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Taking the right decisions now can avert disastrous pharmacy collapse

Rampant inflation does not have to be the catalyst for community pharmacies to close, if new choices are made, National Pharmacy Association (NPA) Chair Andrew Lane says

The NPA recently commissioned David Taylor of University College London and Panos Kanavos from the London School of Economics to investigate the implications of high inflation rates for community pharmacies.

Their findings make grim reading. Together with historic underfunding, high inflation is now threatening to force many pharmacies to close.

However, it would be wrong to interpret this as a prediction of an inevitable network-wide collapse. It is instead a warning that prompt action is needed to avert that catastrophe.

It’s about making choices that can lead to significant improvements, and not just a scream of despair.

Read more: Sector in crisis: Thousands of pharmacies at risk of closure as inflation bites

This is a far from perfect metaphor, but the situation brings, to my mind, NASA’s ‘DART’ rocket, which successfully diverted an asteroid and showed in the process how a relatively small intervention can make the world of difference.

In our case, that relatively small intervention would be to restore pharmacy funding to its real-term historic average.

Our paymasters in government and the NHS need to take decisive action to invest in community pharmacy so we can play our full part in overcoming the NHS backlog.

In turn, we must choose to pursue a clinical future – one that is patient-facing, community-based, integrated with other parts of the health service and tech-enabled, without losing the human touch in healthcare, wholeheartedly.

On a closely related note, we must face up to the fact that pharmacies have long been stymied by the volume-based contractual framework in England. It’s time to cast off the shackles of the existing framework and think much bigger than we have allowed ourselves before.

Otherwise, the sector is destined to continue its slow drift to the cliff edge of mass business failure. So let’s be open to the idea of a fundamentally different type of pharmacy contract that gives patients what they need and addresses structural issues, which make us vulnerable too.

Read more: Pharmacy bodies blast ‘devastating’ English funding deal

Integrated care boards across England are responsible for allocating many billions of pounds and they need to understand the benefits of community pharmacy services.

The NPA was closely involved in the recent Fuller Stocktake of primary care, which points to opportunities for integrated pharmacy-based support in cancer and mental health. We as a sector, again, must make an active choice to engage with the NHS at this level.

There are other choices for us, too. For example, to what degree do we tilt towards providing non-NHS clinical services to supplement NHS income? The NHS is by far our biggest paymaster and we absolutely need to deliver for it. But we are, to an unhealthy degree dependent on NHS income and the prescribing behaviours of GPs.

So, it's understandable many pharmacies are developing private offerings, too. Among the most popular private services offered are travel jabs and point-of-care testing. 

Others are pushing the boundaries in terms of aesthetics, like my fellow NPA board member Amish Patel. It’s a sensible strategy to diversify income streams, but it would not be wise to neglect NHS services in the process.

Read more: Can you make a Botox and dermal filler service work in your pharmacy?

In short, our future as a sector is not fixed and predetermined. We have choices, and so do others, in government, the supply chain and the NHS.

The Taylor-Kanavos report highlights what can be achieved when the right choices are made, as has been the case in Scotland and Wales recently.

The authors estimated that while NHS community pharmacy contract sum funding in England stands at £46 per head of total population, the equivalent figures for Wales and Scotland are £66 and £67.

In Wales, a shift in the balance of NHS pharmacy fees from dispensing towards clinical services is being phased in.

In Scotland, the Pharmacy First Plus scheme is allowing prescribing pharmacists to diagnose and treat a wide range of common conditions, which in the past could only have been dealt with in general practice.

Some forward-thinking local commissioners in England are also showing the way, like Cornwall’s walk-in consultation service

The concluding remarks in the report are therefore highly positive: "With informed policy making and good-will on all sides, NHS community pharmacy ought during the remainder of the 2020s to be able to become a clinical care-oriented NHS profession that is both unequivocally valued and adequately resourced throughout the UK."

Andrew Lane is chair of the NPA

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