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'The referral service is a step towards greater clinical recognition'

"As the number of referrals grows, so will pharmacy’s reputation as a source of clinical expertise"

C+D's editor gives his initial take on the rollout of the latest advanced service for England's community pharmacies to deliver

The new funding contract has understandably received a mix reaction from pharmacies since it was announced in July. Many have decried freezing funding for five years at a reduced level that is already proving unsustainable to run a business and cater to the needs of patients, while others have welcomed the stability needed to plan for the future.

While it certainly didn’t live up to the repeated government promises of “sustainable” funding after three years of cuts, it did at least offer a roadmap for how NHS England would like to better utilise the sector. The new focus on services will see certain pharmacies deliver hepatitis C screening, and potentially identify undiagnosed cardiovascular disease, undertake smoking cessation referrals from primary care, conduct discharge medication reviews and oversee expanded new medicine service consultations.

But top of the agenda was a national referral service from NHS 111.

The accompanying £14 consultation fee, while welcome, will hardly be a panacea for the financial woes suffered by so many of England’s pharmacies – especially if estimates of just one or two consultations a week at the outset prove to be accurate. However, as the number of referrals grows, so – hopefully – will community pharmacy’s reputation among both patients and the wider NHS as a source of clinical expertise. This is even more likely if referrals from GPs – currently being piloted – are added to the service as planned.

Pharmacists have correctly complained for years that their experience and training is rarely recognised, or fully utilised, by primary care and beyond. Let’s hope that this new national service is a step in the right direction.

James Waldron is editor of C+D. Let him know how your pharmacy is coping in 2019 by tweeting him @CandDJamesW or emailing him at [email protected]


Leon The Apothecary, Student

It's still not addressing the issue that at its core, pharmacies is not correctly set up to handle a modern service-led industry. You see it every time there are no checkers available, every time staff levels are not accurate so people are manning two or more areas, every time you see "express lanes" and text notifications as a revolution rather than business as usual.

The NHS wants the pharmacy to be a modern utopia for low acuity ailments, but it first needs to modernize from the core upwards rather than tack onto the side of an already unstable business model.

Paul Samuels, Community pharmacist

Very valid points--nearly all smaller independant phramacies  are not in a financial position to go this direction(although it is the right way to go).Inadequate funding is  the root  cause.

Multiples have the financial clout(facilities) to make these changes(hub & spoke,etc)  whereas unless independants can group together,I cannot see it being financially viable & a lot will be pushed to survive.

NHS can help by making financial inducements to make the sector more efficient,but must first ensure that we are reimbursed appropriately so that we can give the clinical services we all desire to give.However I cannot see that ever happening!!


Mark Boland, Pharmaceutical Adviser

'It's still not addressing the issue that at its core, pharmacies is not correctly set up to handle a modern service-led industry'

There are few pharmacies I have ever worked in that have been anything other than complete chaos. The typical dispensary operates with what can only be described as comical inefficiency and the chains do not have the in-house expertise to correct it. With the technology available and the logistical expertise that can be bought in, it is ridiculous to allow this to continue.

In order to create the time needed to carry out any new services, dispensing will have to be taken off-site. If done with the technological and operational excellence seen in other sectors, the time spent on dispensing prescriptions will be a small fraction of what is seen today.

A generous payment for the supply function was given away with last the contract, it will never return. The phoney 'clinical' services such as MURs and NMS are not cost-effective, are not wanted by the public and do not help support GPs in delivering the best clinical care possible, they will not sustain community pharmacy.

There is an opportunity to use the incredible 'operational' design and technology that is now available. Like most high street businesses, community pharmacy does not have any of the expertise to integrate this technology, but they can the buy expertise in.

If community pharmacy survives, there will be fewer pharmacies, fewer pharmacists and very little on-site dispensing. The final piece of the jigsaw will be the NHS finding a genuinely useful and cost-effective clinical role for community pharmacists. I think they can, but again, it will come from buying in outside expertise and not letting any of the incompetent in-house bureaucrats have anything to do with the changes.

Richard MacLeavy, Dispenser Manager/ Dispensing Assistant

The problem you have with this is that MURs worth £28 per consultation are stopping and being replaced with consultations that are likely to be longer and carry more paperwork but only recieve £14 of funding. So you will have to do twice as many to replace the lost revenue. Its hard to see the positive in this, especially if your staffing resource is already at breaking point

Tony Schofield, Community pharmacist

Well said James. We need to start getting positive about that with which we are asked to do. If the annual discussion with DHSC about costings actually does recognise increases such as minimum wage (being used by all parties to bribe the electorate) we can start to look forward with a bit of confidence as opposed to the abject terror of the last 3 years

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