The government commissioned Patricia Hewitt, chair of the Norfolk and Waveney integrated care board (ICB) and former health secretary, to lead an independent review of ICSs in England in November 2022.

The independent review – known as the Hewitt Review and published yesterday (April 4) - found that the recruitment of pharmacists into PCNs via the additional roles reimbursement scheme (ARRS) is worsening a shortage of pharmacists.

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“Contracts with national requirements can have unintended consequences when applied to particular circumstances,” it said.

For example, the funding of ARRS roles for community pharmacists within PCNs “has on occasion exacerbated the problem of a general shortage of pharmacists”, it said.

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This has led to “some now preferring to work within primary care rather than remain in community pharmacies or acute hospitals, compounding the problem of community pharmacy closures and delayed discharges”, it said.

It added that ICBs have “an important opportunity” to make “the best use of both the staffing resource available and the premises” in primary care.

 

“Absurd” policy

 

The Pharmaceutical Services Negotiating Committee (PSNC) welcomed the report, saying it was “important” to the future of local healthcare commissioning.

“For community pharmacy, the review recognises the damaging consequences that the ARRS has had on the sector, exacerbating workforce issues, which has left many pharmacies forced to close their doors temporarily to patients”, PSNC chief executive Janet Morrison said.

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She added that the “policy of solving one workforce problem by worsening another is absurd” and has both “increased vacancy rates and caused spiralling locum costs”.

PSNC has been warning the government and NHS England (NHSE) about the issue “for some time”, including by calling for PCN recruitment of pharmacists to be halted or for allowing the money to fund “collaboration with community pharmacies”, she said.

Ms Morrison said that it is “clear” that action must be taken to “carefully consider the best use of the limited pharmacist workforce going forwards”.

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However, while ICSs “should be instrumental in this”, local action must be “joined up nationally” so the government must “realise the issues” and put forward solutions in its upcoming workforce plan, which must include community pharmacy, she added.

Ms Morrison told C+D earlier this year that the poaching of pharmacists into PCNs is “damaging” and “at best short-sighted”, with ARRS recruitment resulting in “spiralling locum costs up 80%”.

 

“Own goal”

 

The National Pharmacy Association (NPA) also responded to the review, calling on system leaders to review “the wider workforce impact on their patch” to avoid “silo thinking”.

NPA director of corporate affairs Gareth Jones added that it has also “repeatedly highlighted that it is an own goal for the NHS to subsidise the employment of pharmacists in general practice at the expense of denuding the community pharmacy workforce”.

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The NPA has called for a “workforce risk assessment” at system level before any new recruitment is undertaken via the ARRS, he said.

"We have also asked ICBs to think creatively about what more they can do to optimize community pharmacy staffing for the delivery of locally identified priorities,” Mr Jones added.

The NPA was “pleased to take part” in the review’s consultation stages and welcomed its “straight-talking conclusions".

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ICSs were introduced across England last year, bringing together the NHS, local government and other partners to improve the health and care of people in local areas.

Each ICS has a statutory organisation called an integrated care board (ICB), which became responsible for commissioning local primary care services including community pharmacy from this month.