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HSCC gives scathing review of DH progress on pharmacy pledges

A review of the government’s pharmacy policy commitments in England has found that it has performed inadequately or needs improvement in meeting most of its pledges.

An expert panel – set up by the parliamentary health and social care committee (HSCC) - looked at the government’s progress on its pharmacy policy pledges using Department of Health and Social Care (DH) data and evidence from pharmacy stakeholders in England.

The independent panel chose nine commitments across five policy areas, designed to test the government’s progress towards its own ambition to increase “the role of pharmacies and pharmacy professionals in healthcare”:

  • Community pharmacy
  • Integrated care, including patient safety
  • Hospital pharmacy
  • Workforce education and training
  • Extended services

Read more: New inquiry to rate government progress on pharmacy services pledges

Seven of the nine commitments under evaluation were taken from the community pharmacy contractual framework (CPCF), while two were chosen to test policy related to hospital pharmacies.

The review evaluated each policy commitment on four grounds: whether it was met or on track to be, whether it was sufficiently funded or resourced, whether it had a positive impact and whether it was appropriate. An overall score was also given.

See the results at a glance here:

 

Funding at the fore

 

The report, published today (July 25), found that two policy commitments were not met at all – pledges around a review of the pharmacy funding model and legislation to improve skill mix and clinical integration - while funding issues were at the forefront of the review.

It found “clear” evidence that under the existing funding model, pharmacies are “struggling to deliver services” faced with increased demand. In light of this, the review found that the government had “not met” its commitment to review how community pharmacy is funded.

And the impact of the funding deficiency was found to negatively affect commitments “across multiple policy areas”.

Read more: HSCC chair urges government to deliver extra pharmacy funding 'fast'

The expert panel said that it was “concerned” that the CPCF had not been adjusted to account for greater demand, costs and staffing issues, which in turn left community pharmacies “unable or unwilling” to provide additional services, patients unable to access “some medications” and “reduced access” to community pharmacies. 

The report was also particularly critical of the government’s promise of legislation to make “better use of the skill mix in pharmacies” and integrate pharmacists clinically.

Read more: 'Our funding is rotten': Sector needs £1.1bn now, warns AIMp chief

It found that the community pharmacy sector faced “uncertainty”, both about what the changes would be and when they might arrive.

The review lodged its concern that community pharmacy is being tasked with providing more services “without the legislation to enable them to use staff more efficiently” and judged all criteria reviewed for this pledge as an “inadequate performance”.

 

Tripping up on training

 

The review also examined the training offered for community pharmacists and found that despite courses being on offer - in particular for independent prescribing - there were “significant challenges” that kept pharmacies from taking up training.

It found “high demand” for designated prescribing practitioners (DPPs) required to supervise training, “high pressure on services” that left little time to dedicate to training and again, a lack of funding to cover staff that were being trained.

Read more: Sector denounces 'unfair' GP funding uplift for staff pay rises

The review “consistently found” that workforce shortages and poor staff training were hampering the provision of “safe and effective” healthcare, it said.

It also noted concerns from the community pharmacy sector that pharmacists often leave to work in primary care networks (PCNs) once they have independent prescribing notation or for “better working conditions” via the alternative roles reimbursement scheme (ARRS).

 

Qualified successes

 

Even in the areas in which commitments were met, the review found that work was needed.

While it noted that the community pharmacist consultation service (CPCS) was delivered, the report highlighted that patients with prescription charge exemptions may need to fork out for over-the-counter (OTC) medication if referred to pharmacies using the service.

The performance of the pharmacy integration fund was also highlighted as a success, with three prevention and detection programmes launched and backed by “adequate” funding and infrastructure. 

Read more: 'Pharmacy wastelands’: Over 200 net closures in 2023 so far, DH admits

But here too, the expert panel noted that the extra services were funded from the global sum - which had not been topped up by the government – and said it also “remained concerned” that data on the pilot programmes’ outcomes was not readily available.

Meanwhile, the pharmacy access scheme (PhAS) was judged to have been delivered, but its overall performance was deemed in need of improvement by the review.

Read more: ‘Many supporters’: Cross-party MPs pledge support for community pharmacy

Despite the government claiming that pharmacies that received PhAS payments were “less likely to close” than those that did not, the review found “insufficient evidence” to support its impact, the report said.

It added that the PhAS is “too narrow in scope” to solve pervasive funding issues in community pharmacy and “insufficient to protect access” in areas with fewer pharmacies.

And it found that the uptake of new services was hampered by “typically inadequate” IT systems, which prevented patient information being shared efficiently between healthcare providers and community pharmacies.

 

“It’s time the government listened”

 

Responding to the expert panel’s review, Association of Independent Multiple Pharmacies (AIMp) chief executive Dr Leyla Hannbeck told C+D that the report “does not say anything that we have not said before”.

She reiterated that there is a “desperate need” for a cash injection to cover a “shortfall of £1.1 billion and rising” in the sector’s core funding.

“The public value the services they receive from their local pharmacies and it’s time the government listened,” she said.

Read more: Scotland to see ‘largest ever' £12.3m global sum uplift, government reveals

A DH spokesperson told C+D that access to pharmacies remains good and pointed to recent announcements that seek to provide further support to the sector via funding and training.

“Since the period covered by this report, we have announced £645 million of funding as part of the primary care recovery plan and thousands more training places as part of the long term workforce plan, on top of the £2.6bn we provide every year to the sector,” they said.

“This will further bolster the role of community pharmacies to supply prescription-only medicines for seven common conditions without the patient needing need to see a GP, alongside supporting more blood pressure checks and oral contraception consultations,” they added.

 

Pharmacy funding

 

The expert panel’s review comes as the Scottish government announced a record uplift in its annual financial settlement for community pharmacies, with an additional £12.3m added to the global sum on top of a £20m “cash injection” announced earlier this year.  

Meanwhile, community pharmacy has been at the centre of debate in parliament, with a number of MPs across parties raising questions about the sector last week. 

Read more: HSCC launches new inquiry on future role of pharmacy services

Last week (July 17), former pharmacy minister and HSCC chair Steve Brine called on the government to ensure that “extra” funding is rolled out to community pharmacies “fast”.

And earlier this month (July 13), more MPs pledged their support for the sector at the launch of a policy brief at the House of Commons.

Funding has itself been at the forefront of the debate across community pharmacy, with AIMp boss Dr Hannbeck telling C+D in an exclusive interview that the current funding model is “rotten”.

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