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The Pharmacists' Defence Association (PDA) is supporting pharmacists in England whose employment has been impacted by the creation of new NHS structures. As a result of the 2022 Health and Care Act, Integrated Care Systems (ICSs) were established in England, and Clinical Commissioning Groups (CCGs) were closed on 1 July 2022. Each of the ICSs includes two key parts: an Integrated Care Board (ICB) and an Integrated Care Partnership (ICP). The association said: "The previous structures in England, established by the Health and Social Care Act 2012, originally had over 200 clinical commissioning groups. This number had reduced over recent years via mergers." "However, this latest shift to just 42 commissioning entities means a significant change to significantly larger geographies and populations covered by each ICS. Although each ICS and its activity can be subdivided into 'places', and within places into 'neighbourhoods', it is at the ICS level that the employer is formed." "Whereas CCGs previously employed many local health professionals, including pharmacists, the new arrangements mean that ICBs are now that employer. The PDA is supporting members who have contacted its Service Centre about the impact of these changes."

Integration of primary and community care is key to health service improvement - Lords Committee has said in a new report published on 15 December. The report highlighted the need for better staff training, improved data-sharing, flexible healthcare structures and collaboration across different professions in the healthcare system to support more integrated care. Royal Pharmaceutical Society (RPS) England has welcomed the report, and highlighted the important role pharmacy teams can play in improving patient care. Tase Oputu, Chair of RPS England Pharmacy Board, said: "Pharmacists and pharmacy teams play a vital role in supporting more integrated care, working with multidisciplinary teams across the health service.

The lessons from Covid crisis applied in the future through collaboration can create a better integration between GP practices, hospitals and community pharmacies, Pharmacists Defence Association (PDA) has proposed. Stating that a more integrated healthcare system could enable pharmacists to provide effective and more efficient care to patients, the PDA proposed a model where at least two pharmacists would be working in each community pharmacy, empowered, and enabled with two-way referral pathways, having more clinical input and full access to patient records. "Such an environment could not only help to improve communications between health professionals and increase access to services for patients, but would support the NHS to operate more effectively."

England's chief pharmaceutical officer (CPhO) David Webb has promised his "wholehearted support" for the community pharmacy sector at the board meeting of the National Pharmacy Association (NPA) on 28 June in St Albans. After hearing the CPhO at the meeting, NPA chair, Andrew Lane, later declared: "David is someone we can do business with." Webb thus listed his priorities as head of profession: integration of independent prescribing as part of pharmacy practice by 2026; promotion of inclusive pharmacy practice for all pharmacy professionals; assurance of post-registration practice; developing the role of pharmacy technicians; support for Integrated Care Systems and Primary Care Network pharmacy teams (including community pharmacy); medicines optimisation; and strengthening of professional leadership for community pharmacy. He also reported that NHS England had recently increased its team of regional pharmacy integration leads from seven to 14, creating seven new senior posts. Webb told NPA board members: "I want sincerely to thank community pharmacy teams for everything they are doing and to say that you have my wholehearted support. I believe in the importance of community pharmacy and will listen and engage as I've already demonstrated.

The recruitment of pharmacists in Primary Care Networks (PCNs) has exacerbated a general shortage of pharmacists, revealed an independent review of Integrated Care Systems (ICSs) published on Tuesday (4 April). The review, Rt Hon Patricia Hewitt, highlighted the impact that the Additional Roles Reimbursement Scheme (ARRS) roles for pharmacists are having on the community pharmacy sector. "Contracts with national requirements can have unintended consequences when applied to particular circumstances. For instance, the national requirements and funding of Additional Roles Reimbursement Scheme (ARRS) roles for community pharmacists within PCNs, has on occasion exacerbated the problem of a general shortage of pharmacists, with some now preferring to work within primary care rather than remain in community pharmacies or acute hospitals, compounding the problem of community pharmacy closures and delayed discharges." It set out to consider the oversight and governance of ICS in England and the NHS targets and priorities for which Integrated Care Boards (ICBs) are accountable, including those set out in the Government's mandate to NHS England. As part of this work, Hewitt and her team engaged with a wide range of stakeholders representing various local health and social care settings, including LPCs.

David Webb, the Chief Pharmaceutical Officer for England, acknowledged that the "pressure in the system is high", but urged everyone to "keep our eye on the design" of the NHS plan, adding that the "the objective is to bring the different parts of primary care together" in the patient interest. Speaking during the opening keynote session at the the National Pharmacy Association (NPA) conference held on Thursday (13 October), he added that the NHS plan intends to bring different parts of primary care together to help patients. He said the new integrated care boards (ICBs) are a key strategic framework as they provide the "potential to form partnerships to deliver integrated services across larger populations". "ICBs will want to work with Local Pharmaceutical Committees to plan for the local population and the new community pharmacy clinical leads in ICBs, who have been funded by NHS England, are there to advise." He explained that once an ICB takes over the commissioning of pharmaceutical services (which they are all due to do by April 2023), it could use its funds to commission a local enhanced service as an add on to an advanced service. For instance, a CVD risk assessment could be added to the blood pressure check service.

NHS England has updated its 'Green plan guidance', outlining key actions for Integrated Care Boards (ICBs) and trusts to help achieve net zero carbon emissions. Among the recommended measures to reduce emissions from the medicines supply chain, organisations are asked to encourage patients to return used or expired inhalers to community pharmacies for appropriate disposal. Medicines account for approximately 25 per cent of NHS emissions, with a small number of medications contributing a large portion of this. For example, anaesthetic gases account for 2 per cent of NHS emissions, while inhalers contribute 3 per cent. The updated guidance says that organisations should build on ongoing progress in reducing these "point of use" emissions, while improving patient care and reducing waste. To address emissions from the medicines supply chain, the guidance recommends: Supporting high-quality, lower-carbon respiratory care Optimising inhaler choice by considering clinical appropriateness, the environmental impact of inhalers and patient preference Improving inhaler use and adherence Promoting the appropriate disposal of inhalers Addressing overprescribing and oversupply while ensuring support for patients in greatest need

Community pharmacists involved in the Independent Prescribers Pathfinder Programme will be able to generate NHS prescriptions through the NHS Electronic Prescription Service (EPS). NHS England has secured a new clinical system, CLEO SOLO from Cleo Systems, to facilitate this service. The system is being rolled out to 'pathfinder' sites so they can start delivering their proposed prescribing models and pathways. Integrated Care Boards (ICBs) across England have been informed of this development and are asked to provide support and leadership to their sites throughout the programme, which will run until March 2025. NHS England will also conduct a series of webinars with ICBs to discuss the CLEO SOLO rollout. David Webb, Chief Pharmaceutical Officer at NHS England, highlighted that the Pathfinder Programme will enable community pharmacist prescribers at 'pathfinder' sites to issue NHS prescriptions for conditions such as cardiovascular and respiratory diseases. "This will help us develop a framework which will support the commissioning of independent prescribing as part of clinical services in community pharmacy in the future," Webb said.

The Pharmacists' Defence Association (PDA) is advising locum pharmacists to take screenshots of online agreements due to an increasing number of reports where community pharmacy businesses are unilaterally amending agreed-upon terms after a contract has been confirmed. The PDA highlighted one recent case where a locum was informed at short notice by the community pharmacy business that they would no longer pay the agreed hourly rate. The business then re-advertised the shift, falsely claiming that the booked locum was unwell. Unable to secure a locum at the new rate before the shift, the pharmacy closed, leaving patients and the local community without access to services. In such circumstances, the PDA advises affected locums to notify the relevant health boards or Integrated Care Boards (ICBs) of such breaches of NHS terms of service.

After struggling with COVID, Hemant Petal is back to good health, and now he is on a mission to reduce "health inequalities". Speaking at the SIGMA Conference 2023, he spoke about his new role as Clinical Lead, Health Inequalities and Population Health Management, SE Essex Alliance, Essex ICB. "So, my new role is outside pharmacy, nothing to do with pharmacy. But it is important, I feel that I share some of my insights about the work that I'm doing that might benefit you," he said. Elaborating on the role of integrated care boards (ICBs), he said that they are designed to enhance coordination and collaboration across different healthcare providers and settings. The representatives from hospitals, community services, retail and social care meet on a monthly basis to "look at where there are issues to be resolved, perhaps what can be done to improve the healthcare services."

Pharmacists, councillors and NHS leaders came together at Portsmouth's first Community Pharmacy Summit to address some of the challenges facing community pharmacy locally. They explored ways to reduce the huge pressures on pharmacy, tackle abuse towards staff, enable pharmacists to undertake training to treat more illnesses, and to protect the current and future workforce. Portsmouth City Council, which hosted the Summit on Wednesday 15 November, also invited representatives from Hampshire and Isle of Wight Constabulary, University of Portsmouth, Hampshire and Isle of Wight Integrated Care Board and businesses to discuss new opportunities to work together. Held at Portsmouth Guildhall, the event was chaired by Cllr Matthew Winnington, Cabinet Member for Community Wellbeing, Health and Care, and Cllr Gerald Vernon-Jackson, Cabinet Member for Transport.

Community pharmacy could play an important role in proactive detection of heart valve disease (HVD), which remains under-recognised and under-detected in England, suggested a new report published by Wilmington Healthcare. Pharmacy bodies, including Royal Pharmaceutical Society (RPS), National Pharmacy Association (NPA) and Community Pharmacy England (CPE), have also endorsed the report, which encourages Integrated Care Boards (ICBs) to consider the innovative approach of detecting HVD with the help of community pharmacists. Despite HVD detection being a priority listed in the NHS Long Term Plan, a large number of people with HVD remained undiagnosed and untreated in the country due to lack of awareness of the disease prevalence. In June 2022, a pilot study was launched in Farnborough Primary Care Network (PCN), Hampshire, to evaluate the feasibility of using e-stethoscopes (digital auscultation) to detect this heart condition by a community pharmacist.

Several pharmacies have joined the inhaler recycling scheme in Wolverhampton, West Midlands, to support NHS England's Greener NHS programme, which aims to achieve net zero emissions by 2040. It is part of a collaborative working initiative between the Royal Wolverhampton NHS Trust and AstraZeneca UK Ltd, supported by the Black Country Integrated Care Board and Wolverhampton City Local Pharmaceutical Committee. Under this scheme, old and used inhalers are recycled and transformed into new products, such as coat hangers and waste bins. Simon Evans, group chief strategy officer for The Royal Wolverhampton NHS Trust, emphasised the importance of prioritising the reduction of carbon footprint while maintaining high-quality care, to protect the planet for future generations. "The Trust has already made significant achievements in several areas including the physical estate, clinical services, waste recycling, catering and medicines - with this inhaler recycling scheme from pharmacy being the latest string to our bow," he said.

A worrying rise in pharmacy closures across England is disproportionately affecting older people and rural communities, according to a new report by Healthwatch England. Findings obtained through Freedom of Information (FoI) requests have exposed the scale of the issue, with over 436 permanent pharmacy closures recorded in 2023 and more than 13,800 temporary closures resulting in nearly 47,000 hours lost. The report, published on Thursday, paints a bleak picture of access to vital healthcare services, particularly in rural areas where pharmacy closures have hit hardest. The report found that Integrated Care Boards (ICBs) in rural areas recorded a higher level of temporary pharmacy closures compared to ICBs in predominantly urban areas. Additionally, ICBs with a higher proportion of people over 60 years of age recorded a higher number of hours lost per pharmacy. Healthwatch chief executive Louise Ansari expressed concern about the impact on elderly populations, noting that the closures were undermining the government's flagship Pharmacy First programme, designed to relieve pressure on GP practices by allowing patients to seek care for common conditions at local pharmacies.

The NHS in Suffolk and North East Essex has launched a new campaign to reduce the amount of unused medicines that cost the NHS around £300 million a year. Across the UK, it is estimated that £100 million worth of medicines are returned to pharmacies, with an additional £90 million of unused prescription medicines stored in homes. Through social media, posters, and videos, people are encouraged to return unused prescriptions to pharmacies and avoid stockpiling or throwing them away. Reducing medicines waste not only saves money that can be reinvested into patient care within the NHS, but it's also better for the environment. Tania Farrow, who is leading the campaign on behalf of NHS Suffolk and North East Essex Integrated Care Board (ICB), highlighted that everyone has a part to play in reducing medicines waste.

The Department of Health and Social Care (DHSC) has launched a public consultation to gather feedback on government proposals to eliminate modern slavery from the NHS supply chain. This initiative follows a recent government review which revealed that over 21 per cent of NHS suppliers are at high risk of involving modern slavery in the procurement of medical equipment, particularly surgical instruments, gloves, gowns, uniforms, and face masks. The proposed measures would require public bodies procuring goods and services for the NHS to work with suppliers to identify risks and put forward solutions. These new regulations would apply to all public bodies procuring health goods and services, including NHS trusts, integrated care boards, and local authorities. Health Secretary Wes Streeting said: "The NHS is a public service built on compassion and equality, values which are completely antithetical to the heinous evil of modern slavery." "These new measures will ensure vital checks are made and public bodies act to stamp out the crimes of slavery and human trafficking." He also stated that his government will ensure the NHS leads the fight against modern slavery.

The General Pharmaceutical Council (GPhC) has announced the names of five new members who will be joining its governing Council over the next two years. The new council members are: Professor Dianne Ford, Pro Vice-Chancellor of the Faculty of Health and Life Sciences at Northumbria University. Gareth Powell, a chartered accountant and a Non-Executive Director on the Board of the Port of Milford Haven, the UK's largest energy port. Adeyemi (Ade) Williams MBE, Superintendent Pharmacist and Director of the M J Williams Pharmacy and lead Pharmacist at the Bedminster Pharmacy, Bristol. Tim Jaggard, Deputy Chief Executive and Chief Financial Officer at University College London Hospitals NHS Foundation Trust. Dr Raliat Onatade, Chief Pharmacist and Director of Medicines and Pharmacy for North-East London Integrated Care System. Professor Ford, Powell and Williams will begin their terms on 1 April 2024, replacing Jo Kember, Mark Hammond and Arun Midha.

As we transition in England through yet another NHS organisational change, I ask myself what does this mean for community pharmacy? I would like to think that this change will bring about opportunity and a chance for community pharmacy to showcase and continue the excellent work that was carried out during the height of the pandemic and is still ongoing today. I hope that it allows community pharmacy to be regarded as part of the NHS rather than sitting on the side lines. This change has to lead to better funding for community pharmacy, without sufficient funding we will see more pharmacies close. We are hearing a lot about winter pressures but this year it feels like all year round pressure. What I have seen, whilst the NHS is under such pressure, is North East London (NEL) CCG transitioning to an integrated care board (ICB) almost seamlessly. I have seen people transitioning into new roles, whilst working hard to ensure that all plates are still spinning, which at the moment is no mean feat. I spent a day out recently visiting pharmacies with the chief medical officer of NHS NEL, Dr Paul Gilluley. The visits were positive, we felt listened to and understood. The feedback was great, it was recognised that community pharmacy is often the informal front door to the NHS and that we have so much to offer in terms of ill health prevention. Community pharmacy can offer a total solution as long as we have the tools to do so, which can save so much time and money. An example is the GP CPCS service, which has launched well across NEL.

The British Generic Manufacturers Association (BGMA) has warned that England's 42 integrated care boards (ICBs) may need to allocate an extra £37 million from their budgets annually for the next five years due to the spiralling tax rates. The government's Voluntary Scheme for Branded Medicines Pricing and Access (VPAS) rebate rate increased more than five-fold in the past two years, the BGMA said in its white paper released on Monday (October 30). The report, conducted by consultancy firm Conclusio in consultation with local NHS leaders, examined the potential effects of the VPAS on ICB budgets. BGMA said that due to the elevated VPAS rate, each ICB in England will experience significant increases in expenses for branded generics and biosimilars annually - a consequence of reduced competition.

NHS West Yorkshire Integrated Care Board (ICB)'s decision to withdraw gluten free prescriptions for people with coeliac disease across Leeds and Calderdale has disappointed Coeliac UK. In a statement released on Thursday, the charity, which provides support and advice to those living with the disease, has raised "grave concerns" about the decision, warning that it will have a detrimental impact on the coeliac community. The policy is currently implemented across the ICB's other places including Bradford district and Craven, Kirklees and Wakefield district, preventing coeliac patients from accessing gluten free bread and flour mix on prescription. NHS West Yorkshire ICB wants to align its gluten free prescribing guidelines across its five places. But the charity is worried that the additional cost of gluten free staple products will poses a real challenge to maintaining the gluten-free diet, which is the only treatment for the condition.