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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 Pharmaceutical Services Negotiating Committee (PSNC) has commissioned Nuffield Trust and The King's Fund to develop a new vision and strategic options for community pharmacy. The report is expected to be published in early summer next year, to underpin the future strategy for the sector. It will also support negotiations between PSNC and policymakers as the current five-year Community Pharmacy Contractual Framework (CPCF) comes to an end. Those negotiations will decide what happens after April 2024, and they will be critical to the future of the sector. The development of a compelling vision and an effective strategy for community pharmacy was a key recommendation from the Pharmacy Representation Review Steering Group (RSG). It forms one of the workstreams of the Transforming Pharmacy Representation Programme (TAPR) currently being undertaken by PSNC. But it is also a project that PSNC wants to undertake anyway to help lay the foundations for those crucial upcoming negotiations.

Community pharmacies are located within the very hotspots of peoples' communities, yet a staggering 720 individual businesses have stopped trading since 2015. It has been called a "national disgrace and a betrayal to the elderly and the vulnerable" by sector leaders. The funding crisis has been compounded by a gruelling 18-24 months post-Covid, both have which have placed immense pressure on the retail pharmacy sector. The population is aging and with this comes patients living with a range of long-term health conditions. Medication regimes are becoming ever more complex and as a result, maintaining prescription and medication adherence services is challenging to say the least. Yet the public feel great warmth towards their local pharmacy businesses, and this positive attitude only increased during the pandemic. In fact, in a recent report launched by Omnicell on the Changing Role of the Pharmacist, a survey of public opinion found that a third (32 per cent) said they perception of their local pharmacy had changed for the better since the start of the pandemic and nearly half (44 per cent) said they are more familiar with their local pharmacy services since the start of COVID. This has meant that the role of the pharmacist has also changed and evolved; in part due to a national need and drive for more patients to be seen and supported clinically by pharmacists. This change of service provider role has slowly been developing over the last couple of years. Pharmacists are currently carrying out 65 million consultations a year - a staggering rise of 44 per cent in the last 24 months alone.

After engaging with contractors and stakeholders of NHS Community Pharmacy, the pharmacy review steering group (RSG) is planning to put proposals to contractors' vote before Easter 2022. The group, made up of representatives from the Association of Independent Multiple Pharmacies, Company Chemists' Association and independent community pharmacy, was formed in late 2020 to explore the future of community pharmacy network support. After engagement with the sector, the RSG has defined the roles of the local and national representative bodies, considered the contractor decision-making process, and worked through analysis and suggestions on local representation. It is now focusing on national representation and support.

Dispensing activity by community pharmacy in England has witnessed a 4.2 per cent increase across the year 2021 till March 2022, the Pharmacy Market Review 2022 report revealed. The report launched by Christie & Co, said: "All pharmacy settings saw improvements in dispensing numbers, with standard community settings seeing the highest increase of 4.2 per cent, with the average moving to 7,173 items, albeit still below the combined average." "The independent sector fared better than corporate pharmacy, with a combined average increase of 3.5 per cent versus a 1.8 per cent increase in corporate dispensing. Despite some improvement, integrated pharmacies remained the lowest at 1.9 per cent, in part due to the continued restrictions on patient access." Dispensing activity for England across the year to March 2022 increased by 4.5 per cent to an average of 7,765 items per month, reversing the decline witnessed in 2021.

Community Pharmacy England, Company Chemists Association, and the National Pharmacy Association have all expressed their disappointment at a recent press statement made by Dr Leyla Hannbeck, Chief Executive of the Association of Independent Multiple Pharmacies. The CPE, CCA and NPA refuted AIMp's claim that pharmacy bodies operate independently, emphasising the importance of employing various channels and strategies to shape public policy. "It makes sense to use a variety of channels and tactics to influence public policy," NPA, CPE and CCA said in a joint statement issued on Wednesday (August 13). "Limiting our work to just one Parliamentary channel would be naive and do a disservice to pharmacy owners." On Aug. 12, AIMp highlighted that a lack of cohesion was one of the contributing factors to the sector's difficulty in gaining wider attention. Dr. Hannbeck argued that it's counterproductive for each pharmacy organisation to maintain its own manifesto, essentially a lengthy wish-list that is often unrealistic and unattainable. "This can conveniently allow those in power to easily employ a divide-and-conquer strategy," she said.

NHS England has funded the Centre for Pharmacy Postgraduate Education (CPPE) to offer 80 free places in their Accuracy Checking Pharmacy Technician (ACPT) programme. Starting August 2024, up to 10 NHSE-funded places will be available each month on a first-come, first-served basis for pharmacy technicians working in community pharmacy, NHS hospitals, and in health and justice. The funding will continue until all 80 places are allocated or until March 2025. CPPE has revealed that 50 per cent of the funding has been allocated for community pharmacy and 50 per cent for other sectors. The ACPT programme is a 3-12 month course aimed at helping pharmacy technicians achieve various competencies, ensuring they can provide safe and effective patient care.

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."

A recent survey conducted by YouGov for the National Pharmacy Association (NPA) has highlighted concerning trends in the community pharmacy sector. The survey published on July 18 and conducted over two days in June this year reveals the subsequent challenges patients face due to the increasing pharmacy closure rates. The survey findings, conducted among 2,183 UK adults, indicates that 18 per cent of the respondents reported at least one pharmacy closure in their local area within the past year. Specifically, 12 per cent respondents noted closure of one pharmacy, while 6 per cent observed the shutdown of more than one. These closures are distributed across various regions, underscoring a nationwide issue rather than an isolated one.

Professional leadership bodies from around the world discussed workforce shortages in community pharmacy and other challenges affecting the sector at a global meeting held in Paris last month. Delegated from Denmark, Australia, Ireland, New Zealand, Portugal, Spain, US and the UK updated the conference on how the profession was progressing in practice, technology and workforce development in their respective countries. The UK was represented at World Pharmacy Council meeting by National Pharmacy Association chair Andrew Lane and chief executive at the Pharmaceutical Services Negotiating Committee Janet Morrison. Lane said: "It's very useful to be part of a global network of pharmacy bodies who are all going through similar challenges as we are in the UK. Sharing intelligence on other pharmacy systems around the world helps us to prepare the right strategy for engaging with the NHS at home. "Hearing some of the strides in services and digital technology in the profession gives us hope for the future of the sector. It's clear however that key challenges such as workforce shortages are starting to have an effect in other parts of the world too."

Community Pharmacy England (CPE) has expressed dissatisfaction with the spring budget as it brings "no specific relief" for the community pharmacy sector, which is grappling with "soaring costs and severe medicine supply and pricing issues." UK Chancellor Jeremy Hunt announced his Spring Budget on Wednesday, confirming an extra £2.5 billion in day-to-day revenue funding for the NHS in England in 2024-25 and a new NHS productivity plan worth £3.4bn to modernise IT systems. The Chancellor said that day-to-day spending would grow by 1 per cent per year on average in real terms, and the productivity plan is estimated to "unlock £35 billion worth of savings" from 2025-26 to 2029-30. However, CPE chief executive, Janet Morrison commented that the budget has "no obvious good news" for community pharmacies who need "urgent relief from the ongoing unsustainable funding and operational pressures" they are facing. Morrison described the investment in Pharmacy First as "the most significant investment in pharmacies in a decade", but emphasised the need for further support to stabilise the sector and its core contractual arrangements.

Those of us who work in community pharmacy know there is a workforce crisis created in large measure by PCNs actively recruiting pharmacists and pharmacy technicians from our sector. It is welcome, if long overdue, that this has now been officially acknowledged in a report commissioned by the English Health Secretary. PCN hiring 'exacerbates pharmacist shortage' says DH-commissioned report, which states such recruitment has "on occasion exacerbated the problem of a general shortage of pharmacists" which has compounded "the problem of community pharmacy closures." We have been telling the government this for years only to be told "problem? What problem?"- but now that Steve Barclay has his own official report sitting on his desk, he and NHSE cannot continue in denial mode. The facts are there for all to see. Time to act. No more dithering, delay or indifference. You asked if there was a problem and you have been told there is. In the absence of a holistic workforce strategy and cross-sector career pathways, PCNs poaching from community pharmacy is a zero sum game adding nothing to improving patient care.

Community Pharmacy England (CPE) is aiming to reach an agreement with the Department of Health and Social Care (DHSC) and NHS England (NHSE) on negotiation with regards to expanded services and payment model in the pharmacy sector. Chief Executive Janet Morrison, said: "We are working at pace in negotiations with DHSC and NHSE. The process remains on track with the Government's original timescale - i.e. aiming for agreement in July, with cross-government clearance later in July, and implementation from July through to September." CPE is involved in working groups on service expansion of Hypertension Case-Finding and the Pharmacy Contraception Scheme and service design for the Common Conditions Service; and are in in-depth negotiations on Payment models. These discussions critically look at the balance between funding core capacity and activity payments, how the funding streams will be distributed and how CPE will measure delivery and impact. NHSE has been leading on the development of the PGD pathways for each of the 7 conditions, with external medical, pharmacy and other experts feeding into the process - pharmacy owners from the Community Pharmacy England Committee have also been involved but the discussions are clinically led to ensure they comply with NICE principles and concur with Antimicrobial Stewardship policy.

Amid media speculations that a large pharmacy multiple was putting all its stores at risk of closure, PSNC supremo Janet Morrison said the sector was in crisis and in danger of a significant collapse. Addressing delegates via a video link at Sigma Pharmaceutical's 13th Annual Community Pharmacy Conference held last week (March 4 -9) in Punta Cana, Dominican Republic, she said while "a lot of consolidation or sales" would continue, a lot of the smaller, independently-owned community pharmacies - which had to work harder and harder to make ends meet - were just "hanging on in there". "But I don't know how much longer people can go on," she said, adding that the risk of actual closure was rendering the remaining pharmacies so fragile that "they may not be able to pick up the slack of many thousands of patients" who would need repeat prescriptions. "The disruption is frightful and awful. We have got 53 per cent of the population on repeat prescriptions, so that matters." Her comment on the opening day of the conference was a sober reminder that the sector - which relies heavily on income from prescriptions - couldn't afford to "carry on with the current format of a contract and the current amount of money" it was paid to deliver numerous tasks which have been heaped on it to share the burden of a crippling NHS.

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.

Prince Charles has praised the "dedication and professionalism of pharmacy staff" at an event held in London to celebrate the work of community pharmacists during the Covid-19 pandemic. Two hundred pharmacists, pharmacy staff and other health service representatives were invited to attend a special reception hosted by His Royal Highness at St James's Palace on Wednesday night (May 4). According to the National Pharmacy Association, the event was held, in part, to mark the NPA's recent centenary. In his closing speech, The Prince of Wales paid tribute to the work of pharmacies on the NHS frontline. He praised "the dedication and professionalism of pharmacy staff" during the Covid-19 pandemic and said: "I very much hope that this evening's event will help, a little bit, to highlight the marvellous work you do in your communities day in and day out."

Staff shortage has begun to bite the community pharmacy sector with several high street pharmacies closing doors due to workforce crisis triggered by the NHS poaching. More than 200 pharmacies closed last year and several are reducing their hours, posing a significant risk to patients' access to care, medicines and advice. Many in the industry have raised concerns related to workforce crisis and warned that plans for community pharmacies to help ease pressure on GP surgeries could also take a hit. The NHS plans to recruit a total of 6,000 pharmacists in England by 2024, equivalent to nearly three full years of new pharmacists. Since 2019, 3,000 pharmacists have been recruited into NHS primary care networks, which accounts for around 10 per cent of the community pharmacist workforce.

The Department of Health in Northern Ireland has announced an immediate intervention worth over £5.3m in value, and a commitment to progress wider reform arrangements in collaboration with the Community Pharmacy NI (CPNI) to support pharmacies to deal with the ongoing pressure. The Minister and Department are 'very aware of the pressures facing community pharmacies'. They discussed the situation with CPNI representatives at a meeting last week. The scale of the unprecedented budgetary pressures and uncertainty currently facing the Department were spelt out. The Department said: "Notwithstanding these pressures, CPNI were informed that a support package for their sector was being finalised. This package includes immediate interventions worth over £5.3m in value, plus a commitment to progress wider reform arrangements in collaboration with CPNI." Recently, the CPNI highlighted that community pharmacists have issued a stark warning that shortages and skyrocketing prices of many medicines could result in pharmacies being unable to supply important prescription medicines to patients.

Community Pharmacy England (CPE) has explained MPs on instability that puts operational pressures on pharmacies, financial pressures on businesses at a Parliamentary drop-in event held on Monday (10 July). The association has been in Parliament today alongside patient representatives and others to highlight our ongoing concerns about medicines supply to MPs. It said: "Medicines supply remains a critical issue for community pharmacies with disruption causing problems both accessing medicines and procuring them cost effectively." In CPE's recent sector polling, community pharmacy owners rated medicines supply instability as being the most severe pressure facing their businesses. This echoed the results of CPE's Pressures Survey which found 97% of pharmacy owners survey are facing significant increases in wholesaler and medicine supply issues, with 71% saying this was leading to delays in prescriptions being issued. During the Parliamentary drop-in event, CPE talked MPs through the issues and set out what it believe needs to happen to resolve them, calling for- Reform of Serious Shortage Protocols; Allowing generic substitution; An overhaul of the concessions system; and a strategic Government review of medicine supply and pricing with a shift to focusing on how to improve the functioning of the supply chain rather than solely on the drive to depress prices and margins.