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Pharmacies across Northern Ireland are in financial turmoil, reporting that they are dispensing prescription medicines at a loss due to inadequate reimbursement from the Department of Health (DoH). This crisis has led to the closure of almost a dozen pharmacies over the past 18 months, with many others struggling to stay open. Siobhan McNulty, who runs Melvin Pharmacy in Garrison, County Fermanagh, described the dire situation. "We're dispensing medicines at a loss," she said. "The reimbursement rates don't match the cost of the drugs, and we're left to cover the gap." McNulty relies on sales of non-pharmaceutical products to keep her business running.

Recognising the changing practices in healthcare, the Royal Pharmaceutical Society (RPS) has revised and updated its position on the separation of prescribing and dispensing or administration of a medicine by the same healthcare professional. It's previous guidance, published in March 2020, restricted prescribing and dispensing by the same healthcare professional only in exceptional circumstances. The new guidance, jointly developed with the Royal College of Nursing (RCN), has made prescribing and dispensing of medicines more flexible. It clarifies that "where there is a risk assessment in place and in the best interests of the patient, the same healthcare professional can be responsible for the prescribing and dispensing / supply / administration of medicines." The change in the position statement follows an extensive year-long engagement exercise with medical associations, members, fellows, expert advisory groups, patient groups and the RPS Country Boards.

Blackwells Chemist, a community pharmacy in South East London did not meet all the General Pharmaceutical Council (GPhC) standards. The pharmacy was inspected on Thursday (01 June) and it was found it did not keep all its records up to date and accurate, particularly its responsible pharmacist records. Investigation report stated that the principle of Governance and principle of Services, including medicines management was 'not met at all'. Under the principle Governance, the report stated: "The pharmacy generally manages the risks associated with its services adequately. People using the pharmacy can provide feedback or raise concerns. And staff generally protect people's personal information well. Team members know what to do to help protect the welfare of a vulnerable person. The pharmacy has written procedures, but these are not easily accessible to team members to refer to. And they are not regularly updated. So, they may be less useful to staff, and may not reflect current best practice." In the inspection it was found that the pharmacy does not always store its medicines properly. It cannot show that it stores all its medicines requiring cold storage at the appropriate temperatures.

Pharmacies are the lifeblood of community healthcare, being a vital pathway to care and support in every borough of the UK. There are 11,600 pharmacies across the country, amongst which yours stands proudly. Pharmacies obviously have a duty of care to their patients and customers, and rigorous safety practices surrounding the safe storage and dispensation of medicine - but that duty of care also extends to fellow staff. This is to say that health and safety is a paramount concern for any pharmacy or pharmacist, and that great care should always be taken to uphold the highest possible standards with regard to health and safety. With this in mind, what follows is a refresher on some of the key hazards that could give way to workplace injury in your pharmacy - and how to mitigate the risk of injury. Biological Hazards Biological hazards are ever-present, and prescient in the aftermath of the coronavirus pandemic. Though the COVID-19 virus was eventually shown not to be particularly resilient on surfaces, good practice was still to regularly disinfect surfaces and handles where possible - something which should still be a part of regular routine in your pharmacy. Likewise, face masks are a solid way to reduce the risk of infection or contamination, particularly where the handing over of biological samples is concerned.

In many cases, a pharmacy's most valuable asset is its NHS contract. This is what buyers are paying for - the right to provide pharmaceutical services commissioned by the NHS and be reimbursed for the medicines dispensed. However, a pharmacy consists of more than just an NHS contract and when buyers look for a pharmacy to buy, they will also examine these other areas - the pharmacy's customer base, its staff, the property it operates from - to name a few - because these are all also crucial to a successful pharmacy. In this day and age, another important consideration is the pharmacy's intellectual property (IP) i.e. the pharmacy's rights to certain types of information, ideas, and forms of expression. At the most basic level, this includes the trade mark in the name of the pharmacy, because all pharmacies will have a name by which they distinguish themselves from other pharmacies. The more well-known the name, the more valuable this form of IP is - mention 'Boots', for example, and most will have an instant association with the largest pharmaceutical retailer in the UK.

The Department of Health and Social Care (DHSC) has published plans to amend current pharmacy legislation on dispensing errors and clarify how registered pharmacies are governed. The Department's response to a public consultation on rebalancing medicines legislation and pharmacy regulation programme first proposed in summer 2018 was delayed due to Brexit and the Covid-19 pandemic. The programme aims to clarify and strengthen the organisational governance arrangements of registered pharmacies, specifically to define and clarify the core purpose of the Responsible Pharmacist and Superintendent Pharmacist roles. It will also give the General Pharmaceutical Council (GPhC) powers to define in professional standards how those roles are fulfilled.

The Medicines and Healthcare products Regulatory Agency (MHRA) has reclassified codeine linctus, a medicine used for the treatment of dry cough, from a pharmacy-only medicine (P) to a prescription-only medicine (POM) owing to the risk of dependence, addiction, and overdose. This implies that the dry cough syrup, which is also known as codeine oral solution, can only be dispensed upon the submission of a prescription at a pharmacy, rather than being accessible over the counter upon request. Patients are cautioned that as an opioid medicine, codeine can be addictive, and the risk of addiction may increase, particularly with prolonged use over an extended period. According to the medicines regulator, codeine is converted into morphine by the liver enzyme CYP2D6. In individuals identified as ultra-rapid metabolizers, this conversion from codeine to morphine occurs at a faster rate than in others. "If you want to stop taking it and have been taking codeine linctus for a long time, then it is important to reduce the amount you take slowly with the help of your prescriber," the agency said in its drug safety update issued on Tuesday, 20 February.

The NHS plans to train hundreds of pharmacy staff, expanding their ability to provide advanced clinical services and assume wider roles in dispensing medicines. With a targeted launch in September, up to 840 pharmacy technicians can join in the training programme. The online modules will cover consultation skills, therapeutics, clinical decision-making, assessment skills, and service improvement. "Community pharmacies are pivotal in local communities, and this novel training scheme empowers them to extend their service offerings to a wider patient base," said Health Minister Neil O'Brien. "Through our investment in the workforce, we're bolstering the implementation of the Pharmacy First initiative with £645 million, ensuring patients have access to expert assistance for various common ailments, including urinary tract infections and earaches." NHS said the training will offer flexibility to align with the working schedules and prior experience of community pharmacy technicians. It will combine independent online e-course study, educational supervision, and clinical skills training. Facilitated workshops will concentrate on enhancing clinical assessment skills and applying knowledge and skills through case studies, practice activities, and group discussions.

Community pharmacy chain Jardines Pharmacy has partnered with patient relationship management platform Charac to launch a new app designed to digitalise its services, enhance operational efficiency, and elevate customer satisfaction. The app allows patients to order repeat prescriptions, access medicine home delivery and book consultations with their pharmacist all in one place, enabling faster pharmacist-to-patient care. By incorporating Charac's platform into its business, Jardines is able to boost prescription dispensing efficiency, helping reducing wait times for patients. Additionally, its delivery feature enables patients to track their orders directly through the app, thereby streamlining the overall patient experience. The app also minimises administrative and manual tasks for pharmacists, giving them more time to focus on helping patients and delivering the outstanding customer service. Patients of Jardines can also use the app to book appointments digitally for Pharmacy First consultations, blood pressure checks, earwax removal, travel vaccinations, and emergency contraception services. Santosh Sahu, Founder and CEO of Charac, said: "We are pleased to support Jardines Pharmacy and its patients across England. Our mission is to ensure that community pharmacies are empowered to digitalise, making care easier and more accessible for patients.

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 General Pharmaceutical Council's Investigating Committee took decisive action on March 25, 2024, by issuing a warning to Dilsha Kiran Shah, registration number: 2049787, for her conduct as Superintendent Pharmacist of Jhoots Healthcare Ltd. Miss Shah's failure to uphold the Medicines Act 1968, specifically in ensuring the proper management of medicinal products, triggered this warning. The Act mandates supervision in "keeping, preparing, and dispensing medicinal products other than those on a general sale list." Moreover, pharmacies are inspected on five principles - Governance, Staff, Premises, Services including medicines management, and Equipment and facilities to meet the right standards. The alarm was initially raised in August 2021 when a Jhoots Healthcare Ltd pharmacy branch under Miss Shah's supervision operated without a responsible pharmacist. Despite explicit instructions, pharmacy staff were allegedly instructed to proceed without proper supervision, raising grave concerns regarding patient safety.

The Department of Health and Social Care's (DHSC) response to the 2019 consultation on community pharmacy drug reimbursement reform has paved the way for the second phase of consultation with the pharmacy negotiator. The second round of the consultation will focus on eight proposals: Changes to the way Category A prices are set Changes to how medicine margin is distributed in Category M drugs Changes to how Category C prices are set for drugs with multiple suppliers Inclusion of non-medicinal products in the Drug Tariff Changes to the way prices of drugs in non-Part VIIIA are set Changes to arrangements for reimbursement and procurement of 'specials' Changes to reimbursement of generically prescribed drugs and appliances dispensed as 'specials' Changes to the discount deduction scale The Pharmaceutical Services Negotiating Committee has been discussing these proposals with the DHSC and the outcome was featured in the final package of the 'Community pharmacy in 2016/17 and beyond' document.

The General Pharmaceutical Council (GPhC) has raised concerns over the rising risks related to online pharmacy services. It revealed over 30 per cent of its open Fitness to Practise (FtP) cases were related to online pharmacy, which is disproportionate to the sector of the market that online services occupy. The regulator has advised pharmacists and pharmacy owners providing online services that they should "not work with online providers who try to circumvent the regulatory oversight put in place within the UK to ensure patient safety". In the past five months, the Council has imposed seven interim orders on the registration of pharmacists who have worked for or with online prescribing services - after identifying serious concerns with their practice. It said: "These pharmacists were working as pharmacist independent prescribers for online services or were dispensing medicines prescribed online. Some of these pharmacists were the Responsible Pharmacist (RP) or the Superintendent Pharmacist (SP)."

The Department of Health and Social Care (DHSC) and the Medicines and Healthcare Products Regulatory Agency (MHRA) have authorised community pharmacies throughout the UK to dispense original full packs of Valproate-containing medicines upon prescription. The necessary changes in regulations came into effect on 11 October which was strongly supported by 85 per cent of respondents concerned about risks to the unborn baby if valproate-containing medicines are used in pregnancy. The decision was made to ensure patients receive safety warnings and pictograms, including a patient card and the Patient Information Leaflet (PIL), contained in the manufacturer's original full pack. Valproate is a treatment for epilepsy and bipolar disorder but is also associated with birth defects and neurological disabilities.

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.

Digital transformation is sweeping across the healthcare landscape. Fuelled by ambitious government policy, exciting innovation and huge injections of funding, it's hard for anyone in the sector not to catch a dose of digitisation fever. But digitisation is not a universal tonic, and it certainly isn't always a 'good thing'. In fact, there's a real danger to digitising healthcare. Such a fundamental change to the very nature of care delivery is an inevitably high-risk process: sometimes things or people get forgotten, vital processes stall, or new systems fail to replicate the strengths of those they replace. Take, for instance, the digitisation of pharmacies. Over recent years, the public's use of online-only pharmacies have boomed: in March it was reported that the number of items dispensed from distance-selling pharmacies in England, UK quadrupled between 2016 and 2021. These online providers offer an attractively convenient way for patients to receive their medicines; replacing a trip to a high street pharmacy with a package delivered straight to their door. On the surface, this digital solution seems perfect not only for young patients with busy schedules, but also for older patients or for those with restricted mobility who may struggle with in-person collection.

Two weeks prior to the closing of the hub and spoke consultation, issues around patient safety, costs and competition as well as practicalities such as what to do with uncollected medicines were discussed in a webinar on hub and spoke dispensing on Wednesday (May 26). The webinar was organised by Sigma Pharmaceuticals in association with the National Pharmacy Association (NPA). NPA director of corporate affairs Gareth Jones chaired the event and was joined by Sigma's Hatul Shah and Raj Haria as well as NPA vice chair Nick Kaye and NPA head of advice and support services Jasmine Shah. Kaye said: "There are still many 'unknown unknowns' with hub and spoke and the jury's still out on any potential benefits. I have lots of reservations about cost and it worries me how efficient this is for the business and the long term sustainability for the sector as a whole. Above all we need to think about the patient at the centre of all this and the potential confusion for them." Jasmine Shah felt patient safety was going to be the key in regards to whether the spoke and the hub would hold the ultimate responsibility and "who is going to take the accountability as far as patient care goes". She added: "It is most important that GPhC standards and NHS requirement are both met in identifying all the risks associated with the arrangement with hub and spoke and ensuring that (patient safety) measures are in place. Everything that needs to be looked at is by putting the patient at heart of the arrangement and seeing what is the safest way for them to receive care from both spoke and hub."

Online pharmacy PillTime has taken a step to boost its prescription growth by implementing new Patient Medication Record (PMR) system Titan in its state-of-the-art premises. PillTime moved to new, expanded 26,000sqft premises in Cribbs Causeway on the edge of Bristol earlier this year, where it has also installed state-of-the-art robotics in a bid to significantly enhance future productivity and capacity. Teething problems over Easter weekend saw PillTime struggling to seamlessly integrate all the new systems and processes while physically moving premises which affected service delivery and customer support. However, CEO Leighton Humphreys was supported by Tariq Muhammad, CEO of Invatech Health, who is a former community pharmacist and has worked with independent pharmacies around the UK as well as larger online businesses, to integrate Titan into their workflows. Alongside integration work, Muhammad and his team supported PillTime with necessary design, governance and pharmacy expertise as the company struggled to meet its usual high standards for dispensing medicines to patients.

Skelmersdale-based online pharmacy Chemist4U has secured a £12 million investment from Pitalia Capital, an equity investment company led by Anil Pitalia. Chemist4U is part of JCCO Healthcare, which also houses the weight management platform myBMI. Anil Pitalia is a health enthusiast, who heads SpaMedica, a company providing cataract surgery to the NHS. This investment will propel the group's expansion, with John Davies, Managing Partner of Pitalia Capital, joining the board, the company said. Moreover, it will facilitate the extension of services by myBMI in the realm of weight management. "Our goal is for Chemist4U to emerge as one of the largest NHS dispensing facilities in the country, while also providing vital support to our partners through our rapidly expanding outsourced dispensing services division," said said James O'Loan, Chief Executive Officer of both Chemist4U and myBMI, who joined Chemist4U as a superintendent pharmacist in 2012 before becoming CEO in 2018. Meanwhile, Anil Pitalia, Head of Pitalia Capital based in Bolton, cited the compelling growth potential as the driving force behind his investment in Chemist4U's next-day medicine delivery service.

Atorvastatin, a medicine to treat high blood cholesterol, is the most dispensed drug with 59 million items in England in 2022/23, revealed the NHS Business Services Authority (NHSBSA) on Thursday (8 June). While Apixaban (an anticoagulant) was the drug with the highest costs of £430 million. Apixaban 5mg tablets had the largest increase in cost between 2021/22 and 2022/23 in England, with an increase of £280 million. NHSBSA's annual statistics report 'Prescription Cost Analysis-England 2022/23' published also has revealed an eight per cent rise in the prescription items that were dispensed in the community in England. The report highlighted that in 2022/23, 1.18 billion prescription items were dispensed at a cost of £10.4 billion in the community in England, witnessing an increase of eight per cent from £9.69 billion in 2021/22.