Shortage of pharmacists remains a big challenge for community pharmacies as the chief executives of the national community pharmacy bodies met with senior NHS England and NHS Improvement officials to discuss the precarious situation in October-end.
In the last few months, several pharmacy contractors have reported increased staff shortages that caused difficulties in maintaining services, leading to temporary closures in some instances.
The sector is also facing chronic shortage of other staff including van drivers and pharmacy technicians.
During the meeting, NHS England's director for primary care, Ed Waller, and chief pharmaceutical officer Keith Ridge held talks with leaders from across the pharmacy sector on a variety of topics.
The Pharmaceutical Services Negotiating Committee (PSNC) has launched a four point plan at its parliamentary drop-in event for MPs and peers hosted on Tuesday
(15 November).
The event lasted for two hours, during which MPs had the opportunity to drop-in and have their blood pressure measured by pharmacists with experience of working on
the front-line and were briefed on the urgent need for action to address the pressures on the sector.
Outline of the four-point plan:
Resolve the funding squeeze: Community pharmacy needs an immediate funding uplift to prevent large-scale pharmacy closures, as well as emergency business relief to
get through this winter.
Tackle regulatory and other burdens: Pharmacies must be protected from medicines market shocks, supported to help them weather the workforce crisis, helped to free
up capacity and freed from red tape that does not enhance patient care.
Help pharmacies to expand their role in primary care: Pharmacies could do more to support the delivery of primary care for example through offering clinical services
for long-term conditions - like hypertension, diabetes and respiratory disease, supporting people to adopt healthier lifestyles and prevent the development of
long-term conditions, medicines optimisation, and a much wider variety of NHS vaccinations.
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.
The National Pharmacy Association (NPA) has raised concerns over the upcoming increase in the National Living Wage, saying it will make things even worse
for local pharmacies already facing nearly a decade of cuts in real terms.
Scheduled to go up from £10.42 to £11.44 per hour starting April, the National Living Wage rise is expected to put a lot of financial pressure on many pharmacies.
The NPA says "it will cost them over £10,000 in salary bills, and for some, even more, without getting more from the NHS funds. and has asked the government to
deal with the ongoing problem of underfunding for community pharmacies.
The association has warned that without additional funds, pharmacies could face staff layoffs or reduced services to cover the increased wages, calling for
a "comprehensive new funding deal to prevent further closures of vital local services, which have been shutting at the rate of eight a week."
NHS England has mandated a business continuity plan for pharmacies dealing with temporary closures from the end of this month.
Community Pharmacy England (CPE) has put together a briefing and a template plan to help guide pharmacy owners through the process. It explains what is required
in the plan, describes how and when to implement it, and outlines some additional considerations.
"This could be added as an annex to your pharmacy's existing business continuity plan. A checklist has also been added, which may be used in the event of a
temporary suspension," said CPE.
"NHS England will be publishing the approved particulars shortly. NHS England is also still to publish guidance on the amendments to the Pharmaceutical Regulations
that came into force on 25th May, which will include guidance on these requirements.
The National Pharmacy Association (NPA) survey revealed that 93 per cent of respondents experienced 'at least one month' of negative cash flow across their
pharmacy business in 2022.
Nine out of 10 pharmacy owners responding to NPA survey said they made a net loss dispensing medicines for the NHS during 2022, for at least one month of the year.
According to the poll, 48 per cent of them lost money on this core NHS service for six months or more. 45 per cent said their overall outgoings had exceeded overall
income in at least six months of the year.
NPA Chair Andrew Lane said: "This survey shows the bleak financial reality facing many independent pharmacies after years of underfunding. Dispensing at a loss and
negative cashflow is clearly unsustainable."
"This funding crisis must be addressed urgently or pharmacies will fall into a spiral of declining services and ultimately widespread closures, he added. "Tragically,
the story is playing out very much in line with independent research commissioned by the NPA last year, which warned of a nationwide financial emergency in our
sector."
The Challenges
There cannot be anyone working in or with community pharmacy that either feels or sees the pain that emanates from the current operating climate. Pharmacy
closures; increased workload and operating costs; increased patient and commissioner expectations; and, more fundamentally, an inadequate, undervalued and
poorly structured remuneration and reimbursement contractual framework.
As important as they are, we will not focus on these points here as they are not in the control of pharmacy owners and managers. They are the responsibility
of those organisations that represent them at a national and local level who must deliver a better outcome as difficult as that may be.
However, there are matters which are in the control of pharmacy owners and managers. These include their premises, their team, their systems and processes, their
relationships with other healthcare providers and the broader community, their NHS and private service offer, and how they promote and deliver them to give the best
patient experience.
In order to create the head space to develop and implement a business plan, pharmacy owners and managers must make time to work on their business as well as in it.
Then it requires the capacity and capability within their team to deliver the services and that excellent patient experience.
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.
Prime Minister, Rishi Sunak, has backed pharmacists to play a greater clinical role in the health and well-being of the nation, describing them
as "valuable and trusted" members of the community.
Pharmacists have faced a difficult year with 222 community pharmacies closing in just the first six months.
Boots alone will be closing 300 branches over the next 12 months.
Sunak, however, insisted that his government knows the "hard work of pharmacy teams", and that he wants to "enable them to do more to support the NHS."
Speaking at the annual Sigma Conference in London on Sunday (5 November), the prime minister reiterated that community pharmacy is in line for a much-needed
boost in funding.
"Earlier this year, the government announced plans for further investment of up to £645 million over the next few years to support the Pharmacy First service
for patients," Sunak said in a letter read out at the conference by Lord Dolar Popat.
"This means that community pharmacies will be able to assess patients and provide some options to protect them without a GP appointment."
At the recent 'Locum Matters' online event held on June 25, 2024, members of the Pharmacists' Defence Association (PDA) discussed critical issues facing
locum pharmacists, with a disturbing trend taking center stage: employers pressuring locum pharmacists to accept lower rates under the threat of potential pharmacy
closures.
The event, organised in response to feedback from PDA locum members, addressed a range of significant topics including training for the recent Pharmacy First
Services, respect for professional autonomy, and the need for adequate rest breaks.
However, the issue of rate pressure and pharmacy closures was a focal point.
Several locum pharmacists reported that some employers were leveraging the possibility of pharmacy closures to coerce them into working for lower pay.
This unethical practice has raised alarm within the locum community, highlighting the precarious working conditions many face.
The NHS England and Improvement has announced the emergency provisions introduced during pandemic to provide flexible opening hours for pharmacy contractors end today.
The flexibilities were enacted in March 2020 when changes to the Pharmaceutical Services (Advanced and Enhanced Services and Emergency Declaration) Directions 2020 were made following a declaration of emergency at the height of the Covid-19 pandemic.
Since March 2020, the flexibilities have permitted temporary opening hours and closures during a specified period due to a genuine Covid-19 related emergency. NHS
England and Improvement has advised pharmacy contractors that the emergency declaration will not be extended further and will expire on 31 March 2022.
Pharmacy contractors will therefore no longer have the option to close pharmacies within their agreed contracted hours with the NHS.
Lack of appropriate funding is making survival a massive challenge for community pharmacy, a sector relied upon as a vital support system by both primary and
secondary care in England.
The Telegraph newspaper ran a story on Monday (August 22) which highlighted the dire straits community pharmacy finds itself in. Seasoned pharmacist Ian Strachan
told the paper: "Our four pharmacies were the only point of call that was open (during Covid). We were there every single day, even when the virus was prevalent and
people were dying."
Describing the current situation, he said: "What is happening is we're facing a system that's just not working at all in our favour." Strachan says the issue is that
pharmacists are "just not getting the help we need to be able to do this job properly".
The sector is hugely dependent on funding from the NHS. The government had agreed in 2019 to set £2.6bn as annual funding for the sector. However, according to a
report from EY that amount was already down £200m on the 2016 levels of government funding.
"We've been starved of appropriate funding since 2016," Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies told The Telegraph.
"It looks grim for businesses. The fees pharmacists get are going nowhere, but now, there's higher utility bills, higher staff fees and higher drug costs."
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."
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Those of us who work in community pharmacy know there is a workforce crisis created in large measure by PCNs actively recruiting pharmacists and pharmacy
technicians from our sector. It is welcome, if long overdue, that this has now been officially acknowledged in a report commissioned by the English Health Secretary.
PCN hiring 'exacerbates pharmacist shortage' says DH-commissioned report, which states such recruitment has "on occasion exacerbated the problem of a general
shortage of pharmacists" which has compounded "the problem of community pharmacy closures."
We have been telling the government this for years only to be told "problem? What problem?"- but now that Steve Barclay has his own official report sitting on his
desk, he and NHSE cannot continue in denial mode. The facts are there for all to see. Time to act. No more dithering, delay or indifference. You asked if there was
a problem and you have been told there is.
In the absence of a holistic workforce strategy and cross-sector career pathways, PCNs poaching from community pharmacy is a zero sum game adding nothing to
improving patient care.
As Prime Minister Rishi Sunak announces the forthcoming UK general election, pharmacy bodies are calling on all political parties to commit to solving the
issues facing the sector.
The next UK general election will be held on 4 July, Sunak announced it on Wednesday afternoon during a press conference outside 10 Downing Street.
"As the election is called it's imperative that any incoming government addresses the crisis in primary care and the looming cliff edge facing pharmacies, which
for millions of people are the front door to the NHS and a crucial source of frontline health care," said Paul Rees, Chief Executive of the National Pharmacy
Association (NPA).
Noting that the first responsibility of the government is to keep its people safe and healthy, he emphasised the importance of addressing the "deep funding gap
that is pushing record numbers of pharmacies to the edge of closure and beyond, exacerbating the issues of waiting lists for GPs and hospital care."
High street pharmacy giant Boots permanently shut down two more branches on Saturday (March 16) as it moves forward with its plan to close 300 stores.
The Wrightson House branch at the Pavilion Shopping Centre in Teesside and the Aslake Close pharmacy in Sprowston were closed for good, according to BirminghamLive.
The pharmacy giant and chemist announced that all their prescriptions from its branch in Sprowston will be moved to Lawson Road Health Centre, with the nearest
Boots branches located in London Street and Aylsham Road.
The closure of the branch at the Pavilion Shopping Centre in Teesside was confirmed to the public with a notice placed in the shop window, informing customers
about nearby Boots stores to collect their prescriptions.
The notice reads: "We are closing. This store will close, on March 16, 2024. Your nearest store for collecting prescriptions will be Thornaby Health Centre,
Trenchard Avenue, TS17 OEE. Other stores nearby are: 12-14 High Street, Teesside Retail Park, Norton, TS20 1DN 21B Goodwood Square, TSI7 7BW."
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.
Community Pharmacy England (CPE) Chief Executive, Janet Morrison met with the new Pharmacy Minister, Dame Andrea Leadsom MP this week and discussed a
range of critical topics, including funding and pressures.
Janet informed the minister that community pharmacies continue to face immense financial pressures, and highlighted the need for an improved core contract.
She told the minister that 35-50 per cent real term cuts and rising costs have led to closures, consolidations and cashflow.
This has weakened the capacity for the network to respond to displaced patients, increased risk in terms of the safety of medicine supply, and led to loss of
service for communities in the most deprived areas, she said.
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.