. Meanwhile, NHSE is leveraging the widespread accessibility of pharmacies by expanding blood pressure monitoring and introducing direct prescribing of clinically safe oral contraceptives-an initiative that has been well-received.

Community Pharmacy England (CPE) has launched its third annual Pressures Survey to uncover the various challenges encountered by individuals owning or working in a community pharmacy. The Committee expressed concern that community pharmacies in England are now in a critical situation, significantly affecting workload, stress levels, patients, and businesses. The 2024 Pharmacy Pressures Survey is aimed at finding out more about these issues and other areas such as medicines supply problems and workforce challenges as well as the recently launched Pharmacy First service, it said. CPE chief executive Janet Morrison said that they were able to receive a huge number of responses in previous surveys and they are expecting to achieve a similar level of engagement this year too.

As an Alphega pharmacy mentor, Sue Dobson has worked with pharmacists across the country, helping them adapt to the growing responsibilities and challenges they face in their profession. One of the most exciting developments in recent years has been the Pharmacy First initiative, which positions community pharmacists as key players in patient care, especially through GP referrals. However, Sue has seen firsthand that the success of this initiative depends largely on the strength of the relationships we build with GPs and how we integrate these referrals into our day-to-day operations. Some pharmacists have thrived by establishing strong, collaborative relationships, while others have struggled to break down initial barriers of trust. In this conversation, she speaks with Anil Chauhan, a Preston pharmacist who, along with his partner Yasar Hussain, has made GP referrals a seamless part of their practice. Their success story is a great example of how perseverance, trust-building, and a proactive approach can truly make a difference in the Pharmacy First model. Sue Dobson: Anil, you and Yasar have done a great job with the Pharmacy First initiative and GP referrals. Can you start by sharing how you first got involved with GP referrals and what made it successful in your practice?

Pharmacy owners discussed the key concerns and priorities for the future at the Community Pharmacy England's (CPE) digital briefing event held last week (on 7 May 2024). More than 500 pharmacy owners and their representatives registered for the event, which provided them an opportunity to learn more about the committee's work in key areas and share their views on important issues. Major concerns raised by them included underfunding, dispensing at a loss, and challenges in implementing Pharmacy First. Attendees described the new service as "slow", "challenging" and "underfunded", while also highlighting the importance of improving GPs' understanding of the service.

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.

Victoria Atkins MP, the new Secretary of State for Health and Social Care, visited NPA board member Sukhi Basra (L) at CliniChem pharmacy in Central London on Thursday (16 November). Basra was accompanied by NPA Chief Executive Mark Lyonette. This was among Atkins' first appointments following her recent promotion in the recent Cabinet reshuffle. Atkins met with staff and patients to explore clinical services and discuss the evolving role of the community pharmacy sector. "Welcoming politicians and officials to my pharmacy is always a pleasure," Basra said. Basra highlighted the opportunity to brief the Health Secretary on the latest developments, including Pharmacy First.

It was an unprecedented move, to call for the first ballot in the 103-year history of the National Pharmacy Association (NPA), and now the organisation has warned that it's more than just a scare tactic and pharmacies will go through with action in January if there isn't an acceptable resolution forthcoming from the government. "We're looking for the government to consider our ballot, digest the results, and then come up with a proper proposal for community pharmacy - a fair deal," chief executive officer Paul Ree told Pharmacy Business. "If that's not forthcoming, we've got a board meeting in a couple of weeks, we then need to decide when to take action, but we would be looking at taking action in January." The NPA announced the results of the collective action ballot on 14 November in which nearly all pharmacy owners, who participated in the ballot, voted to limit their services, insisting that a lack of additional funding is jeopardising patient health and safety. "Our members have voted, they've spoken clearly, and unless the government come up with a fair deal soon, we will regrettably have to move to the next step, which is calling for action," said Rees.

A recently published report on medicines optimisation highlights the urgent need for transformative changes across all pharmacies to unlock their full potential in delivering integrated care. The report by Public Policy Projects (PPP) is first of the four in the series that emphasises the significant benefits that medicines optimisation can bring to integrated care systems (ICSs). This includes reducing health inequalities and improving population health. Pointing to the "untapped opportunity" that medicines optimisation presents for ICSs facing financial challenges, the report underscores the vital role of pharmacies in enhancing patient outcomes. The launch of the Pharmacy First services has already demonstrated the essential contribution of pharmacies to the health and care system. With "medicines being the second highest cost to the NHS," the report recommends ways "to achieve better value for money while improving patient outcomes".

The Pharmaceutical Services Negotiating Committee (PSNC) has expressed disappointment as the government continued to refuse to "a much-needed broader funding uplift" for the community pharmacies in England. This follows conclusion of the first Annual Review of the progress of the five-year Community Pharmacy Contractual Framework (CPCF) deal by PSNC, the Department of Health and Social Care (DHSC) and NHS England & NHS Improvement (NHSE&I). "We remain deeply frustrated by government's refusal to agree a much-needed broader funding uplift for the sector, but we are determined to continue to look for better ways forward for the sector throughout 2022 and beyond," said Bharat Patel, PSNC vice-chair, negotiating team member and an independent contractor. Patel noted that despite some important wins such as recognition of key challenges faced by pharmacies, the commitment to consider these as part of our Year 4 negotiations, and agreement to take forward work on service fee and other regulatory changes, the PSNC is disappointed that the review did not lead to "immediate and tangible outcomes and improvements for contractors." The negotiator had put forward data and analysis showing the capacity and cost constraints faced by pharmacies.

The Company Chemists' Association (CCA) has urged NHS England to expand the Pharmacy First service by increasing treatment options, adding more conditions, and integrating Independent Prescribing into the service. This would further promote pharmacists as antimicrobial stewards while enhancing patient access to urgent care, it said. Managing patient demand for antibiotics remains a challenge for healthcare professionals, including pharmacists. However, a new report by CCA confirms that pharmacists are acting as responsible providers of antibiotics, in line with Antimicrobial Resistance (AMR) guidelines. The service allows pharmacies to provide advice and treatment, including prescription-only medication, for seven common conditions: earache, uncomplicated urinary tract infections (UTIs) in women, sore throat, sinusitis, infected insect bites, impetigo, and shingles. Patients can access the service via GP referrals or by visiting or contacting a pharmacy directly.

Jonathan Rees, a member of the National Pharmacy Association (NPA), will become the first pharmacist to present oral evidence at the UK Covid-19 Inquiry hearings tomorrow (Thursday, 10 October). During the pandemic, Jonathan worked at Penclawdd Pharmacy near Swansea, while also supporting the NPA's efforts to respond to the extra needs of its members across Wales during the peak of the crisis. Jonathan is expected to give evidence about the role and responsibilities of pharmacies during the pandemic, the impact of the pandemic on pharmacy services, working conditions and medicines supply, and the challenges faced in obtaining Personal Protective Equipment Equipment (PPE). Commenting on the significance of this milestone, NPA chief executive Paul Rees stated: "The NPA is proud to be telling the story of the vital role pharmacies played during the Covid pandemic, and ensuring that our members' voices are heard in this inquiry.