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British health officials on Wednesday (September 28) warned that increased circulation of flu and a resurgence in Covid-19 could lead to a difficult winter that increases pressure on the already stretched NHS. Warnings over a possible "twindemic" of Covid-19 and flu have been issued each winter since the start of the coronavirus pandemic in early 2020, but Covid restrictions that limited social contact have meant flu levels stayed low. However, the government ended coronavirus restrictions earlier this year, meaning that social contact rates have returned to near pre-pandemic norms while immunity to flu is relatively low. The UK Health Security Agency (UKHSA) said that given the risk it was important those eligible took up vaccines against Covid and flu. "There are strong indications we could be facing the threat of widely circulating flu, lower levels of natural immunity due to less exposure over the last three winters and an increase in Covid-19 circulating," said Susan Hopkins, chief medical advisor at UKHSA.

Winter pressures are already mounting on NHS staff ahead of December, with high levels of demand in hospitals due to a significant increase in cases of norovirus infection. Norovirus is a highly contagious virus which spreads through contaminated food, water or surfaces and causes vomiting and diarrhea. New NHS figures revealed that an average of 351 people were hospitalised with diarrhoea and vomiting symptoms every day last week in England, almost triple the number during the same period last winter, which was 126. The number of children in hospital with the virus was also higher last week (13) compared the same week last year (an average of just three), according to the weekly winter update published by the health service on 30 November.

The Royal Pharmaceutical Society (RPS) England Chair Thorrun Govind has called for Government action to support pharmacy teams experiencing huge demand for their services. "Pharmacy teams are under immense pressure at the moment, in common with other NHS services, and working extremely hard with health service colleagues to provide the right care for patients," said Govind. "As winter pressures mount, pharmacies see increased numbers of patients seeking support with illness and also because they have heard other areas of the health service are struggling to cope. The society has also stated staffing pressures, alongside an increase in workload has created an extra burden which takes a toll on the wellbeing of pharmacy teams. Govind added: "Issues such as medicine shortages can also take up many hours of time for pharmacy teams tracking down medicines when they could be directly helping patients. In community pharmacies, rising costs and fairly static funding are adding to business pressures. "However, pharmacies remain the most accessible part of the health service and provide expert advice to patients without the need for an appointment and are open long hours and at weekends."

Pharmaceutical Services Negotiating Committee (PSNC) has asked the government and the NHS to give more support to all community pharmacies as they gear up for "an extremely challenging winter period." During talks with NHS England and NHS Improvement (NHSE&I) and the Department of Health and Social Care (DHSC) last week, PSNC highlighted that contractors are already under pressure because of workforce crisis, capacity issues and escalated staffing costs. all these factors could pose a bigger challenge during the busy winter season, it said. Though PSNC supported the government's aim on booster vaccinations and approval of more pharmacy sites, it expressed concerns over the impact of the vaccination drive on all community pharmacies. To ease the pressure on pharmacies, the negotiator has sought additional support through regulatory measures, the removal of administrative burdens and changes to the current Pharmacy Quality Scheme (PQS).

The ongoing pharmacist workforce crisis has posed a significant risk to patients' access to care, medicines and advice - particularly affecting the elderly and vulnerable living in areas with health inequalities. Many from the sector have raised concerns about this issue with the Company Chemists' Association (CCA) recently acknowledging the shortage of pharmacists or pharmacy technicians in the country to meet the needs of patients and the NHS. The trade body representing almost 50 per cent of the community pharmacy sector said that pharmacy teams are exhausted after working tirelessly during the pandemic, adding that Covid, Brexit and NHS reforms have exacerbated the shortage. Covid and winter-related sickness absences are adding to the strain and with Brexit it has become difficult to attract overseas pharmacists to the UK.

Pharmaceutical Services Negotiating Committee expects the next round of negotiations to set the arrangements for the Community Pharmacy Contractual Framework (CPCF) in 2022/23 - Year 4 of the five-year CPCF deal, to begin soon. The negotiator held a meeting on November 24 and 25 to discuss the burning issues affecting the sector and to plan for upcoming negotiations with the Department of Health and Social Care (DHSC) and NHS England and NHS Improvement (NHSE&I). It aims to complete these negotiations by April, allowing ample time for contractors to make arrangement prior to the beginning of the financial year. PSNC vice-chair, and independent contractor, Bharat Patel said the entire sector is worried about the "outlook for pharmacies as we head into a difficult winter," and is working to find solutions. He noted that PSNC "will be bringing proposals for additional funding and support, particularly around the treatment of 'walk-in' patients, to the table, along with a heavy dose of realism for government and the NHS about the current challenges in the sector." While expecting a difficult round of discussion with the government, Patel remained optimistic about a favourable outcome for pharmacies.

The English health secretary has fumbled the opportunity to prevent a crisis in the NHS this winter. She either does not understand or value the role of community pharmacy as the third pillar of patient access to essential healthcare. Her announcement that she wants community pharmacy to provide more services to take the strain off A&E departments and GP surgeries comes on the same day DHSC announces no new long-term investment to sustain the sector. Does she not understand that as a result of years of government underinvestment in England the network is in decline with random closures across the country? Too many pharmacies are temporarily closed every day due to workforce shortages beyond the control of pharmacy owners. Adding a new service here and there, even with some additional funding, does not address the longer term viability of the network which needs to know which patient services it will be expected to provide over the next 10 years - not just the next few months - and how those will be adequately remunerated. Asking more from our sector with no new investment is a strategy which is bound to fail. The pharmacy contract remains economically illiterate. The sector's finances need open heart surgery not a couple of paracetamol tablets.