By Janet Morrison
In March of this year, the Community Pharmacy England Committee accepted the new Government’s funding settlement as a significant step change and vote of confidence in community pharmacy. Despite the positive funding uplift, the decision was a very difficult one.
Every Committee Member knows only too well the fragility of their own businesses and the struggle to stay afloat – and the misery of the 30 per cent real terms cuts in funding since 2014 writ large in the huge funding gap quantified by the independent economic review.
It was a reluctant decision, influenced in no small way by the Government’s pledge to work with us to secure a sustainable funding and operating model for the sector.
Since then, there have been encouraging signs for the future, such as the ambitions in the 10-Year Health Plan for community pharmacy to play an integral role in the neighbourhood health service, in prevention and in long-term condition management.
And of course, we remain hugely supportive of the Labour’s manifesto commitment to a Community Pharmacy Prescribing Service, building on Pharmacy First and the Independent Prescriber Pathfinder Programme, with the new generation of IP qualified pharmacists due to graduate next summer.
But the community pharmacy network remains exceptionally fragile. The 19p increase to the SAF has largely been wiped out by the rises in the National Minimum Wage, Employers NI and inflation, and the underfunding of retained margin provides subsiding foundations for dispensing. Analysis of company accounts, reduced opening hours, closures and our pressures survey data shows the sector’s dire state of health and poor outlook for the future.
This poses massive risks to the whole network – and to pharmacy access (particularly in the most deprived communities), safety of medicines supply and future ambitions for the sector. As pharmacies roll out seasonal vaccinations and prepare for winter pressures with their usual commitment to their communities, they don’t have the same capacity to increase staffing to meet patient demand or flex their services – they are struggling to pay their staff, wholesalers and utility bills – and yes, themselves.
Yet despite the challenges, we have a contractual framework that has in recent years embraced the clinical potential of community pharmacy.
We know that there are strong clinical and economic bases for the Discharge Medicines Service and the New Medicine Service. In Pharmacy First, the Hypertension Case-Finding Service and Pharmacy Contraception Service there is great potential to build for the future – optimising the investment already made.
Pharmacy First should be expanded to include integral roles for prescribers, widened to cover more minor ailments, with medication reviews and de-prescribing commissioned, all supported by increased pharmacist flexibilities to change prescriptions.
We should be broadening the Hypertension Case-Finding Service into a hypertension management service, expanding our role in women’s health, and in weight loss, and developing an open access stop smoking service. It is also a no-brainer that community pharmacy could do much more to deliver a wider range of NHS vaccinations accessibly in the heart of communities.
The investment case for growth in clinical services is strong. Community pharmacies are accessible, with open doors on every high street, and they are highly valued by the public.
We are the most efficient and flexible part of the NHS and offer compelling value for money. We deliver clinical services that relieve pressure on other frontline NHS services, including general practice – and we could do more to keep the population in good health and work. If pharmacy teams are enabled to act at the top of their clinical licence, we can help other parts of the NHS to do so too – supporting the left shift from hospital to community.
But investment in services needs to build on solid foundations. We can’t keep loading more and more services onto collapsing foundations.
Pharmacies need sufficient core funding to keep their pharmacies open, to procure and supply medicines, and to invest in their premises, modernised systems and robotics – in line with the vision in the Government’s 10-Year Health Plan.
We are all aware of the economic outlook for the country and the massive challenges facing the NHS – from hospital waiting lists to accessing cancer care, the difficulties getting to see a GP, or secure an NHS dental appointment.
We know that the latest Spending Review settlement is not enough to meet all the demands across the NHS and social care. But the risks to patients, carers and communities if pharmacies fall over are unconscionable.
It is vital that the Government and NHS England have the courage to shift resources out of hospitals and into a revitalised primary care system with community pharmacy a valued and vital partner.
We now need to see evidence of the Government’s stated political will, and to work together in earnest to secure a sustainable model for the sector and a roadmap for the future – including the development of further clinical services – for the benefit of patients everywhere.
(Janet Morrison is the chief executive of Community Pharmacy England)
