Pharmacy bodies have urged the Health Select Committee to hold the government to account on pharmacy funding and workforce challenges.
In a show of unity, leaders from the sector came together to write a joint letter to the chair of the committee and former health secretary Jeremy Hunt and bring to
his attention how financial pressures worsened by nearly a decade of a real-term decrease in funding have made the sector virtually untenable.
The Pharmaceutical Services Negotiating Committee (PSNC)'s recently published 'Pharmacy Pressures Survey' confirms how this has had an impact on pharmacy contractors,
their teams as well as patients.
The survey found that 91 per cent of pharmacies are experiencing staff shortages. At the same time, demand for community pharmacists has risen - nine in ten pharmacy
teams reported a significant increase in phone calls from patients about prescriptions, and 86 per cent reported a rise in requests for healthcare advice.
The letter to Jeremy Hunt is signed on behalf of the four chief executives of the PSNC, the Association of Independent Multiple Pharmacies (AIMp), the Company
Chemists' Association (CCA) and the National Pharmacy Association (NPA).
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".
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.
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Digital pharmacy app Charac has raised over £1 million in debt and equity, bringing total funding to date for the London-based startup to £2.5m.
Pharmacy Business understands while the majority of the new finance, worth about £1.2 million, comes from the National Pharmacy Association (NPA) coffer, the
remainder is put forward by a number of individual pharmacy businesses.
The pharmacy sector is in a state of crisis, experiencing nearly two closures per week over the past two years, Charac said in a statement.
According to data from the NHS Business Services Authority, there are now only 11,026 community pharmacies in England, the lowest number since 2015. The current
crisis is attributed to escalating operational costs, a shortage of staff, and diminished government financial support.
The Health Select Committee Expert Panel has concluded in its report published on Tuesday (25 July) that the funding aspect in the community pharmacy sector
'requires improvement' based on the evidence received.
The Expert Panel reviewed nine Government commitments, seven of which were from the Community Pharmacy Contractual Framework.
It was found that available funding was not sufficient to keep pharmacies open, struggling financially with increased demand for dispensing, workforce pressures
and rising costs due to inflation. One of the other commitments requiring improvement covered a scheme intended to protect access to local physical NHS pharmaceutical
services in areas where there were fewer pharmacies.
Professor Dame Jane Dacre, Chair of the Expert Panel, said: "Pharmacy plays a key role in the delivery of care so it's disappointing that progress overall to
deliver on the Government's commitments was rated as 'requires improvement'.
There is clear evidence that the majority of distance selling pharmacies are operating in breach of their NHS contracts, and a failure to properly
regulate 'pseudo' distance selling pharmacies is leading to local pharmacy closures, the Company Chemists' Association has reported.
According to the CCA's recent findings, 72 per cent of DSPs dispense over 50 per cent of their prescriptions to patients within a single postcode area within
10 miles of the pharmacy.
"Operating within constrained geographical regions, pseudo-DSPs achieve reduced overheads and operational costs by focusing on localised marketing and medicine
delivery. They compete against local brick-and-mortar pharmacies, causing them to lose vital trade," the CCA claimed, based on its recent survey - The Impact of
Pseudo Distance Selling Pharmacies.
"As per their terms of service, DSPs are obligated to provide prescription delivery nationwide, extending beyond local patients," said the CCA, adding that the
financial savings resulting from the lack of patient access are balanced by the necessity to function on a national scale.
Whether it's the effects of the coronavirus pandemic and those suffering with long Covid, or the financial pressures of rising living costs, these hard times
can affect absolutely anyone's mental health.
Mental health problems have worsened across all age-groups in the last few years, from lack of social interaction, unexpected bereavements or the significant impact
of a physical injury or long-term illness taking its toll on mental wellbeing - these challenging experiences and situations that we face throughout life leave a
big strain on the population.
Ultimately, there is an urgent need to reduce rising levels of mental ill-health in our society. As a pharmacist with 25 years' experience in healthcare, I feel I
have an obligation to my patients to support them with their healthcare needs, and mental health should be treated just the same as physical health.
Despite efforts to improve NHS mental health services, patients may still not be receiving the appropriate immediate care as they are often provided with online
counselling or an App for long-term support (online support introduced since the pandemic).
Community pharmacists are in a unique position to be advocates for patients with mental illness as they are the healthcare professionals' patients see most often.
This is a good opportunity for pharmacists to speak to patients face-to-face and give them advice in a more practical way rather than potentially waiting weeks for
an GP appointment.
What skills does a pharmacist need these days? You'd think it would be sufficient to have a good understanding of pharmacy and the ability to offer a great
patient service. Whilst this is true of course, the reality of the day to day role demands skills which most pharmacists have not been trained for as part of their
formal qualification.
At the very least, pharmacists find themselves responsible for running the pharmacy, managing people, managing processes and dealing with issues relating to customers,
suppliers, surgeries, regulators and stakeholders. Even the most junior pharmacists quickly find themselves being accountable for the financial performance of their
department and having to work within budgets or deliver on targets.
Remarkably, despite the apparent lack of any formal training in these areas, pharmacists have been able to adapt and meet the challenges of whatever their job has
thrown at them.
Many pharmacists go even further, bringing out their inner entrepreneurial spirit to set up their own business. There are now over 6,000 pharmacy businesses owned by
independent pharmacists, with this segment growing.
Whilst pharmacists have historically adapted to their environments and picked up the necessary business skills, the rapidly changing landscape of pharmacy will
require pharmacists to establish new skills to help ensure their businesses survive and thrive.
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.
The NHS has made major improvements across long waits, urgent and emergency services, and cancer care, latest performance figures published on Thursday (11)
have shown.
The number of patients waiting more than 18 months fell to 10,737 by April - down by more than 90 per cent from 124,911 in September 2021 and by more than four-fifths
since the start of January when there were 54,882.
Around half of NHS trusts in England have no patients on their elective care waiting lists apart from those who have chosen to wait longer. More than one in
five (21%) trusts had completely eliminated 18-month waits.
However, the overall waiting list has risen to over 7.3 million entries in England.
"I promised I would cut NHS waiting lists and we are delivering," Prime Minister Rishi Sunak said. "Reducing 18-month waits by over 90 per cent is huge progress,
and it is testament to the hard work of NHS staff who have achieved this despite one of the busiest winters on record.
"We still have work to do, but backed by record government investment and the ongoing efforts of the NHS, I am confident we will get patients the care they need
more quickly."
Ambulance response rates have improved to their fastest in two years, with average category two response times now at 28.5 minutes and category one at 8 mins.
The 62-day cancer backlog has fallen for the first time since before the pandemic, with those waiting two months or more down from 21,823 at the end of the last
financial year (March 2022) to 19,248 at the end of this March (2023). This is down almost 15,000 from a peak of 34,000 in July 2022.
After the government announced to award pay rise to pubic sector workers, pharmacy trade bodies have expressed their disappointment at the neglect shown
towards funding crisis in community pharmacy.
The National Pharmacy Association (NPA) chair, Andrew Lane, said: "Our sector can't help but feel utterly neglected after seven years of crushing real terms cuts
to pharmacy funding, amounting to half a billion pounds, and no hint of any relief to come.
"This week's public sector pay awards, which include a large number of our health service colleagues, highlight that there's an unresolved funding crisis in
community pharmacy which needs urgent attention."
"Four months into this financial year, there is as yet no clarity even on current arrangements."
"After stepping up to tackle Covid and keep the wheels on the NHS, the sector deserves better than to be neglected in this way," Andrew opines.
The Pharmaceutical Services Negotiating Committee (PSNC) has expressed its concerns over sustained pressures on medicines supply that are having a very
serious impact on community pharmacy teams and their patients.
It has asked contractors and their teams to continue using its regular reporting tools to help them demonstrate the scale of the problems to the Department of
Health and Social Care (DHSC) and to support escalations as needed.
The committee said: "The sustained increases in price concessions that we have seen so far in 2022 - with more than 100 concessions being granted in some months -
show no signs of abating, and we know that many pharmacies now find themselves in a critical situation trying to source medicines in timely manner and facing
significant financial risk due to greater uncertainty around expected reimbursement prices for a large number of medicines."
"We know that some concessions being imposed by the Department do not match contractors' experience on the ground, and we would ask all contractors to continue
reporting pricing issues to us on a regular basis to support our representations: Report product over Drug Tariff price."
The Pharmacists' Defence Association (PDA) is probing major concerns arising from Boots' communications to pharmacists regarding the company's recently
announced pension arrangements.
In November, Walgreens Boots Alliance (WBA), the parent company of Boots, transferred the Boots employees' pension scheme to the financial service provider Legal
and General (L&G) in a £4.8 billion deal.
Boots notified staff that terms allowing an unreduced pension from age 60 have ceased immediately, following its agreement with L&G.
The PDA highlighted member concerns regarding Boots management's announcement that an unreduced pension from the age of 60 is a discretionary benefit and not
guaranteed under the Boots Pension Scheme (BPS), contrary to some members' assumptions.
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The Pharmaceutical Services Negotiating Committee (PSNC) has published a guidance for community pharmacies to help them in the implementation of the new
Prescription Prepayment Certificate (PPC) for hormone replacement therapy (HRT).
The new policy will rollout from 1 April 2023, patients who are not already exempt from NHS prescription charges will be able to purchase an annual HRT PPC for the
cost of two single prescription charges
Major concern raised by PSNC is that the NHS systems have not kept pace with policy, as the certificate is launching without the IT in place to support it.
PSNC has been clear that this is totally unacceptable, including raising this with Ministers directly and warning them that introducing the PPC without this
infrastructure risks causing confusion for some patients and adding to the burden for pharmacy teams.
"Government recognises the challenges but is determined to move forwards with the policy, said the committee. "DHSC has recognised the impact this will have on
pharmacies and we are still pressing for appropriate financial compensation. We have also sought guidance for GPs, and now published our own guidance to try to
make the launch go as smoothly as it can for pharmacy teams."
There has been a lot of coverage in the national and pharmaceutical press of the prices being charged to pharmacy owners for certain medicines.
Leaving aside the reasons for steep price rises, I have been asked on social media and elsewhere whether pharmacy owners can refuse to supply prescribed medicines
if they would make a significant financial loss.
Legal obligation
The first thing to point out is that the National Health Service Act 2006 imposes a legal duty on the Secretary of State and NHS England to make arrangements for
people to receive sufficient prescribed drugs.
These arrangements involve the publication of the Drug Tariff.
The Drug Tariff includes reimbursement prices or a method for determining prices. Various factors can be taken into account in determining reimbursement prices. The
Drug Tariff does not provide a pound for pound reimbursement for medicines that pharmacies supply on NHS prescriptions.
What will it take to get help from the government before an individual or sector breaks? Pharmacists raised questions after the Pharmaceutical Services
Negotiating Committee (PSNC)'s 2023 Pharmacy Pressures Survey confirmed the ongoing pressures and health issues faced by the pharmacies.
Pharmacists are not all shocked by the PSNC's survey report as they feel the same as what has been reported related to their businesses and health. They hope
the government listens and work with them to find resolutions.
"We are bullied into a corner," said Salim Jetha Chairman, Avicenna.
"Unlike other industries, we can't increase our prices. Most of the daily calls I get from Independents is about financial health of their business and any cost
cutting would be detrimental to patient care. Urgent holistic review is required."
Bristol pharmacist Ade Williams said: "The report is a dire indictment, and I would also warn, likely an underestimate of the extent and detrimental impact of the
ongoings pressures and squeeze on Community pharmacies."
"If the closest interface of the NHS to communities and patients is so distressed, what does that mean for those that need and depend on us? We are notoriously very
stoic, so this is a warning light, which, taken with workforce pressures, market-exit activity, and other reports raising concern about wellbeing and stress, must
beg the question; what will it take to get help before the sector and individuals break?" he questioned.
The survey results don't surprise Kent-based community pharmacist Amish Patel. He said, "I have been feeling exactly what has been reported for far too long. I'm
burnt out and would say beginning to suffer with my own health because of it. Now it's for PSNC to talk to government, and government to listen and work with us to
find resolutions."
Community pharmacies will be able to deliver approximately 15 million blood pressure screenings by 2026, revealed the Company Chemists' Association (CCA)'s new
research.
This will also prevent 15,000 people from suffering heart attacks or strokes. CCA has called the Government to take up their offer and commission pharmacies as the
first port of call for cardiovascular care.
"Thousands of lives can be saved with ambitious commissioning and the investment to match," said CCA.
There is an opportunity to use the expertise of community pharmacy to go further and provide the care these newly identified patients' need. To do this the sector
needs funding and workforce.
The association said: "Community pharmacy is under great financial pressure, suffering a real term funding cut of over 30% over 8 years. With funding, the sector can
transform to deliver this critical need for patients.
Whilst there are plans to train Independent Prescribers (IPs), there are no clear roles for them to use these skills. There is a need to accelerate training plans to
allow pharmacists to deliver the service described here and play their part in CVD management."
In a significant move to enhance the working conditions of over 50,000 postgraduate doctors in the National Health Service, NHS England has unveiled a
series of measures aimed at providing greater choice and opportunities to the new entrants in the medical profession.
With flexible rotas, reducing payroll errors, and easing the financial burden of course fees, the NHS has taken steps to address the issues faced by junior
doctors in order to support their well-being.
In recent announcement, 83 per cent of senior doctors and dentists accepted the government's pay offer.
Alongside the junior doctors who still fighting for fair pay and recognition, the senior medical professionals demanded that the authorities help them tackle
issues pertaining underfunding and overworking in the NHS.
Junior doctors in training also often face challenges with frequent moves between trusts, leading to short notice changes in work schedules and duplicated
inductions when transitioning to new hospitals.
As a measure taken by the health serivces, the committee aims to review the minimum legal requirements for statutory and mandatory training, potentially halving
the time burden for such training and allowing doctors to spend more time caring for patients as part of the long-term workforce plan.