Suspend CPCS, overhaul commissioning – what sector bodies want from Sajid Javid’s pharmacy reforms
The health secretary has pledged that pharmacy will be first on the list of the government’s planned reforms to primary care, so what do sector bodies want to see from this overhaul?
Sajid Javid’s announcement may have only come earlier this month (June 15), but pharmacy minister Maria Caulfield tells C+D that details on the government’s plans to reform primary care – with pharmacy up first in the firing line – will be announced in just a matter of “weeks”.
Cue a rush of emergency meetings with pharmacy representatives to get sign-off on the proposed reforms, plus a public consultation on anything that is set out by the Department of Health and Social Care (DH).
C+D thought we’d help speed up the process and ask pharmacy bodies what aspects of primary care they would like to see “overhauled” in order for community pharmacy to thrive.
Click on the links below to jump to each pharmacy body’s response:
- AIMp: “Suspend CPCS” and “introduce a pharmacy first vaccination scheme”
- CCA: “Expand CPCS” and “overhaul commissioning”
- NPA: “Mandatory local impact assessments” and scrap script charge
- PDA: Listen to workers and patients, too
- RPS: “Invest in the workforce, including prescribing budgets”
- PSNC: “Ambitious” about pharmacy’s offering, but it must be adequately funded
AIMp: “Suspend CPCS” and “introduce a pharmacy first vaccination scheme”
For the Association of Independent Multiple pharmacies (AIMp), there are some clear areas that immediately need improving, and CEO Leyla Hannbeck advises the health secretary to “follow his own conviction” when it comes to reforming the sector.
“My advice would be to pursue what he feels is right and to dismiss the rhetoric that has become the mantra of a prejudicial dismissal of community pharmacy not being adequately clinical,” she says.
There are plenty of ways pharmacy can help meet the aspirations of the NHS long-term plan, but to achieve these aims, the bureaucratic burden on community pharmacy must be reduced: “Cut the red tape and free up some time for us to do what matters,” Dr Hannbeck advises.
In addition, the Community Pharmacist Consultation Service (CPCS) is “not working” and should be “suspended”, she argues.
AIMp also urges Mr Javid to “recognise the manpower crisis in community pharmacy is real” and to “introduce immediate emergency funding – not loans – to provide the headroom for community pharmacy to invest in both staffing and resources to develop service provision”.
Also on AIMp’s wish list: a national minor ailments service using patient group directives (PGDs), akin to Scotland’s Pharmacy First scheme; a pharmacy emergency hormonal contraception service; and a “'Pharmacy First' vaccination scheme”, which would allow pharmacy teams to “review patients’ vaccination history, fill in the missing vaccinations and [assess] needs”.
“Secretary of state: Believe in the sector, it won’t let you down. But pharmacy needs breathing space to recover and prepare,” Dr Hannbeck concludes.
CCA:“Expand CPCS” and “overhaul commissioning”
For the Company Chemists’ Association (CCA), reforms to the sector cannot come without a drastic overhaul of pharmacy’s funding structure.
“With no increase in funding since 2014, £200 million worth of cuts in 2016 and the recent crippling rising inflation, the CCA would like to see a rethink in the way that the sector is funded,” it tells C+D.
“Healthcare expenditure has risen by 9.5% per capita between 2014-19 and during the same time, funding for community pharmacies has decreased by nearly 10.7% per capita,” it claims, all of which it says is exacerbating the workforce challenges across the sector.
“The CCA wants to see community pharmacy as a career of choice, and this involves more opportunities for the entire pharmacy team,” it tells C+D, and this includes empowering pharmacy technicians to take on more services.
“We need the NHS to work with the sector to agree the demand and best use of pharmacy professionals across the whole of primary care. This includes a willingness to co-create solutions that enable needs to be met in ways that benefit the patients, the professionals themselves as well as the taxpayer, rather than approaches that often appear to be aimed at meeting the needs of the system.”
"We need to learn the lessons of the past. Dialogue with the sector is imperative"
Rather than suspending the CPCS as AIMp suggests, the CCA is calling for it to be “immediately expanded to include self-referred patients and a range of PGDs to allow pharmacists to use their clinical skills to care for patients with prescription-only medicines, where suitable”.
In a bid to prevent “healthcare postcode lotteries” appearing, the CCA is also calling for “an overhaul in the way that the NHS commissions services locally”.
“We would like to see greater standardisation for the specification of services commissioned locally. This variance in specification and adoption creates a patchwork quilt of care for patients. Instead, we want to see the NHS agree standard specifications for services and then for local systems to decide whether to commission them,” it says.
The CCA’s parting advice for Mr Javid before undertaking these reforms: “We need to learn the lessons of the past. Dialogue with the sector is imperative – we have ‘lived experience’ and can help ensure policies and programmes are implemented successfully on the ground.
“Moreover, new policies need to be matched with appropriate plans, targets and incentives to drive the behaviours of commissioners, prescribers, patients and pharmacy professionals,” it adds.
NPA: “Mandatory local impact assessments” and scrap the script charge
The National Pharmacy Association (NPA) is positive that pharmacy’s “can-do attitude” is key to achieving “radical change in the health service”.
“The scope of this ‘Pharmacy First’ approach can in theory cover everything from minor ailments through to managing medicines for long-term conditions, hypertension case finding and the recently announced cancer referral pilot,” it says.
“But let’s not pretend that it can be done on a shoestring. Sustained new investment is going to be required to underpin a journey of change and development in the sector. The current financial attrition is holding pharmacy back, not propelling the sector forwards,” the NPA stresses.
“It must be obvious to all that the contractual framework needs an overhaul as it fails to properly reward the provision of clinical services and support long-term investment in pharmacy services.”
The NPA, as the CCA does, advocates for pharmacy to have greater oversight and engagement of local commissioning, to further pharmacy’s clinical service offering.
And while changes to the undergraduate degree to include an independent prescribing qualification “could lay the foundation for the next big step up in pharmacy-based support”, pharmacy needs a robust plan for its workforce.
“Workforce planning needs to begin with an acceptance that there is a current shortage of pharmacists and other staff in the community sector” the NPA says.
“Immediate mitigations should include mandatory local impact assessments before any further recruitment of pharmacists into primary care network (PCN) pharmacist roles.”
One aspect of pharmacy that should be scrapped is the prescription charge in England, the NPA stresses.
“[It] adds no value to patient care, but adds red tape in the pharmacy.”
PDA: Listen to workers and patients, too
The Pharmacists’ Defence Association (PDA) says its members have “a lot to say” on service delivery and developing patient pathways, which the PDA will publish more on shortly. But in the meantime…
“We need to ensure not just that there are enough of the appropriately qualified and competent workforce where and when we need them, but also that what they are being asked to do individually and collectively adds the most value to patients,” the PDA tells C+D.
"Please don’t try and fix something within just the limited borders of community pharmacy"
“While pharmacists are working hard, they are not always empowered to work to their maximum potential.”
Its advice for Mr Javid is this: “For historic reasons, the government has often listened to pharmacy business owners. While they are a stakeholder, we’d say make sure you listen to patients and listen to the professionals, and be joined up.
“Please don’t try and fix something within just the limited borders of community pharmacy; think holistically across the patient’s and profession’s entire scope.”
RPS: “Invest in the workforce, including prescribing budgets”
For the Royal Pharmaceutical Society (RPS), “pharmacists and their teams are ideally placed to support collaboration across primary care and the wider health service”. But this won’t be achieved without investment in the workforce.
“The government and the NHS need to start thinking now about how they will make the most of the workforce, including prescribing budgets in community pharmacy, investment in education and training, better data to inform workforce planning, and the long-awaited rollout of read/write access to patient records,” RPS England country board chair Thorrun Govind says.
Pharmacists must have a “strong voice within new integrated care systems (ICS), supported by new ICS pharmacy leads working with pharmacy colleagues across the system”, she adds, echoing sentiments from the CCA and NPA for better commissioning structures.
“With teams already feeling stretched and focused on delivering the best care for patients, I would urge the government to actively engage with the pharmacy profession and stakeholders on the road ahead, so we can work together and support the workforce throughout all these changes,” Ms Govind adds.
PSNC: “Ambitious” about pharmacy’s offering, but it must be adequately funded
The Pharmaceutical Services Negotiating Committee (PSNC) is currently in negotiations with the government and NHS England and NHS Improvement (NHSE&I) on the fourth year of the five-year pharmacy contract, in which it continues to push for sustainable funding.
“Pharmacies are much-relied on by local communities, and this was never truer than throughout the COVID-19 pandemic. We remain ambitious about what they have to offer the NHS going forwards and see community pharmacy as being a vital element of plans for primary care recovery,” CEO Janet Morrison tells C+D.
“PSNC and the entire community pharmacy sector has been arguing for some time that the current funding levels for the sector are not economically sustainable and that this will hamper our ability to meet the needs of patients and the public.”