With the health and social care landscape undergoing fundamental change in the UK and the country recovering from the Covid-19 pandemic, the role of community pharmacy is evolving at a fast pace. However, the sector is under intense pressure and needs new strategy to strengthen, a community pharmacy report by Breaking Barriers Innovations said.

The report, authored by Dr Jon Bashford, George Evans-Jones and Nicholas Werran, not only discusses the role of community pharmacy and the challenges it faces, but also highlights the steps that needs to be taken to overcome those cliff edges.

“Now is not the time for new strategy or visions, this is a time to act,” the report warned.

“It is imperative that government, NHS England and NHS Improvement and Integrated Care Systems (ICSs) work collaboratively with community pharmacy leaders to address the structural placement of community pharmacy on a sustainable basis.”

This also is an opportune time for the sector to help deliver on the current policy agenda to reduce health inequalities, it added.

In 2022, ICSs are expected to be put in place system to enable a collective model of responsibility and decision-making between system partners.

The report said community pharmacy can play a pivotal role in delivering some of the top priorities for ICSs in the coming year:

  • Delivering the NHS COVID vaccination programme and continuing to meet the needs of patients with Covid-19
  • Service transformation including expanding primary care capacity to improve access, local health outcomes and address health inequalities
  • Transforming community and urgent and emergency care to prevent inappropriate attendance at emergency departments (ED)

Key challenges

As the government kept the funding for community pharmacy unchanged at £2.592 billion for the year 2021-22, over 38 per cent of the network could face financial deficit with more than half (52 per cent) of contractors planning to sell their businesses.

The report estimated network-wide financial deficit to be as high as £497 million, adding, “no industry is likely to be sustainable with so many operators in deficit.”

The additional financial burden placed on community pharmacies due to the pandemic also needs urgent attention from the government.

The All-Party Pharmacy Group has recently called on the government to honour its commitment that the NHS would receive all the funding it needs to deal with pandemic, and that community pharmacies should be included in that settlement.

Besides finances, adequate staffing has also become a challenge for the sector, the report said.

The majority of respondents to Ernst and Young’s survey stated that they cannot afford to take on the staff to provide more services and those that have extended their hours to provide more services are twice as likely to be in deficit.

Training is another bottleneck for the sector, as traditional training models equip professionals for work on a single sector basis with insufficient focus on transferability of skills.

Meanwhile, Health Education England (HEE) is working with the Royal Pharmaceutical Society (RPS), NHS England and NHS Improvement to deliver innovative training and development opportunities.

It is important to see that this project is aligned with ICS workforce planning and transformation, the report said.

Separately, a pivot towards more digital services, entry of ecommerce giants like Amazon and creation of online pharmacies could further add to the existing financial pressures and destabilise the sector.

New steps needed

The report suggested to strengthen community pharmacy leadership through the Local Pharmacy Committee and the facilitation of negotiations across system leaders including the Local Medical Council, the ICS and NHS England and NHS Improvement.

This will ensure greater contributions of community pharmacy towards a broader discussion about patient needs and progress.

Highlighting the poor history in the NHS of realising the benefits of new information technology, the report called for secure messaging and access to shared electronic records between the GPs and pharmacists.

Besides, testing new electronic dispensing systems including hub and spoke mechanisms to improve quality of service and ensure fairness is needed, it said.

It advised to revise term of service for community pharmacy to protect patient choice and ensure stability and sustainability of the sector.

ICS estate plans for supporting clinical and service strategies should consider the contribution of community pharmacy, and ensure that they benefit from the broader capital investment programmes.

On the subject of the workforce development, the report said there should be more opportunity for cross-professional learning to enable more pharmacists to train as advanced practitioners.

Breaking Barriers Innovations are seeking to work with the community pharmacy and lead ICSs on developing the building blocks for a pathfinder programme on the future commissioning of the sector.

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