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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 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).

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.

Wes Streeting's speech at the Labour Party Conference 2024 outlines several key health and social care reforms, which hold significant implications for community pharmacy in England. His focus on reforming and rebuilding the NHS to ensure fair, universal access to care, with prevention and early intervention at its core, presents both opportunities and challenges for community pharmacy. Here are the potential implications: 1. Prevention Focus Streeting's vision of a shift from a reactive, hospital-based model to a preventive healthcare system presents a promising future for community pharmacies. These changes could significantly reduce pressures on GPs and hospitals, integrating pharmacies more closely into primary care networks and enhancing their role in preventive care. 2. Digital Transformation The move from an "analogue to digital" NHS could see community pharmacies adopting more digital tools and systems for service delivery. This would likely involve greater use of digital prescribing, telehealth consultations, and AI-driven services. Pharmacies will need to invest in digital infrastructure and ensure that pharmacy professionals are trained to operate within a more tech-centric environment. 3. Reform and Redistribution of Services Streeting's plans to extend choice and equitable access to services mean that community pharmacies could become integral to providing care in underserved or disadvantaged areas. With a focus on decentralising healthcare and bringing it closer to local communities, community pharmacies could play a more significant role in supporting healthcare delivery in areas where GP services are stretched. This may include expanding access to pharmacy services in the most deprived areas, aligning with Labour's emphasis on addressing health inequalities.

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.

Pharmacies are valuable healthcare assets, meeting increasing public demand. However, a substantial portion of their capacity is consumed by unfunded work. According to Community Pharmacy England's (CPE) 2024 Pharmacy Advice Audit, community pharmacies conduct over 1.3 million unfunded consultations each week, equating to 69 million annually. The average pharmacy completes around 22 of these consultations daily, each taking approximately 5.6 minutes of staff time -adding up to over two hours daily. This represents nearly 50 per cent more consultations than in 2020 and a 78 per cent increase in time spent on unfunded healthcare advice since the 2020 audit. The audit, which surveyed over a third (3,916) of community pharmacies in England earlier this year, also highlights that pharmacies handle nearly 150,000 informal referrals from GPs and NHS 111 each week. All these referrals could have been routed through the Pharmacy First service, which would have potentially secured over £115 million in funding for the sector, the CPE noted.

A recent analysis conducted by the Company Chemists' Association (CCA) has revealed stark disparities in patient engagement with the Pharmacy First service across the country, likening the pattern to a 'patchwork quilt'. It indicated that patients in the highest-performing Integrated Care System (ICS) received seven times more Pharmacy First consultations than those in the lowest-performing regions. As of April 21, more than 3,000 CCA member pharmacies had delivered 126,484 Pharmacy First consultations since the programme's launch. However, the analysis found significant regional variations, with nearly 13,000 consultations completed in the North East and North Cumbria ICS, while only 948 were completed in Gloucestershire ICS. The CCA calculated that if every ICS had as many consultations as the highest-performing ICS, there would have been an additional 600,000 Pharmacy First consultations nationwide.

The Council of Pharmaceutical Society NI acknowledged the contribution of pharmacy technicians in Northern Ireland on 'Pharmacy Technician Day' celebrated on 18 October. The society said: "Today we mark Pharmacy Technician Day and wish to acknowledge the significant contribution Pharmacy Technicians and support staff make, as an integral part of the pharmacy team, to patient wellbeing and care in Northern Ireland." In June, Health Minister Robin Swann announced that he has approved work to begin to bring Pharmacy Technicians in Northern Ireland under statutory regulation by the Pharmaceutical Society of Northern Ireland. The public consultation was launched in March 2022 on a proposal to introduce statutory regulation of the Pharmacy Technician workforce in Northern Ireland.

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."

Community pharmacy continues to play a crucial role in providing patients with access to essential NHS care through the Pharmacy First service, especially when other parts of the healthcare system are difficult to reach. According to the Company Chemists' Association (CCA), the sector delivered an estimated 65,000 Pharmacy First consultations in the week leading up to Christmas, marking a 10 per cent increase compared to previous weeks. At a Rowland's Pharmacy in Warsop, Mansfield, pharmacist Taseta saw a notable rise in the number of patients seeking consultations for sore throats, particularly among school children and staff. The pharmacy also experienced an increase in urinary tract infection (UTI) consultations, while earache cases remained consistent. Taseta explained the surge, noting, "Lots of people do not want to be ill over Christmas so [they] wanted easy and quick access to care, which we could do in the pharmacy." They also saw more patients engaging with the Pharmacy Contraception Service, which Taseta attributed to time constraints at the local surgery.

The Pharmacists' Defence Association (PDA) has raised concerns over "certain elements" of the Pharmaceutical Society of Northern Ireland (PSNI)'s consultation on pharmacy staffing levels. PSNI recently consulted on its draft guidance for pharmacy staffing levels which sets out to explain what pharmacy owners and superintendents must do to ensure that each pharmacy has enough skilled and qualified staff. This includes having an appropriate skill mix, to provide safe and effective pharmacy services which comply with the standards. PDA said that the role of the 'responsible pharmacist' has not been "fully acknowledged" and that more clarification is needed. The association has made a few recommendations to PSNI that includes: the guidance must explicitly recognise the statutory role of the responsible pharmacist and their authority in securing the safe operations within the pharmacy. "The guidance should specify that pharmacy owners and superintendents must ensure that they do not set incentives or targets which may compromise the professional judgement of staff." It also recommended that unregistered staff (including unregistered managers) are accountable firstly to the responsible pharmacist for any activity involving the clinical care of patients (for example unregistered managers must not interfere in diary bookings for vaccinations).

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.

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."

Pharmacy Minister, Will Quince received flu vaccination and blood pressure check at his visit to a Boots pharmacy in Westminster arranged by the Company Chemists' Association (CCA). The Boots pharmacist, Flavia, explained to the Minister the broad range of services the pharmacy delivers, from the new medicines service to emergency contraception and the community pharmacy consultation service. The Minister witnessed first-hand much of what the community pharmacy sector has to offer patients and the NHS. Malcolm Harrison Chief Executive of the CCA said: "We share the Minister's vision on how community pharmacies and their teams can contribute to the 'Plan for Patients' set out by the Secretary of State. It is great to have the support of the Minister and we are excited for the future of pharmacy.

The implementation of the 2017 standards for the initial education and training of pharmacy technicians (IETPT) has improved the performance and preparedness for practice among recently registered pharmacy technicians and the wider workforce, according to a new study. Results of the 2023 research study commissioned by the General Pharmaceutical Council (GPhC) showed that 72 per cent of pharmacy technicians felt "well prepared" for practice after training. More number of pharmacy technicians in the community pharmacy expressed readiness for practice (82 per cent) than their peers in the hospital pharmacy (64 peer cent). Led by the Centre for Pharmacy Workforce Studies (CPWS) at the University of Manchester and the consultancy service, ICF, the study involved 142 recently registered pharmacy technicians and 21 employers and supervisors of trainees. Overall, 96 per cent of the surveyed respondents believed that the course effectively covered person-centred care, professionalism and professional knowledge and skills.

In response to a Scottish government consultation, the National Pharmacy Association (NPA) has called for continued investment to develop community pharmacy teams and create additional capacity in existing services. The consultation examines different ways patients access healthcare services in Scotland and focuses on sources of healthcare other than GPs that exist in the community. The inquiry was discussed with NPA policy leads across the UK, NPA Scottish members and other Scottish pharmacy stakeholder organisations. The NPA stated that services delivered during the pandemic has proven the importance of Scotland's 1,258 community pharmacies, and believes additional capacity for existing pharmacy services, and expansion of pharmacy Public Health Services is possible with continued investment from the government.

The General Pharmaceutical Council (GPhC) has called for comments and views on the recently launched consultation on selecting the appropriate mode of consultation when assessing a person's needs by pharmacy professionals including pharmacist prescribers. The guidance note sets out what the pharmacy professional or prescriber, in agreement with the patient, needs to consider when selecting the mode of consultation - such as face-to-face; video-link, video-chat, or other online platforms; telephone and online questionnaires - best suited to gaining the information needed to deliver safe and effective pharmacy care. The principles outlined in the guidance apply to consultations undertaken in all pharmacy settings, including those undertaken by online pharmacy services providers. "Our plan is to include the contents of this guidance note in the document: 'In practice: Guidance for pharmacist prescribers' when we undertake our next review," said the regulator.

The Royal Pharmaceutical Society (RPS) has been on the lookout for innovative ideas and suggestions that could transform the future of pharmacy practice in England over the next decade. The society's new project with the King's Fund to transform the future of pharmacy practice in England is at a consultation phase, seeking views and opinions of pharmacy teams from all areas of practice including primary, secondary, social and community care to ensure that the system gets the best out of pharmacy and the public receives seamless, joined-up care. "We want to build a vision that sets out the role of and value of pharmacists and pharmacy teams working across systems, providing patient care and NHS services," said RPS in a statement. "Transforming the future of pharmacy practice recognises the urgent need to build on new ways of working established across health and care systems during the pandemic to meet the increasingly complex health needs of people and improve patient outcomes."

Northern Ireland's chief pharmaceutical officer paid a visit to a community pharmacy in Belfast on Monday (November 7) - marking the end of this year's Ask Your Pharmacist week, an annual public awareness campaign launched by the National Pharmacy Association. Cathy Harrison interacted with patients and staff in the pharmacy before recording a video to promote NI's 'Pharmacy First' service in which she described community pharmacies as "one of the front doors to the health service" with over 500 outlets located across the country. "In our community pharmacies you can always rely on friendly staff, medicines expertise, and walk-in access to face-to-face advice," she said. First launched in Scotland, the NHS Pharmacy First service enables patients to have a consultation with a pharmacist for advice on minor ailments. Ms Harrison also drew attention to community pharmacy's role in cancer awareness and helping people to quit smoking, as well as managing patients with urinary tract infections, in addition to playing their part in delivering Covid-19 and flu vaccinations.

Pharmacy technicians will soon be recognised as fully regulated healthcare professionals in North Ireland. Work has begun to bring pharmacy technicians under statutory regulation by the Pharmaceutical Society of Northern Ireland, health minister Robin Swann has announced. The public consultation was launched in March 2022 on a proposal to introduce statutory regulation of the Pharmacy Technician workforce in Northern Ireland. The minister said: "This will be a key enabler to enhancing the contribution that pharmacy technicians can make to the delivery of healthcare across all settings. It will allow the regulator to strengthen its role in protecting patients and promoting high standards, thereby enhancing the public's confidence and trust in pharmacy practice." He added: "While there are many practical issues to be worked through with stakeholders, and legislative change required, I have now instructed my Department's officials to develop a detailed project plan to bring about the statutory regulation of pharmacy technicians by the Pharmaceutical Society of Northern Ireland".