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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).

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."

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.

A combination of factors, including the doctors' strike, medicine shortages, and funding scarcity, indicates that this upcoming winter could be the most challenging period for both community pharmacies and the NHS, Community Pharmacy England has said. In a September 4 blog post, CPE Chief Executive Janet Morrison emphasised that the relentless pressures show no signs of easing. "Pharmacy businesses, like numerous other sectors, are grappling with the challenges of staying afloat in the current economic climate, compounded by the detrimental effects of historical funding cuts." "The doctors' strike, despite ongoing assurances from the Health Secretary that their pay deal is final, will inevitably exacerbate the demand for both primary and secondary care, leading people to turn to their local pharmacies for assistance," she added. "This, in turn, will heighten the pressure on community pharmacies." "Whatever the coming winter brings I am sure of two things: that community pharmacies are going to be more critical to the health of the population than ever before, and that your representatives here will be fighting on all fronts to get you the help that you need."

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 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.

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 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 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.

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.

Ninety-six per cent of community pharmacists surveyed in the Royal Pharmaceutical Society (RPS) Workforce Wellbeing survey said they were at 'risk of burnout'. A higher number of respondents working in community pharmacy (20%) reported not being offered breaks compared to all other sectors (8%) and were more likely to experience verbal or physical abuse from patients and the public (69% vs an average 44%). The annual Workforce Wellbeing survey also revealed that 88 per cent of pharmacists surveyed are at high risk of burnout due to winter pressure. Therefore, RPS is calling for workforce planning for pharmacy to address skill mix and staffing levels so that workloads can be effectively managed. Top factors causing poor mental health and wellbeing revealed by the survey include inadequate staffing (70%), lack of work/life balance (53%), lack of protected learning time (48%) and lack of colleague/senior support (47%). This is the fourth survey RPS has run in partnership with the charity Pharmacist Support on the state of mental health and wellbeing in pharmacy. The findings demonstrate continued pressure on pharmacists and trainees across the workforce, especially in community pharmacy where 96% of those surveyed said they were at risk of burnout.

Teva UK has alerted the Secretary of State for Health and Social Care to the problem posed by steep energy prices. Teva's UK General Manager Kim Innes wrote to the minister seeking assurances that the distribution of medicines to patients will be safeguarded over what's likely to be a difficult winter. The problems posed by steep energy prices and the potential for power rationing is putting pharmacies under pressure from increased costs and the risk of losing power supplies as a 'non-domestic' energy user, said the company. Kim said: "In our letter to the Secretary of State we acknowledged that the government knows that medicines manufacture is strategically important and that it's a vital component in maintaining patient health." "But I wanted to make sure that the Secretary of State also realises the consequences of the energy crisis further down the supply chain - for example, the need for a pharmacy to have a fridge switched on at all times for storing cold chain products."

Community Pharmacy England (CPE) is seeking views from all community pharmacy owners about the pressures faced this autumn season. A survey has been launched as the "November Pre-Committee Opinion Poll" until 6 November to seek views from independents and non-Company Chemists' Association (CCA) members. The results of the poll will be sent to the head offices of CCA multiples next week for discussion at the November Committee Meeting. CPE confirmed: "The results of these polls and the outcomes of the meeting will be reported back to the sector afterwards. They said that the survey "will be used to feed into our ongoing work to press for an uplift to core funding by enhancing our evidence base of what pharmacy owners are experiencing."

To support NHS, clear the backlog created by the Covid-19 pandemic and help community pharmacies support more people, the Welsh government has announced an allocation of further £12.5 million funding. Of the total amount, £10mn will be distributed across the 22 local authorities to buy equipment to help people to live independently in their own homes post hospital stay. The remainder, £2.5mn, will be used to support community pharmacists and patients to improve access to treatment and advice for a range of common ailments. The move is aimed at alleviating waiting times and reducing winter pressures on the NHS. Commenting on the announcement, Elen Jones, Royal Pharmaceutical Society director for Wales said: "We are delighted that the Welsh government continue to recognise the value of pharmacists in patient care and we welcome this additional investment and support for Community Pharmacy teams across Wales.

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."

British health officials on Wednesday (September 28) warned that increased circulation of flu and a resurgence in Covid-19 could lead to a difficult winter that increases pressure on the already stretched NHS. Warnings over a possible "twindemic" of Covid-19 and flu have been issued each winter since the start of the coronavirus pandemic in early 2020, but Covid restrictions that limited social contact have meant flu levels stayed low. However, the government ended coronavirus restrictions earlier this year, meaning that social contact rates have returned to near pre-pandemic norms while immunity to flu is relatively low. The UK Health Security Agency (UKHSA) said that given the risk it was important those eligible took up vaccines against Covid and flu. "There are strong indications we could be facing the threat of widely circulating flu, lower levels of natural immunity due to less exposure over the last three winters and an increase in Covid-19 circulating," said Susan Hopkins, chief medical advisor at UKHSA.

Winter pressures are already mounting on NHS staff ahead of December, with high levels of demand in hospitals due to a significant increase in cases of norovirus infection. Norovirus is a highly contagious virus which spreads through contaminated food, water or surfaces and causes vomiting and diarrhea. New NHS figures revealed that an average of 351 people were hospitalised with diarrhoea and vomiting symptoms every day last week in England, almost triple the number during the same period last winter, which was 126. The number of children in hospital with the virus was also higher last week (13) compared the same week last year (an average of just three), according to the weekly winter update published by the health service on 30 November.

NHS England is rolling out a range of tech and data solutions, including an artificial intelligence (AI) system, across the health service to tackle winter pressures. The AI system will be used to identify patients at risk of hospital admission so community NHS teams can get to them first and reduce pressures on A&E departments. On a trial basis, four GP practices in Somerset have started using the innovative technology which can highlight registered patients with complex health needs. Health coaches, nurses, or GPs will then reach out to the people most at risk, and provide them with a range of preventive care such as monitoring, food parcels, cleaning, shopping, as well as escalating care to specialist doctors.