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National Institute for Health and Care Excellence (NICE)'s diagnostic advisory committee has recommended the use of HM-JACKarc or OC-Sensor quantitative faecal immunochemical tests (FIT) in a draft guidance release for consultation on Wednesday (5 July). Under existing NICE guidance, FIT was already offered to some people presenting to primary care with symptoms suggestive of colorectal cancer, while others were immediately referred on the suspected cancer pathway. The new draft guidance will now see everyone receive a FIT. A sample is sent in the post to a laboratory where the amount of blood in the faeces is measured. The results are usually available within a week and people with 10 or more micrograms of haemoglobin in their faeces should then be referred for further investigation. Further assessment using colonoscopy, or CT colonography, is required to diagnose cancer. The tests cost between £4 and £5 per sample, and can correctly identify about 9 out of 10 people with colorectal cancer. The committee agreed it is important that GPs can refer people for colonoscopy without a positive FIT result if they think it is necessary and where symptoms persist. The institute believes that the recommendation of the tests should reduce the number of unnecessary colonoscopies, thus freeing up appointments for more non-urgent referrals. This should lead to 50% fewer referrals for urgent colonoscopies being made by GPs in primary care settings each year.

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."

The Pharmaceutical Services Negotiating Committee (PSNC) has announced that the new Pharmacy Quality Scheme (PQS) for this year will officially begin on October 10. From previous scheme £75m funding is also available and contractors will be able to claim an 'Aspiration payment' if they wish to, later this year. PSNC, the Department of Health and Social Care and NHS England have agreed the arrangements for the 2022/23 PQS, as well as those for the 2023/24 PQS, with a focus on supporting recovery from Covid-19 and wider national health priorities. The committee said: "In our negotiations on the scheme, PSNC has managed to reduce the scope of this year's PQS so that the estimated contractor costs and time required to complete the criteria will be below those associated with the original NHS proposals for the scheme." "A further reduction in scope has also been agreed due to the delayed start of the 2022/23 PQS. PSNC hopes that this, along with arguing for more realistic targets across the scheme, will help reduce the impact on contractor workload, at what continues to be a very busy and pressured period for the sector."

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."

Workforce issues, staff retention and capacity continues to be a big concern for the Local Pharmaceutical Committee as it discussed the topics at a recent meeting with the Pharmaceutical Services Negotiating Committee (PSNC). The meeting, attended by delegates from 66 LPCs, focused on the current challenges faced by community pharmacies as well as the planning for the next year. Around 64 per cent of delegates said workforce was the top challenge faced by pharmacy contractors, and suggested reducing the migration of pharmacists to Primary Care Networks (PCNs). Other suggestions included - "improving the development opportunities available for pharmacists and their teams, and rebranding the profession to make community pharmacy a more attractive route for young graduates." On the development of Integrated Care Systems (ICS), the majority of respondents were positive about their LPC's engagement in the new setting.

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 Health and Social Care Committee (HSCC) has undertaken an inquiry into prevention and has published its first report of the series which focuses on vaccination. It has announced ten workstreams that will form the basis of inquiry, of which vaccination is one. HSCC said: "The UK has long been one of the world leaders on vaccination - one of the most successful and cost-effective preventative tools available. However, if challenges around uptake and bureaucratic processes in clinical trial set-up are not addressed, there is a very real risk that the UK's position as a global leader could be lost. This cannot be allowed to happen and in this report we set out some of the steps that we think will make a difference." It recommended a more flexible delivery model making use of a wider range of healthcare professionals. "The NHSE vaccination and immunisation strategy must have a strong focus on tackling practical challenges that limit vaccination access, make best use of a wider array of professionals, empower local leaders to pursue ways of addressing uptake in their own areas, and to set out guidance and examples of best practice around how voices other than NHSE can communicate important messaging around vaccination programmes," it suggested.

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 British Generic Manufacturers Association (BGMA) on Monday alerted the Health and Social Care Committee that medicines shortages have increased and are "around double what they were a year ago." BGMA chief executive Mark Samuels told the committee that they have been highlighting the medicine shortage risk to ministers since July 2021 and the association is "very concerned" about the current situation. "We've been monitoring it for several years now, and as you saw in the written evidence, shortages have increased. They're around double what they were a year ago. We have them at 101 shortages in February this year," said Samuels. Dr Rick Greville, director of distribution and supply at the Association of the British Pharmaceutical Industry (ABPI), highlighted that the problem of drug shortages in the UK is a "long-standing issue" and the scarcity of certain medications "continues to be challenging".

Nine more new products have been classed as 'Drugs for which Discount is Not Deducted' (DND) from 1 July 2022, announced Department of Health and Social Care (DHSC). This takes the total number of products granted DND status over the past 2 years to over 500 following checks made by the Pharmaceutical Services Negotiating Committee. The Committee had made an application to DHSC and NHSBSA for the following 9 products to be added to the DND list of Individual items to which the discount deduction scale will no longer apply from July 2022: Fludrocortisone 50micrograms/5ml oral suspension (Group) Lorazepam 1mg/5ml oral suspension (Group) Lorazepam 500micrograms/5ml oral suspension (Group) Zopiclone 3.75mg/5ml oral solution (Group) Zopiclone 7.5mg/5ml oral solution (Group) GA explore5 oral powder 12.5g sachets HCU explore5 oral powder 12.5g sachets MSUD explore5 oral powder 12.5g sachets TYR explore5 oral powder 12.5g sachets The DND list is updated monthly by the DHSC and includes grouped and individual items. Individual items are separately listed in Part II of the Drug Tariff.

Department of Health and Social Care (DHSC) has increased the rate of discount deduction for generics from 17.52 per cent to 20 per cent. The Drug Tariff for April 2023 will contain changes to the discount deduction arrangements for pharmacy contractors, which will include- all concession lines to be considered as Group Items for Discount Not Deducted i.e. DND or zero discount (ZD) items; and rate of discount deduction for generics to increase from 17.52% to 20% The Pharmaceutical Services Negotiating Committee (PSNC) and DHSC agreed on the changes for all concession lines to be considered as Group Items for Discount Not Deducted. Therefore from 1 April 2023, a new category will be introduced into Part II of the Drug Tariff 'Drugs for which discount is not deducted'. However, the committee had rejected the changes in the rate of discount deduction for generics. It said, "Following pressure from NHS England, Ministers have now chosen to impose changes to the previously agreed discount deduction arrangements, which come into effect from 1 April, and will be kept under review."

The Health and Social Care Committee (HSCC) has announced the appointment of six specialists to scrutinise the government's progress made on its commitments to pharmacy services in England on Wednesday (26 April). "They will work alongside the core members of the Expert Panel to produce a report evaluating Government progress across nine of the Government's own commitments across the four areas. A CQC-style rating from "inadequate" to "outstanding" will be awarded against each specific pledge with a final overall rating given," said DHSC. Professor Dame Jane Dacre, Chair of the Expert Panel, said: "The role of pharmacy in delivering care whether in hospital, the community or primary care has never been more important. "The Government has made a number of commitments aimed at improving pharmacy services and we'll be looking at the progress to achieve these targets. "In the process of our evaluation we'll be hearing from stakeholders from across the industry, including the pharmacy workforce and NHS and independent providers of pharmacy services. We'll be considering pledges covering frontline services as well as the education and training of the workforce." National Pharmacy Association (NPA) chief executive, Mark Lyonette, is one of six panel members with specialist expertise in pharmacy. They will work alongside five standing members who are all renowned healthcare policy experts and professionals. Professor Dame Jane Dacre will chair.

The National Institute for Health and Care Excellence (NICE) has issued draft guidance on 'Evusheld' which is not recommended for vulnerable adult with high risk of severe Covid-19 on Thursday (16 February). The draft guidance is open for public consultation until 9 March 2023. The committee will consider any comments received at a meeting currently due to take place on 4 April 2023. It comes after last month's decision by the US drug regulator to withdraw its emergency use authorisation for Evusheld as a preventative treatment for Covid-19, which said there was insufficient evidence that Evusheld is effective against the dominant variants of Covid-19 in the US. NICE's independent appraisal committee has reached the same conclusion having considered evidence which shows Evusheld is unlikely to prevent infection with most of the variants circulating in the UK now and in the near future. It has also announced that it is developing a new review process to update recommendations on the cost-effectiveness of Covid-19 treatments so they can be made available more quickly to patients if they show promise against new variants and are found to be cost-effective.

The Pharmaceutical Services Negotiating Committee (PSNC) has challenged price concessions imposed by the Department of Health and Social Care (DHSC) on some of the medicines. It has raised concerns on the process for setting price concessions to senior government officials responsible for medicines supply, warning that the system is not working in the current environment from a community pharmacy contractor perspective. "When a new government takes over next week, this will be one of several urgent topics being raised by PSNC to new ministers, alongside the fuel price crisis, inflationary pressures and winter pressures on pharmacy businesses," said PSNC. The final update to August price concessions was announced yesterday taking the total concessions granted to a record 138 for August. PSNC said: "Of those, 99 were in line with PSNC requests, but prices for 39 lines were imposed by the Department of Health and Social Care (DHSC): those impositions do not match the purchase prices reported by contractors and the evidence of market prices which we passed on to DHSC. In particular, the final imposed prices of Apriprazole and Temazepam tablets has generated a lot of concern amongst contractors due to the large variation between their reimbursement prices and purchase prices during the month of August."

Chair of the health and social care committee Steve Brine and England's chief pharmacist David Webb are among a raft of speakers who will be addressing delegates at the 13th Annual Sigma Community Pharmacy Conference to be held in Punta Cana, Dominican Republic from Sunday (March 5). Day I of the conference will also feature a Q&A session with PSNC CEO Janet Morrison and her lead negotiator Mike Dent, which will be presented as a live webinar via YouTube for those unable to attend in person. Sigma Pharmaceuticals has invited all interested community pharmacists and stakeholders in the UK to join the 90 minutes session by clicking this link. Those joining the session will not only be able to listen to the Q&A session - which will run between 6.30PM and 8.00PM in UK on Sunday - but also ask questions to the PSNC executives via a live YouTube chat. Sigma says the operating landscape for community pharmacy has altered dramatically since it last held its 'away conference' in the Philippines in February 2020. The role of the independents - post pandemic - has rapidly evolved and has now been recognised by the health secretary as playing a significant part in the health of the nation.

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.

NHS England and NHS Improvement (NHSE&I), in association with the Royal Pharmaceutical Society (RPS) and the Association of Pharmacy Technicians UK (APTUK), has published its first inclusive pharmacy practice (IPP) bulletin, with an overarching ambition "to make community pharmacy a more inclusive environment for all pharmacy professionals". The IPP programme will take practical steps to improve the awareness and understanding at all levels of different cultural beliefs and attitudes, according to the Pharmaceutical Services Negotiating Committee (PSNC). As a member of the IPP Improving Practice and Engagement Group, PSNC has contributed to this issue of the Bulletin, which focuses on how pharmacy professionals can help to reduce health inequalities via the detection and prevention of cardiovascular diseases. The IPP programme, of which the Bulletin forms a part, aims to engage with local communities to help improve their health and reduce inequalities in care - particularly among those from ethnically diverse and disadvantaged backgrounds.

The Parliamentarians have called the government to urgently consider the short-term funding to stabilise the community pharmacy sector. 39 MPs and Peers from across the political spectrum have signed letters to the Health Secretary, Steve Barclay MP and raised their growing concern about the pressures facing England's community pharmacies and the risks this poses to patient care and safety. "Steve Barclay MP received correspondence from 23 Opposition MPs, with six Peers also signing a letter. Separately, 9 Conservative MPs also wrote to the Health Secretary and up to 10 others have signalled their intention to write to the relevant Minister," said the Pharmaceutical Services Negotiating Committee (PSNC). The Parliamentarians acknowledged that pharmacies have the potential to do more to support the NHS and they called for the government to urgently consider a commitment to working with the sector to create a fair and fit for purpose future funding model that ensures sustainability and properly funds pharmacies for what they do. All signatories also called for the introduction of a fairly-funded Pharmacy First service.

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.

The Pharmaceutical Services Negotiating Committee (PSNC) has called for improved workforce planning to be undertaken by the government and NHS. However, for this to happen, it added, "high quality workforce data for community pharmacy needs to be available." For this reason, the Department of Health and Social Care (DHSC), NHS England and PSNC have agreed that it will be a Terms of Service requirement for contractors to complete the annual Health Education England (HEE) community pharmacy workforce survey, which will then provide a full picture of the community pharmacy workforce, including identifying the number of vacancies and regions where these are particularly hard to fill. PSNC said: "It is acutely aware of the challenges that contractors and their teams are currently facing, so in recognition of the workload associated with completing the annual workforce survey, we have negotiated with DHSC and NHS England that the requirement to undertake an annual patient satisfaction survey will be removed from the Terms of Service from 1st October 2022." This means that contractual requirement will no longer apply to contractors in 2022/23 and going forward.