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Political Pills: There is clearly something wrong in community pharmacy

Steve Brine, former pharmacy minister and C+D's newest columnist, reveals the back story behind the HSCC inquiry, and warns that Janet Morrison and the CPE will need to be on top of their game once parliament resumes...

There are no shortage of promises being made by those who want your vote at the General Election on 4 July. That trend has seen an even steeper curve this week as the main political parties publish their manifestos.

The national campaign may not have inspired great confidence when it comes to coherent discussion of what is likely to move the dial in terms of primary care, but the health select committee did its best, publishing a well-received report on pharmacy.

Over the past year I chaired this major inquiry, which explored issues impacting different types of pharmacy, with a particular focus on community, primary care and hospital services. We got it out just before parliament was dissolved at the end of May.

The headline finding of our cross-party work is that the next government must urgently reform the funding framework for community pharmacy if more clinical services are to be delivered and increasing demands for medication are to be met.

Without that, manifesto promises are just that.

Bottom line, there is clearly something wrong if the funding that pharmacies receive from the NHS does not cover medicine costs, given one core function is dispensing medicines.

Complete overhaul


The report finds the current Community Pharmacy Funding Framework “not fit for purpose” and urges a complete overhaul to reduce its complexity.

We said a new framework is necessary to deliver adequate funding and prevent damaging cross-subsidy between clinical services and prescription dispensing, as is currently the case.

Reductions in core funding to community services of 30% since 2015 equate to an annual shortfall, per pharmacy, of between £67,000 and £100,000. Meanwhile, 1,100 pharmacies have closed in that time, more than a third of which were serving the most deprived areas.

No deal

Janet Morrison from Community Pharmacy England confirmed to C+D last week there will be no new community pharmacy funding deal until after the election. That doesn’t mean discussions will stop but it does mean nothing can be agreed until the new government is in place.

Nothing especially unusual about that in a period of ‘purdah’, and July is only a few weeks away of course, but pharmacy will then have to wait its turn in an in-tray full of things demanding the new minister’s attention.

CPE will need to work hard on its attention grabbing ‘OVER HERE’ technique and make the case that no new promises on pharmacy can realistically come to pass without a complete overhaul of the Community Pharmacy Contractual Framework (CPCF) in close consultation with the sector.

Shortages


The report calls for government to urgently address medicine shortages which risk undermining flagship initiatives (such as Pharmacy First) by eroding public confidence in pharmacists.

It is also especially worrying that shortages are resulting in patients being directed back into general practice. There is a serious risk that any capacity general practice gains through Pharmacy First will be negated by the time spent re-issuing prescriptions as a result of shortages.

The report calls for an independent review of the medicines supply chain to identify the weak links and to determine how the UK’s response to shortages can be improved.

The global supply chain for medicines is complex, with a range of different actors involved in getting medicines from the raw materials to the manufacturer to the patient.

The government needs a much clearer understanding and overview of the whole process, and the risks at each stage. If it already has that clarity, it should be communicated to parliament at the earliest opportunity.

We also recommend that government reviews the effectiveness of Serious Shortage Protocols, with a focus on their timing and their administrative burden.

We ask that regulations are updated within three months to allow pharmacists in community settings to make dose and formulation substitutions for out-of-stock items, subject to the safeguards set out in the Royal Pharmaceutical Society’s Medicines Shortage Policy.

Allowing generic substitution would be an important way of reducing the need for patients to return to their GP for out-of-stock medication and that should follow a government consultation focusing on how best this policy could be implemented to ensure patient safety.

While hub and spoke arrangements may be beneficial to some pharmacies, I do not believe this is a ‘silver bullet’ in terms of efficiencies. In the report we urge the government not to assume that hub and spoke alone will deliver the extra capacity pharmacists clearly need to deliver clinical services.

The current government’s response to their consultation and intention to proceed with plans to allow hub and spoke systems to be set up across different legal entities may not survive contact with the electorate and ministers should exercise extreme caution against encouraging, or even mandating, more widespread implementation.

Future potential

The report concludes that community pharmacy has vast amounts of untapped potential and we were unsurprised to hear the enthusiasm within the pharmacy profession to deliver more patient facing care.

There’s no question additional services could be delivered within community pharmacy settings, so we want the new government and NHS England to publish a long-term vision for the further development of clinical services in community pharmacy settings within one year.

This vision should build on the seven health conditions covered by Pharmacy First and the delivery of blood pressure and oral contraception services by pharmacists

We also urge them to set an explicit expectation that community pharmacies offer additional services, for example access to HIV prevention medication (PREP) and all routine and seasonal immunisation for adults and children.

And, back to the future I realise, the reports recommends the creation of a new “Establishment Payment” to be paid to eligible community pharmacies to support the development of consultation spaces for patients.

This funding should be targeted at pharmacies that are the most reliant on NHS work as their main source of income and could be linked to a commitment to provide an agreed level of NHS service. It will be interesting to see if that finds favour with new ministers at DHSC and, in particular, HM Treasury.

In all the report makes thirty recommendations across the areas I’ve touched on, but also around workforce and within hospital pharmacy. There it talks about the clear benefits to be found from using automation and technology and what that could unlock in terms of productivity which so much of the long-term workforce plan hangs upon. Not for the first time, pharmacy holds so much of the NHS in its hands.

Steve Brine is a former pharmacy minister and chaired the cross-party Health & Social Care Select Committee from 2022-2024. He was MP for Winchester 2010-2024.

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