In October, the Pharmaceutical Services Negotiating Committee (PSNC) tasked the Nuffield Trust and King’s Fund think tanks to come up with a vision and strategic options for community pharmacy in England.

Read more: PSNC funds independent research on vision for community pharmacy

The outcome will be the foundation for negotiations between PSNC and the government as the five-year pharmacy contract comes to an end.

Funding

Speak to any independent contractor in England and the most dominant issue in everyone’s minds is funding – or the lack thereof.

However, this does not mean just throwing a ton of money at community pharmacy and hoping for the best.

Instead, it means thinking carefully about funding streams that ensure independent pharmacies are sustainable, protected and able to operate in all areas, including more rural communities.

Read more: Not fair: Public backs calls for increased pharmacy funding as pressures intensify

Ashley Cohen, managing director of Pharm-Assist (Healthcare) Ltd in Yorkshire, has three busy, high-volume pharmacies and like everyone else is having to work 30% harder just to stay still, he says.

"My personal views are that pharmacy is at a crisis point. It’s been cash starved for six to seven years and everything we’re seeing now is that coming home to roost," he observes.

Mr Cohen is taking part in two of the steering committees in the King’s Fund review and is among those who stresses that cash alone isn’t the answer.

However, with increases in the national living wage, rising medicine prices and more, funding does have to be addressed.

"We are dispensing significant amounts of products at a loss and it has been recognised the system is broken," he points out.

Read more: Well blames flat pharmacy funding as it outsources office roles abroad

Martin Bennett, chair and superintendent pharmacist at Wicker Pharmacy in Sheffield, agrees that pharmacies need more government investment if they are to truly thrive.

He says: "Unless [underfunding] is rectified then progress will not be possible."

He adds that "the main aim will continue to be survival".

Funding also underpins many of the other issues facing community pharmacy such as recruitment and retention, upgrading the pharmacy estate, and providing more services, he notes.

"New initiatives must have more funding attached," Mr Bennett stresses. "Funds need to be in place to create more space within pharmacies for additional services and to encourage pharmacies to relocate into larger premises where possible."

Read more: ‘Give us the opportunity’: Pharmacy should take lead on vaccinations, says AIMp

Yet ultimately, a better funding deal would count for nothing if there was no proper strategic direction, according to Ade Williams, superintendent pharmacist at Bedminster Pharmacy in Bristol.

"We’re in perpetual crisis and we need a sustainable direction," he says.

"We need a road map"

Ultimately, clear planning is needed, Mr Williams suggests.

"It will mean an honest and joined up conversation about what we’re trying to achieve," he explains. And, similarly to Mr Bennett, he believes that pharmacy must go beyond merely surviving in the face of innumerable pressures.

"It's all very piecemeal – nobody knows what we will be doing next year. There is a conversation we need to have where instead of innovation for survival, we have innovation for progress," he says.

Mr Williams points out that community pharmacy is very good at adapting and staying relevant, citing COVID-19 vaccinations as an example.

He adds that this is a case of taking one step forward and two steps back and proffers the scrapping of medicines use reviews as a case in point.

A Pharmacy First approach

A national Pharmacy First service seems like the most basic building block of all, says Mr Cohen.

"The government has got to stop tinkering around the edges. Get on with a minor ailments service, a consultation service, pay us properly and we will cut the workload of GPs," he says.

Read more: Pharmacy First: Steve Barclay reveals government is looking at next steps

At the moment, community pharmacy is "haemorrhaging staff", Mr Cohen adds. The pressures and pay in community pharmacy send many to primary care networks and GP surgeries, where they then find out the grass may not always be greener.

"We’re all fighting for the same individuals. Why can’t it be a split role, 50% in community pharmacy and 50% in the GP surgery," he asks.

Read more: ‘Unfair advantage’: PCNs see increase in reimbursable pay for pharmacists

Mr Bennett was involved in developing recommendations for the future of the sector in the early 1990s – some of which he says are still not in place 30 years later.

"Community pharmacy has never been short on ideas on how to develop the service and I am confident that it will not be this time," he muses.

"Given that this process will produce a range of possible models for the future, the desperate need is for the Department of Health and Social Care to say quickly which of these ideas, if any, they wish to pursue and make the funding available."

"We need proper remuneration"

At the moment, Afua Thompson, owner of H.E. Matthew’s Pharmacy in Carshalton Beeches, south London, says community pharmacy is losing out on dispensing fees, on medicine prices, and a lack of commissioned services.

"We were moving premises and I came across one of my old schedule of payments from years back. We were earning more then than now even though we are now doing more items."

She adds: "We always say come and see your pharmacist for free advice but what we’re doing has to be paid for, we need proper remuneration."

Ms Thompson agrees that the current system where a patient has to see a GP to get a referral to the pharmacy under the Community Pharmacy Consultation Service is frustrating for all involved.

"There could be protocols and a formulary in the same way as [a] patient group direction, something along the lines of what we do with emergency contraception," she suggests.

A question of trust

For Lila Thackerar, superintendent pharmacist and chair of Shaftesbury Pharmacy in Harrow, north-west London, the biggest things needed right now are fewer forms to fill out and more trust.

"At the moment, and a lot of my colleagues share the same view, we’re all so frustrated about the bureaucracy," she says.

"At this time of year, it’s the Pharmacy Quality Scheme that’s taking over – but the paperwork in general is endless," she adds.

"For someone like me, the only way to do all this is to get up at 4am and do hours of paperwork because we’re not able to do it at the pharmacy. My role is talking to patients and giving them advice on medications and I want to be able to do that."

She adds: "We shouldn’t have to provide all this evidence to be paid. There has to be a discussion about how to take the pressure off pharmacies and fund us for the things we do."