Community Pharmacy Wales and the Welsh government have entered an agreement on Thursday (December 16), enabling all pharmacies to deliver provision of
contraception, treatment for common minor ailments, and access to repeat medicines in an emergency.
Expansion of clinical community pharmacy service will be supported with an increased funding of £20 million a year by April 2024 from the current level of £11.4m.
The two bodies have been negotiating the terms of agreement, which also includes plans to roll out a Wales-wide pharmacy prescribing service, allowing trained pharmacists to treat an extended range of conditions that currently require GP visits.
The agreement will allow patients to access NHS services closer to home which in turn would free up GP and other NHS services for patients with more complex needs.
Eluned Morgan MS, minister for Health and Social Services said: "I welcome the positive approach to negotiations taken by Community Pharmacy Wales, embracing our ambition for a reimagined community pharmacy service, which is an integral part of a strong primary care landscape."
The new board of the National Pharmacy Association (NPA) has adopted 10 principles for transforming the contractual framework in England.
The board met for the first time in April, believes that the current Community Pharmacy Contractual Framework is failing NPA members, the wider sector, the NHS,
Government and patients.
The association's new vice chair, Jay Badenhorst, said: "We can't wait until the current framework limps to its finish line in 2024 before giving serious thought
to the new race we must all run in the future."
"Before negotiations for a new contract begin in earnest, we want to make our position clear to all of those who will be involved in its development. Years more
of the same would be totally unacceptable. Tinkering at the edges of the current arrangements as the basis for a new deal could not achieve the transformation
that is needed."
Former chair of the NPA, Andrew Lane, listed some of the principles in a speech to industry leaders in January, but this is the first time the approach has been
agreed in its entirety, following months of testing with NPA members.
I have always been passionate about Community Pharmacy and am proud of the way that the sector navigated itself through Covid-19 and is currently navigating itself through all the changes in the NHS landscape.
When I started my role in Sep 2019 as the CEO of Kent LPC, I used to say that community pharmacy has changed more in the last five years than the 15 before that,
however, I now believe community pharmacy has changed more in the last two years than the 20 before.
The year 2019 saw the start of the five-year Community Pharmacy Contractual Framework which set out how community pharmacy would support delivery of the NHS long term plan. What PSNC (or any of us) when negotiating this deal had not envisaged was the Covid-19 pandemic.
Whilst the world turned upside down, we saw high street shops close their doors and immense pressure flood the NHS. Community pharmacy did what they always do, they adapted, teams came together, worked through, and showed resilience in the face of adversity.
In Kent, I saw us integrate into primary are and into the NHS structure very quickly, in the first few weeks after Covid-19. All the usual red tape was removed, we all worked together to implement services to help patients in a matter of weeks when they would have normally taken months.
The 8th Pharmacy Business Conference, organised by Pharmacy Business, unfolded a dynamic narrative around the theme of 'Pharmacy of Tomorrow', highlighting
the trajectory of innovation, adaptation, and the evolving landscape of pharmaceutical services.
Attended by over 200 pharmacy owners, industry leaders, and stakeholders, the conference served as a medium for robust discussions and the exchange of valuable
insights regarding the future of community pharmacy.
Amidst the persistent challenges posed by an underfunded reimbursement system and negotiations with governmental bodies and the NHS for the new community pharmacy
contractual framework 2024/25, the conference pivoted towards investing in staff, adapting to change by investing in new technology, and optimising commissioning
as pivotal strategies.
"Pharmacy professionals are playing increasingly important clinical roles in both primary and secondary care," shared David Webb, Chief Pharmaceutical Officer
(CPO), NHS in a video message.
He highlighted the NHS's commitment to empowering community pharmacy, with plans to expand services and deprescribe to align with the NHS's focus on preventive
healthcare.
Nuffield Trust and The King's Fund are seeking feedback from community pharmacy on their proposals for the future of community pharmacy and they are seeking
feedback from community pharmacy stakeholders.
The online survey is the latest opportunity for pharmacy owners, LPCs and others in the sector to engage with the project to develop a Vision for Community Pharmacy.
Nuffield Trust and The King's Fund want to hear their views on their proposals, ahead of the publication of the final report later this year. The vision is
critically important, as it will be used to develop the future strategy for the sector and lay the groundwork for the next Community Pharmacy Contractual
Framework (CPCF) negotiations.
The survey is asking for thoughts on key aspects of the vision and its recommendations. The vision has been developed by Nuffield Trust and The King's Fund
following an extensive programme of research, interviews and meetings of the vision Steering Group, Advisory Panel, and Working Groups, all of which have
contractors, LPCs and other representatives of the sector at their heart.
The vision project team are looking forward to hearing views from across the sector on their proposals and what will need to happen to make them a reality.
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).
Keith Ridge, who retired from the role of England's chief pharmaceutical officer this month, has written to the NHS regional directors regarding a package to empower community pharmacies to implement clinical services in their integrated care systems.
Though details about this letter are not available, Malcolm Harrison, chief executive officer of the Company Chemists' Association, welcomed the move saying: "It is a positive step towards the greater integration of community pharmacy care into the NHS.
"It is vital for the NHS that patients can benefit from the clinical care services set out in the Community Pharmacy Contractual Framework."
Harrison, however, highlighted that while pharmacies are being pushed to do more, the efforts to introduce new clinical services should be supported with "sustainable funding and material actions to increase workforce numbers in the sector."
"We are concerned that without the funding and people in place, the desired volume of necessary services cannot be delivered, no matter how well coordinated."
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'.
The current funding and contractual framework for community pharmacy is not fit for purpose, the Health and Social Care Committee report has concluded,
recommending a complete overhaul to reduce its complexity.
Published today, the report highlighted the necessity for a new framework to ensure adequate funding and to prevent damaging cross-subsidy between clinical
services and prescription dispensing, as is presently observed.
The report revealed that community pharmacy funding has fallen by over 30 per cent in real terms since 2015, resulting in an annual shortfall of at least £67,000
per pharmacy for individual owners.
More than 1,100 community pharmacies have closed since 2015, of which were serving the most deprived areas, it said.
MPs on the committee have urged the government to address medicine shortages, warning that they could undermine flagship initiatives such as 'Pharmacy First' by
eroding public confidence in pharmacists.
"People living with type 2 diabetes, ADHD, epilepsy and cystic fibrosis, and those experiencing the menopause, have faced challenges accessing the vital
medication they need. Many others are facing similar experiences.
The proposed increase in the national living wage (NLW) is expected to impose an implementation cost of £150 million to £195 million on the community
pharmacy sector, Community Pharmacy England (CPE) has warned. Chancellor Jeremy Hunt recently announced a 9.8 per cent increase in the national living wage,
raising it from £10.42 to £11.44.
"The Autumn Statement overlooks the knock-on effects these measures will have on small businesses like community pharmacies," CPE Chief Executive Janet Morrison
said in a statement. "The majority of pharmacies employ staff on or around the NLW, which has increased nearly 40 per cent since the start of the current contractual
framework."
"This is at a time when pharmacies have faced a 30 per cent real terms reduction in funding since 2015," Morrison added. "No viable business can absorb these cost
increases without significant support. This is just another cost pressure that pharmacies cannot control and must be addressed through a sustainable, long-term
funding arrangement."
The National Pharmacy Association (NPA) has commissioned Professor David Taylor of University College London to investigate the implications of all-time high
inflation rates on community pharmacies in the UK.
Professor Taylor's will assess rates of inflation affecting community pharmacy across the UK, using public data sources whilst examining inflated costs in the
context of the current five year contractual framework in England (2019-2024).
He would review the EY (Ernst & Young) report into pharmacy funding, to identify whether current inflationary pressures could change any of the findings and
consider the policy implications and impacts of inflationary pressures, including pharmacy's ability to prepare for a more clinically focused future and maintain
current core services.
NPA chief executive Mark Lyonette said: "Inflationary pressures are eating into the limited funds provided by the NHS for pharmacy services. We believe the real
level of inflation for pharmacy businesses could be higher than the CPI inflation rate, which itself is at a 40 year high. Staff and locum costs in the sector as
well as medicines costs have risen dramatically.
Community pharmacies are being forced to halt certain NHS and public health services due to escalating financial and operational pressures, a recent survey
by Community Pharmacy England (CPE) has revealed.
In the survey conducted ahead of the June Committee Meeting, an overwhelming 96 per cent of pharmacy owners reported having stopped delivering locally
commissioned services over the past twelve months.
Additionally, nearly one-third of the pharmacies surveyed indicated they had discontinued providing some Advanced services.
The survey also revealed that pharmacy opening hours are being reduced, with 81 per cent of respondents stating they had to stop offering extended hours.
In 90 per cent of the cases, pharmacy owners had to cease employing locum pharmacists, likely due to cost constraints.
Furthermore, over 20 per cent of the more than 2,100 pharmacies surveyed reported having to discontinue the free delivery of prescription medicines to patients.
Wales has begun the rolled-out of a community pharmacy prescribing service as part of reforms agreed by the Welsh health minister last December.
Eluned Morgan approved wide-ranging changes following re-negotiation of the Community Pharmacy Contractual Framework with Community Pharmacy Wales, the
representative body for community pharmacies in Wales.
The roll out will allow appropriately trained community pharmacists to treat an extended range of conditions that currently require people to visit their GP.
Initially pharmacist prescribers will be able to prescribe medicines, including antibiotics for acute illnesses like urinary tract and upper respiratory tract infections, and also prescribe routine contraception.
The first of its kind in the UK, the service is being rolled out progressively across Wales, building on local schemes which are already in place.
In a compelling case for expanding the role of community pharmacies in the UK's vaccination efforts, a new report by a major think-tank has called on NHS
England to designate all adult vaccinations as 'advanced services' under the next Community Pharmacy Contractual Framework (CPCF).
Published in July this year, the report by Reform discusses the power of prevention and highlights the need to boost vaccine uptakes for better patient outcomes.
Calling for the NHSE to allow the 'advanced services' to be routinely delivered by community pharmacies, the report highlights the proven capacity of community
pharmacists to reach a wide demographic, particularly in underserved areas.
It also emphasises on the strategic advantage of utilising community pharmacies which often have more flexible hours and remain open during the evenings and
weekends, making them highly accessible to the public.
The Community Pharmacist Consultation Service (CPCS) will be expanded to enable urgent and emergency care settings to refer patients to a community pharmacist
for a consultation for minor illness or urgent medicine supply from Monday (15 May), the DHSC and NHSE said.
The service builds on the progress made in GP referrals via the CPCS and hospital referrals under the Discharge Medicine Service. It was originally planned to launch
in March, and fee for this service will be the existing CPCS fee of £14, as per the agreement for both year 4 and year 5 of the Community Pharmacy Contractual
Framework (CPCF) 2019 to 2024 5-year deal.
In an update on the CPCF, published today (12 May), the Department of Health and Social Care (DHSC) and NHS England (NHSE) has also committed to the 4 October 2023
launch date for the Tier 2 of the Pharmacy Contraception Service, subject to a positive evaluation of the pilot.
The Tier 1 of the service was launched on 24 April, delayed by over three months. This new service enables community pharmacists to provide ongoing management, via
a patient group direction (PGD), of routine oral contraception that was initiated in general practice or by a sexual health clinic. The fees for this service are as
follows: a fee for each consultation of £18; and a set-up fee of £900, paid in instalments.
The Tier 2 will "enable community pharmacists to also initiate oral contraception, via a PGD, and provide ongoing clinical checks and annual reviews," Alette Addison,
deputy director for pharmacy, dental and optical at the DHSC and Ali Sparke, director for dentistry, community pharmacy and optometry at the NHSE, said in a letter.
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.
The Challenges
There cannot be anyone working in or with community pharmacy that either feels or sees the pain that emanates from the current operating climate. Pharmacy
closures; increased workload and operating costs; increased patient and commissioner expectations; and, more fundamentally, an inadequate, undervalued and
poorly structured remuneration and reimbursement contractual framework.
As important as they are, we will not focus on these points here as they are not in the control of pharmacy owners and managers. They are the responsibility
of those organisations that represent them at a national and local level who must deliver a better outcome as difficult as that may be.
However, there are matters which are in the control of pharmacy owners and managers. These include their premises, their team, their systems and processes, their
relationships with other healthcare providers and the broader community, their NHS and private service offer, and how they promote and deliver them to give the best
patient experience.
In order to create the head space to develop and implement a business plan, pharmacy owners and managers must make time to work on their business as well as in it.
Then it requires the capacity and capability within their team to deliver the services and that excellent patient experience.
A full CPE Committee Meeting was organised in London on April 17 and 18, 2024, to discuss crucial sectoral issues.
Key topics discussed during the two-day meeting included intolerable pressures on pharmacy owners, the ongoing Community Pharmacy Contractual Framework (CPCF)
negotiations, implementation of the Pharmacy First service, and governance changes.
Committee Members reviewed the progress of CPCF negotiations with the Department of Health and Social Care (DHSC) and NHS England. These critical negotiations
are being led by the Negotiating Team (NT), which includes independent pharmacy owners and representatives of CCA and non-CCA multiples.
The CPE has been advocating for an uplift to the core global sum, margin write-offs, an agreed mechanism for regular funding increases linked to activity and
inflation, annual uplifts to service fees, more fundamental reform of the margin delivery framework and an economic review of the medicines supply chain.
The Committee also discussed the results of the 2024 Pharmacy Pressures Survey, which was conducted during March and April.
It's no secret that as pharmacists we are navigating a new and more demanding healthcare landscape. Our role has changed significantly since the start of the 21st century due to increased expectations from the public, advances in science and technology and changing workforce pressures.
The Community Pharmacy Contractual Framework for England has placed a higher focus on clinical service. In addition, the Covid-19 pandemic resulted in significant
acceleration in changing how we work day-to-day and the public perception of our role.
Community pharmacy owners and staff have been under relentless pressure for the last two years. Dispensing volumes are continually increasing but dispensing revenues
are being replaced by launching new services. We must find solutions to reduce the time it takes to dispense medication so we can focus on these new revenue generating services.
To not just succeed, but to thrive, it is becoming increasingly important to understand and embrace the technology available.
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.