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Usually as we head into winter, we can all predict what our patients will be asking us about. But, just like the rest of the year has been like no other in community pharmacy, I'd expect this winter to be different too. This will present us with challenges, but also some great opportunities too. One shift we have seen over the last seven months of Covid is that more and more people in the community are turning to their pharmacy for help, support and advice. With our doors remaining open throughout the height of the pandemic, we've established ourselves firmly at the heart of local healthcare - a trend I'd expect to see continue over the winter, especially now that a second wave, it seems, is upon us. I think there's three different types of patients who we'll be seeing this winter coming to us for help and advice. First, we'll see those with a simple winter illness - for example, a common cold. For these patients our advice will be focused around self-care and home treatments. There is a wide range of products that we can recommend in the pharmacy from decongestants to combination products such as Night Nurse and nasal sprays.

The government has earmarked £200 million to enhance NHS resilience and expedite patient care during the upcoming winter season. This extra amount will bolster the health service during its busiest period, while protecting elective care so we can keep cutting waiting lists, Prime Minister Rishi Sunak has said. On August 13, the Prime Minister and Health and Social Care Secretary met with clinical leaders and NHS Chiefs to strategise and refine planning for urgent and emergency care, while prioritising the preservation of waiting list targets for the upcoming winter season. "Patients can be reassured that I will always back the NHS, so that those who most need help and support will get the care they need," Sunak said. "Winter is the most challenging time for the health service, which is why we've been planning for it all year - with huge government investment to fund new ambulances, beds and virtual wards." "This £200 million investment, assured by the Department of Health and Social Care as new and additional funding, should aid NHS leaders in their preparations and mitigation for what will be a seriously difficult winter period," said Matthew Taylor, Chief Executive of NHS Confederation. "The priority now is swift allocation of funding to local systems for optimal utilisation."

The UK Health Security Agency (UKHSA) and the Office for National Statistics (ONS) will jointly launch a new study to gather data on COVID-19 this winter. The Winter COVID-19 Infection Study (WCIS) will run from November 2023 to March 2024, involving up to 200,000 participants, UKHSA has said on Monday (October 2). UKHSA previously commissioned the Coronavirus Infection Survey (CIS), conducted by the ONS in collaboration with scientific study leaders from Oxford University, analysing more than 11.5 million swab tests and 3 million blood tests from April 2020 to March 2023. Meanwhile, the Winter CIS study involves conducting up to 32,000 lateral flow tests weekly, providing vital insights into COVID-19 prevalence in the broader community. The sample will be structured to broadly reflect key population characteristics.

Community pharmacy representatives and MPs from across all political parties discussed the impact of winter pressures on pharmacies in England during a parliamentary drop-in event held on Tuesday (5 December). As many as 34 MPs attended the event, including Bradford South MP Judith Cummins, who hosted the event. Members of the Community Pharmacy England (CPE) Policy Team and LPC leaders briefed the politicians about the current winter pressures that all NHS community pharmacies are grappling with, and asked them to help get more support. CPE Chief Executive Janet Morrison said: "Community pharmacies play an active role to support their patients throughout the winter period, but the sector needs fair and proper funding to enable its vital services to be delivered in the long term. This event came at a key moment for the sector as we work towards implementing the Pharmacy First service and negotiations begin for the 2024/25 Community Pharmacy Contractual Framework (CPCF).

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.

Winter is imminent and with dropping temperatures viruses are bound to be more prevalent, exacerbating health problems among the vulnerable and immunocompromised patients. This can cause serious complications, and therefore, it's important to know the symptoms, methods to manage them and when to refer. A healthy person can usually manage the illnesses with over-the counter medication. Colds, flu and Covid-19 are caused by different viruses. As some of their symptoms overlap, it may be hard to tell the difference. However, some key differences are shown in the following figure. It is also possible to suffer from cold/flu and Covid-19 simultaneously, which can complicate matters. As per NHS guidelines, anyone with fever, cough, loss/change in sense of taste and/or smell has to self-isolate and request a Covid test. Pharmacy Advice The pharmacy team should advise patients with symptoms to take rest, ensure adequate hydration and take balanced nutrition. Supplements such as Vitamin C, Vitamin D and zinc can also help to boost the immune system and can be recommended.

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.

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The Department of Health (DoH) Northern Ireland is reminding the public to think Pharmacy First this winter to stay well and reduce demands on other parts of their health service. Under this new advanced service, a local pharmacy can provide treatment and advice on a range of health conditions including common colds, stomach upsets, ear aches, diarrhoea, head lice, mouth ulcers and thrush. Pharmacies will also directly provide emergency contraception and advice and treatment for uncomplicated Urinary Tract Infections (UTI) for women aged 16 to 64 years without the need for a GP appointment, the department said. Further the public are informed that 42 community pharmacies across the country will be providing a sore throat service this winter, involving advice, testing for infection and treatment, if necessary.

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A combination of factors, including the doctors' strike, medicine shortages, and funding scarcity, indicates that this upcoming winter could be the most challenging period for both community pharmacies and the NHS, Community Pharmacy England has said. In a September 4 blog post, CPE Chief Executive Janet Morrison emphasised that the relentless pressures show no signs of easing. "Pharmacy businesses, like numerous other sectors, are grappling with the challenges of staying afloat in the current economic climate, compounded by the detrimental effects of historical funding cuts." "The doctors' strike, despite ongoing assurances from the Health Secretary that their pay deal is final, will inevitably exacerbate the demand for both primary and secondary care, leading people to turn to their local pharmacies for assistance," she added. "This, in turn, will heighten the pressure on community pharmacies." "Whatever the coming winter brings I am sure of two things: that community pharmacies are going to be more critical to the health of the population than ever before, and that your representatives here will be fighting on all fronts to get you the help that you need."

A winter NHS crisis is inevitable unless the government acts now to reverse the worrying decline in community pharmacies. Years of government underfunding could see 3,000 pharmacies in England - around a third of the network - having no option but to shut their doors to patients in the next few years. That figure is based on independent assessments from Ernst & Young and UCL/LSE healthcare professors: it is not scaremongering - it is the reality the country faces. Fifty per cent of pharmacies are already in financial distress because government funding has been falling in real terms since 2019 and that figure is predicted to rise to 75 per cent within the next two years. The government needs to act now and invest in pharmacy or sleepwalk into a healthcare disaster as we have seen with access to dentistry care. Prescription volumes have risen consistently year-on-year by roughly 2 per cent which means fewer pharmacies doing more work and under greater pressure than a decade ago. Ten years ago around 11,200 pharmacies in England were dispensing roughly 79,000 prescriptions; nowadays around 11,500 are dispensing roughly 89,000 prescriptions. The secretary of state recently asked pharmacy to do more to avoid a winter NHS crisis and at the same time said there will be no new money to pay for those additional services. This at a time when the network is in decline with random unplanned pharmacy closures - 640 closures since 2016 - and pharmacy staff face huge workload pressures as prescription demand is increasing year-on-year. The government's approach to pharmacy literally does not add up: the pharmacy contract is not fit-for-purpose now let alone dealing with a NHS winter crisis.

In a recent interview with The Telegraph, health secretary Steve Barclay stated that he has asked his officials within DHSC to look at a "pharmacy first" approach to alleviate pressures on A&E departments in order to avoid the widely predicted NHS winter crisis. On the face of it, this a welcome if long overdue recognition that community pharmacy is an essential part of our national healthcare infrastructure alongside our GP and A&E colleagues. But let's not get carried away - we have had lots of praise from politicians in the past which have not then been backed by firm commitments for a sustainable future for the network. Could this be a turning point? I hope so, but I am not confident it will be. I fear this may turn out to be another emergency stop-gap measure which does nothing to secure the long-term viability of the sector in England. The role of community pharmacy during the recent Covid pandemic demonstrated clearly how important we are to ensure people have easy access to essential healthcare support, advice and services. The NHS winter crisis can only be avoided or at least mitigated if the potential of the community pharmacy network to provide more patient care services is unlocked and that Barclay requires you to end pharmacy funding austerity and start investing. The Treasury will no doubt say there is no more money, but what then the alternative other than a NHS winter crisis? And, of course, treating people in secondary care settings is far more costly than community pharmacy based interventions.

Frontline doctors have sounded the alarm over the rising pressure on emergency departments in hospitals across the country as winter virus cases are "creeping up". An average of 234 people were in hospital with flu every day last week, a 53 per cent increase compared to the week before, according to new NHS data. Hospital norovirus cases increased by 15 per cent last week, with an average 406 people hospitalised each day, a 28 per cent increase from the same week last year. Measures to stop the spread of norovirus to other patients led to the closure of an average of 92 beds were closed each day last week.

The Royal Pharmaceutical Society (RPS) has urged people across Scotland to be kind to their pharmacy teams this winter through its campaign called 'Be Kind'. The pharmacies are facing lot of pressure and challenges during winter, RPS has heard from its members that abuse towards pharmacy teams, particularly those in community pharmacy, has 'unfortunately' risen. The campaign has been running throughout December, to promote 'be kind' message to the public at a time when pharmacy services are particularly stretched by winter pressures and other factors, including the recent shortages of antibiotics. "Throughout December, leading figures have provided a series of powerful videos, which all encourage the public to be kind to their pharmacy teams. The campaign has highlighted personal video messages from many figures including Jason Leitch, Scotland's National Clinical Director, Maree Todd, Minister for Public Health, Women's Health and Sport, and Andrew Carruthers, RPS Scottish Pharmacy Board Chair," said RPS.

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."

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