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Has the NHS long-term plan delivered for community pharmacy so far?

In the first of a series on England's broken community pharmacy contract, Andrew Lane looks at how the existing arrangements make a sustainable service-focused future impossible

The NHS 10 Year Plan is a contemporary of the current community pharmacy contract in England. Both were published in 2019 and the contract is explicitly meant to help deliver the plan’s objectives.

The plan promised to “make greater use of community pharmacists’ skills and opportunities to engage patients” and envisaged a future in which community pharmacy was an integral part of the NHS, delivering clinical services as a full healthcare partner.

Four years into the contract, these aspirations are at best stuttering and at worst going into reverse.

The fundamental idea that pharmacies would be viable by taking on new services is not supported by the contract's structure or its associated funding.

Read more: Increased use of community pharmacy ‘essential’ to NHSE 2023/24 priorities

At the time the deal was struck, the National Pharmacy Association (NPA) warned that the government must be prepared to direct more money into community pharmacy, pointing out that static funding year on year would make it difficult to deliver transformational improvements.

Since then, the COVID-19 pandemic and rampant inflation have taken things to a whole new level of difficulty.

Instead of improvements, we see reduced opening hours, pharmacy closures and disinvestment in staff.

There is very little appetite or energy for taking on new services – the focus is on business survival.

At an NPA member meeting this month, 16 of the 17 contractors taking part agreed that the current model of remuneration is broken.

Instead of moving into new clinical roles, which the NHS and Department of Health and Social Care say they want, pharmacies are slipping back, forced to focus above all on maximising dispensing income, where the vast majority of the income opportunity sits.

This is the very opposite of the aspirations stated in the long-term plan.

Part of the problem is the extent to which an individual contractor’s success – or otherwise – is within their own power to determine.

Current contractual arrangements put them at the mercy of circumstances largely beyond their control – be it wholesale price rises or the reluctance of some GPs to refer into pharmacy services such as the Community Pharmacist Consultation Service.

Meanwhile, the retrospective elements of pharmacy funding, like clawbacks for "excess" margin, are a barrier to investment and forward planning.

They are in no way an optimal underpinning for implementing new clinical services or for innovation in service delivery.

Read more: Taking the right decisions now can avert disastrous pharmacy collapse

A fundamental rethink is needed if the sector is to recover, thrive and deliver for patients and the NHS – and it’s not just about the overall quantum of money, although that is of course critical.

Our contractual arrangements should be an enabler, rather than a barrier, to progress.

We are a can-do profession capable of delivering huge benefits across urgent care, public health and long term conditions, with the right framework in place.

 

Andrew Lane is chair of the NPA

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