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Community pharmacy is stuck in a vicious circle. Pharmacies are closing at an alarming rate whilst the government is talking about moving care away from hospitals and into the community to focus on preventative care. While the government talks about this vision for the future, the stark reality is that pharmacies are already struggling to meet the current Pharmacy First thresholds. And now we discover that one of the key components that could create capacity in pharmacy to deliver more clinical services has been put on hold…indefinitely. The recently published Darzi review, which was commissioned after the new government came to power to assess the state of the NHS, praised the value of community pharmacies and preventative services. But it recognised the level of pharmacy closures across the country and warned pharmacy access could be 'at risk'. Community pharmacy is ideally placed to deliver the government's vision of preventative care in the community. But let's all be clear, moving preventative services into community pharmacies has, so far, been nowhere near as successful as it could have been due to the current climate pharmacies find themselves in. The Pharmacy First scheme is a testament to this. Just this week it was announced that consultation thresholds for the Pharmacy First scheme have been reduced from 30 consultations to 20. It's the second time in three months that the thresholds have been reduced and it follows an intervention from Community Pharmacy England who wanted to "save many pharmacies from missing out on a vital payment this month." In June alone, 3,269 participating pharmacies failed to meet the threshold - that's almost a third of all community pharmacies in England.

A harsh funding regime that hasn't adapted to changing macroeconomic realities means the viability of large parts of the pharmacy sector is at risk unless the model changes. Very simply, across the sector, revenue has remained largely fixed while costs have increased significantly, making it impossible for many pharmacies to sustain their business models. The sector has seen the closure of more than 1,500 community pharmacies since 2015, with 700 of these closures occurring since 2021. Larger pharmacy operators such as Lloyds, Boots, and Rowlands have seen the biggest decline in numbers, with smaller businesses operating between one and five pharmacies now accounting for almost 50% of the sector. Despite rising inflation and business costs, the NHS pharmacy funding model has remained fixed. Over the period of the current Community Pharmacy Contractual Framework (CPCF) - 2019-2024 - pharmacies have experienced a 30% real terms cut in core funding leading to an annual shortfall of over £750 million, equivalent to £67,000 per pharmacy in England. The current CPCF is due to end in 2024, and there is still no arrangement in place for future funding, leading to delayed and inefficient spending decisions and hampering the ability of the sector to plan and attract much-needed investment.

Wes Streeting's speech at the Labour Party Conference 2024 outlines several key health and social care reforms, which hold significant implications for community pharmacy in England. His focus on reforming and rebuilding the NHS to ensure fair, universal access to care, with prevention and early intervention at its core, presents both opportunities and challenges for community pharmacy. Here are the potential implications: 1. Prevention Focus Streeting's vision of a shift from a reactive, hospital-based model to a preventive healthcare system presents a promising future for community pharmacies. These changes could significantly reduce pressures on GPs and hospitals, integrating pharmacies more closely into primary care networks and enhancing their role in preventive care. 2. Digital Transformation The move from an "analogue to digital" NHS could see community pharmacies adopting more digital tools and systems for service delivery. This would likely involve greater use of digital prescribing, telehealth consultations, and AI-driven services. Pharmacies will need to invest in digital infrastructure and ensure that pharmacy professionals are trained to operate within a more tech-centric environment. 3. Reform and Redistribution of Services Streeting's plans to extend choice and equitable access to services mean that community pharmacies could become integral to providing care in underserved or disadvantaged areas. With a focus on decentralising healthcare and bringing it closer to local communities, community pharmacies could play a more significant role in supporting healthcare delivery in areas where GP services are stretched. This may include expanding access to pharmacy services in the most deprived areas, aligning with Labour's emphasis on addressing health inequalities.

The All-Party Parliamentary Group (APPG) on Pharmacy published a new report on Monday (January 23) that calls for "urgent action" to relieve funding pressure so there are "opportunities" for community pharmacy teams to deliver even more for their patients. The report highlights the need for a new "strategic vision" for pharmacy and highlights opportunities for the network to be empowered to deliver even more for patients. However, the manifesto also underlines that there are the very real risks that this opportunity may be lost if significant and ongoing pressures are not addressed. The recommendations are based on written and oral evidence gathered from frontline pharmacists, GPs, professional bodies and healthcare experts. To harness the potential of pharmacy, the report recommends the Government must take urgent action to relieve the funding pressures on the community pharmacy sector in the short term and review the long-term funding model for pharmacy. It also suggested the Government must harness the power of pharmacy to help the NHS deal with the COVID-19 backlog and the UK's growing healthcare challenges. It further recommended that future commissioning and funding must recognise that community pharmacy is the front door to the NHS for many patients.

"We need to fix the front door to our NHS by investing in community pharmacy," asserts Daisy Cooper as more and more pharmacies "worry about the future of their business." Reflecting on the challenges faced by pharmacists during the pandemic, she emphasised their pivotal role in launching vaccination schemes across communities and the larger role pharmacies play in complementing traditional NHS facilities. Cooper recalls her collaboration with local pharmacies in St. Albans, where she worked hand in glove with them to address challenges faced by pharmacists to obtain information from NHS England regarding protocols and procedures. She told Pharmacy Business reporter that she had to work out something "hand in glove to help them get those vaccinated schemes up and running, as pharmacies were desperate to take part in the vaccination scheme" in her constituency. Describing their unique selling point (USP), Cooper emphasised the convenience and immediacy of pharmacies located in high street areas and warned that pharmacy closures "should be a real wake up call for the government."

Centred Solutions has been at the forefront of the pharmacy hub and spoke dispensing in England over the last few years. We have already demonstrated that hub and spoke dispensing is a realistic model of dispensing for pharmacy groups of all sizes. We've seen the massive difference that hub and spoke can make to community pharmacy. With pharmacies struggling to survive, the time has come to stop delaying and to now push ahead with model one of hub and spoke dispensing. In our experience, there is no risk with moving ahead with model one of hub and spoke legislation which would allow medicines to be returned from the hub to the pharmacy ready to be dispensed to the patient. We do however understand the need for more policy discussion around the second model of hub and spoke, where the hub sends the medication directly to the patient. This should not delay the implementation of model one. This model would immediately level the playing field for smaller and independent pharmacies, allowing them to use a hub and spoke model of their choice now to create capacity for clinical services. We feel strongly about this issue and that's why we are working alongside HubRx and PillTime to raise awareness.

The health secretary, Steve Barclay was asked over the delay of 'Pharmacy First' model in England that was proposed by the Pharmaceutical Services Negotiating Committee (PSNC) last year, at the Health Committee evidence session held on Tuesday (31 January). Taiwo Owatemi MP (Chair of the Pharmacy APPG) asked whether he was adhering to his statutory responsibility to ensure continued access to medicines and cited the CCA's closures in areas of deprivation research. Barclay replied that the government is 'investing more'. He said, "We put an extra 100 million on top of the 2.6 billion a year we commit to community pharmacy to expand the range of clinical services. We've got over 2 million patients that have been referred to community pharmacy from NHS." He further added: "One of the issues I'm very keen on is to explore what more we can do in pharmacy not least given the pressures on GP and the opportunity to look at what it is currently people go to GPS for where potentially the risk to do more at the pharmacy and we're already doing that."

Pharmacy hub and spoke providers gathered at Westminster on Tuesday (November 19) to highlight to MPs the urgent need to implement Model One of Hub and Spoke legislation. This proposed model, aimed at making hub and spoke dispensing accessible to all pharmacies, was initially scheduled for rollout in January 2025, but has been delayed. Representatives from Centred Solutions, HubRx, and PillTime engaged with over 30 MPs at the event, which was organised with the support of former pharmacist and Labour MP Sadik Al-Hassan. They highlighted the significant benefits of hub and spoke for community pharmacies and stressed the need to extend its use across different legal entities. Sadik Al-Hassan, MP for North Somerset and officer for the Pharmacy APPG, expressed his support, saying, "Community pharmacies are a vital lifeline for our high streets and independents have always been at a disadvantage versus larger chains who can employ economies of scale. "Model One of the proposed legislation would allow the benefits of big pharmacies for smaller ones to help them focus on the service provision our NHS needs during this difficult financial time."

Recently, the English Health Secretary has talked about introducing a 'Pharmacy First' model similar to that which exists in Scotland. This would be a win-win outcome providing people with better access to essential healthcare support, advice and treatment whilst relieving strain on other parts of the NHS, not least GPs and A&E. It is a no-brainer and yet despite a few media headlines there are still no firm proposals on the table to make this a reality. It surely cannot be right that you can receive a broad range of patient care services in Scotland which are not available in England. It works well in Scotland, Wales is keen to develop more pharmacy-based services and Northern Ireland, leaving aside the current funding dispute, has had a minor ailments service for many years. If the English Health Secretary is sincere in his interest in adopting an English version of the Scottish model, then there are critical aspects he needs to consider. Firstly, start with the patient journey through the healthcare ecosystem from illness prevention through to long-term condition management. What is the role of community pharmacy and how do we guide people to seek support from the most appropriate healthcare professional? What is the vision for community pharmacy delivering patient care in the next decade? The lesson from Scotland is that the government needs to sit down with the sector and map that out together. There are no quick fix overnight solutions. This needs to be a long-term commitment backed by adequate funding. Supervision regulations need to change and there needs to be a thought through workforce strategy which avoids community pharmacy shortages as that does nothing to deliver improved patient outcomes.

The Pharmacy Supervision Practice Group consisting of members from AIMp, APTUK, CCA, NPA, PDA, PFNI and RPS held its fourth workshop to continue discussions on the future modelling of pharmacy practice. The ideas around 'supervision' shared by the organisation earlier formed the basis of the discussion during the workshop and helped to expand understanding of where there was consensus and disagreement. Examples of ideas explored during the workshop include: the extent to which a pharmacist should supervise the medicines assembly process, the purpose and extent to which a pharmacist might be absent from the pharmacy and how this might affect patient safety as well as the nature of whether fixed rules versus a broad framework were preferable for future practice. Chair of the group, Dr Michael Twigg, Associate Professor of Primary Care Pharmacy, University of East Anglia, said "Once again the sector bodies have come together in a collaborative and positive manner to explore the concept of 'supervision' in the context of current and future community pharmacy practice. This session provided an opportunity to constructively challenge assumptions and viewpoints within the group with the aim of moving the discussion forward." As part of the session, the DHSC, GPhC and PSNI gave an overview of the difference between legislation, regulation and guidance which was helpful to inform the group's thinking. Each of the organisations have been asked to use the conversation to refine the ideas presented in advance of the next workshop.

The full-time equivalent community pharmacy workforce saw a 6 per cent decline in a year, while the overall number of pharmacists remains nearly constant, according to NHS England's Community Pharmacy Workforce Survey 2022. However, vacancy rates among pharmacists rose 16 percent, suggesting an increased reliance on locum pharmacists who, on average, work fewer hours, the data revealed. According to NHSE, the mandated survey released (Aug. 3) achieved a 95 per cent completion rate among pharmacy contractors, marking a substantial increase compared to only 47 per cent in the previous year. The survey results indicate a shift in working patterns within community pharmacy, with locum pharmacists being utilised more frequently as part of the staffing model. The survey revealed a 6 per cent decrease in the community pharmacy workforce across all roles combined. The number of full-time equivalent pharmacists working in community pharmacy decreased by 2,411, from 20,255 in 2021 to 17,844 in 2022, the survey found. The employed pharmacists decreased by 16 per cent from 12,774 in 2021 to 10,943 in 2022, while locum pharmacists increased by 26 per cent from 4,297 in 2021 to 5,477 in 2022, NHSE said.

A new report has suggested that adopting hub and spoke dispensing model could be a realistic and affordable option for many pharmacies across the UK, not just a select few. The report released by Centred Solutions highlighted several evidence-based benefits of this model, including a return on investment (ROI) within two years for an average pharmacy, debunking the skepticism that has long surrounded the model. Analysis by the software and technology company found that the ROI, from setting up a hub and all operational costs (excluding transport), can be achieved through either re-directing time saved into delivering services, improving resource efficiencies, or a combination of both. One of the key findings is the 81 per cent reduction in payroll costs per item-from 99p in a pharmacy to just 19p in a hub. The report also revealed that by shifting to a hub and spoke model, pharmacies could offload 50 per cent of total dispensing volumes (70-80 per cent of repeat dispensing) from their branches, creating much-needed capacity. The report also projected an average stock reduction of 50 per cent in the first year for pharmacy branches moving to this model of dispensing.

Alitam has announced that it has merged with clinical skills training provider MHRx to upskill UK pharmacists so that its chain of community pharmacies in the UK can diagnose and treat minor medical ailments "quickly and safely". This is a second merger deal announced by the group that has 100-plus pharmacies, just days after its merger with Pharmadoctor to "radically transform the UK and Ireland's community pharmacy sector" into a truly preventative healthcare system. Following the merger with MHRx, Alitam will now be providing a career development platform for its pharmacy teams, which also include nurses and other healthcare professionals. MHRx's training incorporates every aspect of general practice alongside relevant topics including making appropriate patient consultation records in line with NHS guidelines. This, Alitam believes, will allow community pharmacies to carry out formal diagnoses, formulate differential diagnosis plans, and perform full clinical examinations. According to the founder and CEO Feisal Nahaboo, mergers such as these will lead to "a healthcare revolution predicated on building the world's first truly preventative healthcare model".

Women accounted for 62 per cent of GPhC registrants in 2019, according to the Royal Pharmaceutical Society. Despite representing the majority of pharmacists in the UK, only 2 per cent of women are pharmacy business owners compared with 13 per cent of men. Also, the majority of senior pharmacy leadership positions are held by men, with research showing that only 36 per cent of senior pharmacy leaders are women. Sobha Sharma Kandel, superintendent pharmacist and co-owner of Neem Tree Pharmacy, Abbey Wood, London, quoted these statistics while shedding light on the representation of female leaders in the field of pharmacy. So, what is stopping women from reaching leadership positions in the profession? According to Sobha, the barriers hindering female pharmacists from attaining leadership positions include: Gender Bias and Stereotypes Lack of Representation and Role Models Glass Ceiling and Double Standards Work-Life Balance Challenges Imposter Syndrome Unequal Access to Opportunities Negotiation and Advocacy Challenges "There also continue to be gender and ethnicity pay gaps affecting women in pharmacy," said Sobha, who has been advocating for women in pharmacy by being a part of the Female Pharmacy Leaders Network.

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.

Bristol-based Titan PMR, a technology firm specialising in PMR systems for community pharmacies, is set to roll out an innovative platform named 'Titanverse,' that it claims will redefine pharmacy management, offering comprehensive solutions extending beyond prescription management. This new platform takes a versatile approach, efficiently managing all facets of pharmacy operations, from high-level management down to daily tasks, according to top company officials. "Our aim is to reshape pharmacies into genuine health hubs, providing advanced services and harnessing state-of-the-art technologies," said Tariq Muhammad, CEO of Titan PMR. "Titanverse, our latest offering, is positioned to ignite this transformation, revolutionising clinical services in the same way its predecessor revolutionised dispensing. With Titanverse, we have the vehicle to drive this vision forward, placing pharmacies at the forefront of primary care in the future." Titanverse adopts a Teams approach, catering to pharmacies with multiple locations or specific focuses. It furnishes real-time analytics and employs a color-coded rating system for swift performance evaluation. Moreover, the platform eases operations by enabling task delegation, encompassing clinical checks and dispensing, all while backing private services with adaptable templates and workflows.

A group of 20 MPs from the different political parties, including Dame Priti Patel and Judith Cummins, have written a joint letter to health minister Andrea Leadsom, calling for urgent action to address the pressures faced by community pharmacies. Taking note of rising pharmacy closures, they have highlighted the need for more investment and support from the government. Recent NHS figures showed that around 1,400 pharmacies have closed permanently since October 2016, and many more are withdrawing services or reducing their opening hours, particularly in deprived areas. The MPs have urged the pharmacy minister to commit to making essential changes including a fair and sustainable core funding model, an effective implementation of the Pharmacy First service and an expansion into other clinical service areas.

The recent announcement that Royal Mail will be partnering with distance selling pharmacy (DSP) giant pharmacy2U highlights how standards of regulatory enforcement are being ignored to accommodate the DSP model. The brunt of these double standards hinges around the levelling down of temperature enforcement standards by the Medicines and Healthcare products Regulatory Agency (MHRA) which demands mapping must be audited from the point of dispensing to the patient. The MHRA has a well recognised duty to ensure medicines reach patients in a safe condition. The current anomaly appears to turn a blind eye to this step in the supply chain at the point the wholesaler releases goods to the pharmacy hub. Equally the training on delivering medicines safely and effectively direct to patients should apply fully to all hubs including DSPs. Why is it that DSPs are being treated differently to bricks and mortar pharmacies? It's essentially the same patients receiving the same medicines from the same wholesalers. A further regulatory disparity exists around how parcels must be "tracked and signed for" to be reasonably certain medicines are delivered into the hand of the intended recipient, as per existing regulations. Clearly an untracked, unsigned package cannot be guaranteed to finish in the hands of the intended recipient. There is a very real possibility that such omission could lead to community pharmacy closures which will, in turn, lead to unemployment and a reduction in the care services. At a time when integrated care systems have just gone live, the removal of vital support services leading to further inequalities is the wrong message for both providers and patients alike.

HubRx has appointed Dr Sarah Passmore as superintendent pharmacist ahead of launching what the company called "the UK's first state-of-the-art automated pharmacy hub". Dr Passmore brings more than 20 years of pharmacy experience - having held key regulatory roles with Rowlands Pharmacy over a 11-year tenure, which also saw her involved in a number of pharmacy automation projects. Commenting on her appointment, Dr Passmore said: "As a pharmacist, who has spent more than 10 years working within community pharmacy, I'm excited by what a hub and spoke model for prescription dispensing can bring. "Pharmacists are highly trained in delivering clinical services to patients - and like me - it's often a part of their job that they thoroughly enjoy. The option of using hub and spoke to support dispensing prescriptions will give community pharmacists the gift of more time that can be spent helping patients. "I'm excited to join HubRx and for it to become the first state-of-the-art automated pharmacy hub designed for independent community pharmacists to launch in the UK."

Over-the-counter (OTC) medicines can empower customers and pave the way for a sustainable healthcare future. By embracing OTC products, pharmacies can achieve greater freedom, stability, and enhanced profitability. In our exclusive interview with Anna Maxwell, founder and CEO of pioneering consumer healthcare company Maxwellia, we explore their game-changing pharmacy brands leading the way in self-care. Why pharmacies should embrace OTC medicines? There's never been a more critical time for pharmacies to lean into the OTC space. Right now, about 90 per cent of pharmacy income in the UK is tied to NHS funding-a model that's increasingly unsustainable.[1] We all value the NHS, but it simply can't afford to cover every treatment at the point of use indefinitely. If pharmacies could achieve even a modest shift in NHS reliance this would mean more freedom, stability, and profitability for the business. OTC medicines are the key to making that happen, offering a way to quickly provide, effective treatments that help customers while reducing the administrative and financial burdens on pharmacists.