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Overcoming challenges to achieve the Pharmacy First vision

A Pharmacy First approach could improve patient access to health services – but only if certain challenges can be addressed, says Steve Brownett-Gale

NHS figures show that almost five million patients in England wait over a fortnight for a GP appointment each month, highlighting the need for a shift in the accessibility of healthcare.


Read more: I didn’t need an eye injury to see the NHS is broken


This is one of many symptoms of “decades of underfunding and poor resource planning”, as noted by Professor Kamila Hawthorne, chair of the Royal College of GPs (RCGP), back in April.


Considering these challenges, the sector is focusing its attention on creating a Pharmacy First model to transform patient access to general healthcare, medicines and advice while improving patient outcomes and alleviating pressure on other NHS services.


But achieving the Pharmacy First vision isn’t simple; the sector is facing challenges of its own including supply chain instability, pricing volatility, staff shortages and workforce burnout.


Read more: ‘Enormous pressures’: MPs flag pharmacy funding, workforce and drug supply woes


In this article, I explore these challenges in more detail and how they can be overcome to ensure the front door to health is wide open.



Chronic underfunding



As the chief executive of the Company Chemists’ Association (CCA), Malcolm Harris, said back in January, “community pharmacy is now seriously underfunded”, calculating the annual shortfall to be sizeable – more than £750 million, or £67,000 for each pharmacy in England.


Funding has been declining year-on-year and the effects are apparent, with recent branch closures across big pharmacy chains such as Boots and Lloydspharmacy.


Read more: Lloyds pharmacy branch numbers dropped almost 50% in nine months


Ultimately, an underfunded pharmacy sector affects patients, who need stable and secure access to health services and medicines, both before and after GP and hospital care.


In May 2023, the government announced a £645m injection of funds into English community pharmacy for clinical services, which was welcomed and represents a clear vote of confidence in the Pharmacy First vision.


The investment was announced as part of a new government and NHS blueprint, setting out plans to improve access to primary care; including allowing patients who need prescription medication for seven common conditions to get this directly from a pharmacy.


Read more: Progress on £645m funding negotiations ‘slower than we hoped’, CPE admits


This is a step in the right direction, but the potential of pharmacy services extends far beyond the seven common conditions pharmacists will be able to prescribe for under the national Pharmacy First service.


I believe that a financially supported community pharmacy sector can do so much more, so sustained investment is key.



Supply instability and pricing volatility



In July, Community Pharmacy England’s (CPE) chief executive, Janet Morrison, named supply instability as “the most critical issue facing community pharmacy owners”.


Earlier this year, CPE’s pressure survey revealed that 97% of pharmacy owners had experienced significant increases in wholesaler and medicine supply issues, causing problems in both accessing medicines and procuring them cost effectively.


According to the survey, pharmacists are relentlessly chasing medicine supplies, often spending up to 11 hours per week trying to procure them in a cost-effective way – up from the 5.3 hours reported the previous year.


As a result, pharmacies are left to take on high risks, procuring medicines without any surety of reimbursement and the margin they’re allowed to earn has long since been capped, often leaving them out of pocket.


Read more: Communication fundamental to avoid medicines shortages


The National Pharmacy Association (NPA) pinpoints supply instability and pricing volatility to three key areas - globalised supply chains, branded medicine quota systems and increases in wholesaler prices.


During a parliamentary meeting with various stakeholders, suggested solutions included: reform to the serious shortage protocol; allowing generic substitutions; and overhauling the concessions system, which disproportionately impacts pharmacies dispensing large quantities of affected medicine lines.


A government review of supply chains has also been called for, looking into improvements to the supply chain itself as the root cause of price volatility and low margins for pharmacy businesses.


Recruitment, training and avoiding burnout



A Pharmacy First model ultimately means an expansion of community pharmacy services and the workforce needed to deliver them. This means recruitment strategies must keep up with increased demands and pressures, as well as ensuring top quality training to deliver the best service possible.


But according to the CCA, NHS leaders have funnelled eight years’ worth of growth of the community pharmacy workforce into filling gaps in primary healthcare within general practice.


Read more: Shortfall of 3,000 community pharmacists in England over 5 years, CCA claims


Against a backdrop of workforce shortages, expanding responsibilities and supply chain volatility, burnout is a real concern already affecting community pharmacy staff today.


A survey carried out by The Royal Pharmaceutical Society revealed 88% of community pharmacy staff are likely to experience burnout, causing poor mental health and periods of absence. Cited reasons include inadequate staffing, poor work-life balance, lack of protected learning time and reduced senior support.


An NHS training programme has also been recently launched with the aim of further equipping pharmacy staff to deliver expanded clinical roles. Again, I think this is a step in the right direction and has been well received by the sector, but it must be funded long-term and widened as the role of the community pharmacy grows under this vision.



Hope for the future



It’s clear there are many challenges facing the adoption and roll out of the Pharmacy First vision. And given the country also faces an aging population and rising major illnesses rates, the time to act is now.


And there is hope.


Recent parliamentary debates, a large funding injection and NHS training schemes prove that stakeholders are committed to support a thriving and expanded community pharmacy service, to improve access to healthcare and patient outcomes.


Further important advances have been successfully implemented, such as giving pharmacists key worker status in the event of a health crisis - including pharmacists in life assurance schemes and all NHS workforce initiatives; enhancing pharmacists’ access to health and wellbeing support; and extending visas to attract and retain talent from abroad.


The issue is certainly on the agenda of the powers that be, and with continued positive action and attention, these challenges will be overcome.


Steve Brownett-Gale is the marketing lead at Origin – a company specialising in pharmaceutical packaging solutions


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