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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 community pharmacy bodies, along with England's largest pharmacy chains, have urged the Prime Minister, Rishi Sunak to resolve fund and workforce crisis in the sector. In the joint letter the Chief Executives of Association of Independent Multiple Pharmacies (AIMp), Company Chemists' Association (CCA), National Pharmacy Association (NPA) and Pharmaceutical Services Negotiating Committee (PSNC), along with Boots, Lloydspharmacy, Well and Rowlands Pharmacy, said they are pleased to see Government now recognising the key role that community pharmacy' could have in alleviating the strain on other NHS services. However, the associations also warn that although the sector is ready to support, 'this will not be possible unless pharmacy is properly funded.' Janet Morrison, PSNC Chief Executive, said: "The Prime Minister should also know that community pharmacies are also facing a crisis. They need sustainable investment, urgently, if we are to avoid devasting consequences for pharmacies and for their patients." The letter calls on Government to help pharmacy to resolve the funding, workforce and capacity issues engulfing the sector. It said: "Community pharmacies are in crisis and after 7 years of 30% funding cuts have reached their limit."

A survey of over six thousands pharmacies has revealed that the community pharmacy sector is buckling under growing cost and capacity pressures. The survey conducted by the Pharmaceutical Services Negotiating Committee, which also involved two thousand community pharmacy confirms, rising costs, patient demand and medicine supply issues continue to grip the sector. PSNC's 2023 Pharmacy Pressures Survey, run as a follow up to the 2022 pressures survey, provides clear comparative data showing the worsening situation across the sector. Govt must act now The result of the survey indeed paints a bleak picture for community pharmacies and it is clear that without urgent action from government and the NHS this will only get worse: more community pharmacies will either be forced to reduce the number of services they provide or, in the worst-case scenario, will be left with no option but to close their doors for good. The PSNC has urged the government to act now "to save our pharmacies, before it is too late for patients, the public, and the rest of the NHS". "This year's survey clearly shows that community pharmacies are buckling under growing cost and capacity pressures," said PSNC Chief Executive Janet Morrison.

The Company Chemists' Association (CCA) has published a 'pharmacy paradox paper' which outlines how community pharmacy can match the ambition amidst the workforce crisis. The sector is experiencing a workforce crisis, exacerbated by NHS recruitment of community pharmacists into primary care networks. Pharmacies are also facing a significant increase in demand on services. CCA said, "A stretched and reduced pharmacy workforce is having to deliver more and more. This is unsustainable." "Unless the tension between ambition and capacity is addressed, there is a risk that community pharmacies will not only not meet their potential, but the existing offer could be compromised." Therefore, the association has set out solutions to resolve the current paradox between ambition and reality.

Prime Minister Rishi Sunak was questioned whether he 'will take urgent action to prevent pharmacy closure'. At Prime Minister's Questions (PMQs) in Parliament held on Wednesday (26 April) he replied, "we will continue to do everything we can to support community pharmacies." Labour MP for Knowsley and All-Party Pharmacy Group member, George Howarth said: "Given the chronic lack of capacity in the NHS, the Prime Minister will be aware that community pharmacy can help deal with minor illnesses. But there is a problem on average 10 Pharmacy close every month in England." Prime Minister was further asked "will he take urgent action to prevent further closing and commission a properly funded 'Pharmacy First' service for minor illnesses? Sunak replied: "I've been a wholehearted champion and believer in the role that community pharmacists can play. we want to make sure that they can do everything to ease some of the pressures in primary care.

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) 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.

Pharmacy bodies are "bitterly disappointed" that the latest deal on the national contract makes no commitment to "fresh funding", with one organisation calling it "the biggest dis-service ever done" to community pharmacy. The only commitment made in monetary terms was one in which NHS England agreed to write off a sum of £100m in excess margin earned by contractors in previous years. This allowance, which can't be seen as new cash injection, was said to have been made in recognition of the pressures facing the sector. The figure - reached after what the the Pharmaceutical Services Negotiating Committee called "a tense period of negotiations" with the Department of Health and Social Care and NHS England - will cover the final two years of the current five-year Community Pharmacy Contractual Framework. The deal was announced by PSNC chief executive Janet Morrison at an annual LPC Conference in Manchester on Thursday (22 September). Welcoming the attendees, she assured everyone that the committee was well aware of the pressures the sector was facing. "I heard how contractors are feeling and their frustrations over growing pressure and lack of financial support from the government. They confirmed that many now are unable to deliver the full range of services, and others are struggling to maintain core levels of services. And the ongoing impact of capacity and workforce crisis is critical, leading to temporary closures.

The new Labour government has pledged to deliver an extra 40,000 NHS appointments, operations and diagnostics every week, equivalent to two million a year, to tackle the ongoing waiting list crisis. It aims to ensure that 92 per cent of patients start routine hospital treatment within 18 weeks by the end of this parliament - a target that has not been met for nearly a decade. However, a new analysis by healthcare consultancy CF (Carnall Farrar) and the NHS Confederation has revealed that these extra appointments alone will not be enough to achieve the 18-week Referral To Treatment (RTT) target by 2028/29. The study estimates that 40,000 extra appointments per week would deliver only about 15 per cent of the additional activity required to hit the 18-week target, assuming demand continues to grow at current rates and care delivery remains unchanged. While the report acknowledged that increasing capacity is a positive step, it stresses that further reforms and transformations in care pathways are necessary to bridge the gap.