Community pharmacies across England have been clamouring to help the nation administer COVID-19 vaccines. Pharmacy organisations have estimated that the sector could jointly administer at least one million vaccines a week, but NHS England and NHS Improvement (NHSE&I) has only committed to commissioning 200 out of more than 11,000 pharmacies to provide the service.

The underuse of pharmacy made national headlines earlier this month in a media wave sparked by The Telegraph publishing a front-page article featuring Simon Dukes, chief executive officer of the Pharmaceutical Negotiating Services Committee (PSNC), saying pharmacy’s efforts to get involved in the vaccine drive had been met with “silence”.

C+D spoke to Mr Dukes for a podcast about his frustrations with the situation, the progress that has been made with recognition from politicians, and the need for more funding to prevent further closures (article continued below).

The entry of pharmacies into the COVID-19 vaccination programme has been slow compared with other healthcare providers. Some 65 pharmacy-led hubs joined the national effort this week, following six pharmacies that went live last week.

On January 21, NHSE&I deputy chief pharmaceutical officer Dr Bruce Warner said: “After our successful launch in pharmacies last week, scores more sites are now offering the life-saving jab.

“As more vaccine supply comes online, we will be able to open even more helping us to vaccinate vulnerable people even faster.” But it is not clear when this will happen or how many pharmacies will eventually be involved in the service.

Mr Dukes says community pharmacy being largely overlooked for administering COVID-19 vaccines is due to it not being seen as a core part of the NHS. “It’s part of the wider, ongoing challenge that we as a sector face in trying to persuade officials, NHS and the Treasury, to see pharmacies not just as part of the NHS family – which the pharmacies see themselves as – but as a hugely valuable part of it,” he says.

“On the [pharmacy] front, you'll see people wearing NHS lanyards around their necks. Pharmacy teams regard themselves as part of that wider NHS family effort…I think it is desperately sad that we are not viewed as a sector in the same way by the NHS, as part of that NHS family.

“It does a disservice to every community pharmacy up and down the country when they're not seen in that light.”

The initially minor role of pharmacy in the COVID-19 vaccination programme was the latest in a long-standing history of the government snubbing the sector. Pharmacy professionals were disheartened by their treatment from the authorities in spring last year when the government failed to directly mention them as “key workers”.

“What more could we do?”

However, Mr Dukes hopes the sector’s role in the pandemic and its attempts to administer COVID-19 vaccinations might place it in better standing with the government in the future. “The praise and the thanks and the warm words and everything that we get from the public and from the politicians – that's fantastic.

“I want to see that turned into tangible financial support for pharmacies, because I think if it's not, the sector, quite rightly, will say: ‘Well, what more could we possibly do?’”

PSNC asked the government to waive the £370 million in advance payments of COVID-19 funding made last year, a request that the Department of Health and Social Care (DH) is “carefully considering”. The negotiator is also requesting that the government increase its annual funding of £2.592 billion, which is set to remain at this level until after 2023-24.

Further pharmacy closures are “inevitable” as a consequence of funding remaining at current levels, Mr Dukes says. Earlier this week, the PSNC chief revealed that more than 200 pharmacies in England had closed over the 12 months up to October last year. “How can that be right?” Mr Dukes asks.

There needs to be a sustainable increase in funding to stop pharmacies from losing money and to enable them to help the NHS long-term plan through improving health inequalities and supporting prevention, Mr Dukes says.  

Signs of progress?

Long-term funding will determine whether pharmacy is able to help in future pandemics. Mr Dukes has been frustrated by the sector’s absence from the COVID-19 vaccination programme, but says there are signs of hope that it could have more of a role in the wake of the media furore.

“We’ve seen a number of signs of progress, not just ministers and the Prime Minister expressing support for the sector, and its ability to play a role, but we’ve had meetings with ministers and the NHS. We are working out proposals as to how a wider programme might work and we look forward to discussing that with officials in the coming days.

Thousands of community pharmacies should be involved in this work, but it really is...ultimately for the NHS to decide.”

On January 6, Prime Minister Boris Johnson told parliament how “a vital role can be played by pharmacies” alongside GPs, hospitals and the army. The next day, health secretary Matt Hancock acknowledged how pharmacies could help spread vaccine access to all corners of the country. But these words have not yet led to substantive action.

Community pharmacy contractors have told PSNC they want to play a part, Mr Dukes says. “The Prime Minister has set an ambitious target for vaccinations…and therefore it really is ‘all hands to the pump’. You've got a network of [approximately] 11,400 pharmacies across England, each one, pretty much, containing a clinician who is able to provide vaccines, so why aren't we using them?

“During the course of the interviews that I've done on this topic, both politicians and indeed media commentators have said words to the effect of ‘well, this is a no brainer, why aren't we using pharmacy?’ And I would have to agree with them.”

Throughout the pandemic, pharmacy has been repeatedly disappointed by its treatment by the government. Mr Dukes makes clear that the cost of the government continuing to ignore the sector’s pleas for funding will be further closures. 

And ultimately, “it'll be patients that suffer” as a result, he says.

Listen to the full interview below.