Peter Kelly, Head of the Generics Business Unit at Sandoz, tells Pharmacy Business that community pharmacists are currently being under-utilised and are key to the NHS 10 Year Plan…
Community pharmacists have the ‘skill’ to play a ‘much broader role in the healthcare system’ but need the government to fund the sector to ensure pharmacies remain open to serve their patients, according to Peter Kelly.
“If you look at the span of things pharmacy can do, it's grown massively in the last five to ten years,” Kelly said.
“Think of all the extra services that pharmacies now do – Pharmacy First, vaccinations, travel services etc. The skill is there, the will (to do more services) could be there if the incentives are in place.
“It’s so important that with the new agreement from 2026 there is a broader view of how pharmacy gets remunerated and what they get remunerated for.”
Kelly added that in order for pharmacists to deliver more services, measures needed to be put in place to relieve them of daily pressures such as sourcing medicine.
In July, Community Pharmacy England (CPE) released a report that described a ‘distressing new normal’ of medicines shortages on patients and community pharmacies across England.
The report found that medicines shortages and supply disruptions remain widespread, with mounting pressure on pharmacies as more time needs to be spent on managing medicines supply.
The owners of over 4,300 pharmacy premises in England and 1,600 pharmacy team members were surveyed with one in four pharmacy teams saying they are spending more than two hours a day sourcing alternatives for their patients.
Many pharmacists have now resorted to using various buying platforms versus traditional ordering predominantly through a preferred wholesale supplier.
This, however, Kelly argues is having an adverse effect on medicine shortages.
“We supply lots of wholesalers in lots of high-volume products and we see the challenge they face in managing their demand,” he said.
“Normally a shift in market share may occur in a wholesaler over a number of months or even years, but now it can almost be day-to-day.
“When we talk about having an impact on supply chains and resilience and shortages, the single biggest impact right now is probably the bouncing around of demand. You can
literally be talking to a wholesaler who could say they'll sell 100,000 of something one day and then almost zero the next.
“How do wholesalers plan for that in their network and their capacity, but also, how do they work with manufacturers to say ‘our forecast this month, or even this week is X number of packs’.
“We know roughly the size of the UK market in every product we sell but on a week to week basis, that demand can be bouncing around customers and so that can make it quite tricky to manage.”
Earlier this month, the European Court of Auditors (ECA) said that though medicine shortages have been a recurring issue throughout the EU, it still lacks a system to tackle severe shortages.
It warmed medicine shortages can have ‘severe consequences for patients, compromise public health and come at a high cost for doctors, pharmacies and countries alike’.
While the EU has taken some measures in recent years, certain structural problems persist and efforts to deal with the root causes of shortages are at an early stage.
Hence, Europe continues to be at risk of running short of medicines, including common antibiotics and other vital treatments, the ECA warned.
All categories of medicines, including innovative patented medicines, off-patent generics, or vaccines, are vulnerable to shortage.
They become critical when a country has no suitable alternatives and coordinated EU action is needed to resolve the shortage, it added.
“Every time there's a shortage, we know it’s a challenge for the healthcare professional and it's a challenge for the patient,” said Kelly.
“What I would argue at the minute is actually the market's really quite well supplied. If I talk to my wholesale colleagues, they tell me that their service level outbound to pharmacy is the best it's been for a number of years.
“If I look at market prices, which is generally a function of how well supplied the market is, they're at a historical low.
“All those things would suggest that in historical context actually right now the market's well supplied.
“Therefore, I would argue that most of the shortages that we hear about are linked to the economics and not necessarily the actual supply.”
Sandoz manufacturing site in Kundl, Austria.
In July, Sandoz produced a report looking at the need to modernise reimbursement ahead of the 2026 funding deal.
It argued that community pharmacy is still limited by the £900 million of retained buying margin each year - a figure first set in 2014 and only changed once since - while wages have increase 40 per cent in this decade and other costs have inflated.
It added that pharmacies are spending disproportionate time chasing the lowest possible prices.
Buying portals and algorithmic procurement tools reroute demand to the rock-bottom price and block purchases above reimbursement, creating operational drag - multiple daily deliveries, more invoices, continual switching, and pulling time away from patient-facing care.
In 2022/23, 1.12 billion medicines were dispensed in the community in England, with generics representing 80 per cent of all medicines dispensed but only around a quarter of NHS drug spend.
Over 800 million month-equivalent packs are dispensed for less than 80p - less than the price of a daily newspaper.
This historic lows in unit prices, Kelly argues, is ‘creating a widening mismatch between workload, risk and reward’.
“There is such a thing as too much of a good thing,” added Kelly.
“The UK’s reimbursement system effectively bakes today’s ultra-low selling prices into tomorrow’s Drug Tariff, so the harder pharmacies are pushed to procure at the very bottom, the further the tariff ratchets down.”
He added: “If you can't source medicine under the reimbursement price, for example, and maybe these buying platforms are stopping people ordering it, maybe that sometimes feels a bit like a shortage.
“If the demand is bouncing around different places, that means not all the stocks are in all the right places all the time.
“Sometimes this feels like a shortage, even if there is enough medicine in the UK. I've seen data that will show that you get these sudden peaks when people hear that the price might be going up on certain medicine.”
Kelly added that it was imperative to the success of the NHS 10 Year Plan that the government supports community pharmacy to be able to move away from stressing over dispensing margins.
“I don't really see how that (NHS 10 Year Plan) can happen without pharmacy because the capacity that pharmacy has to deliver services is so important but at the moment it’s under-utilised and under-incentivised,” he said.
“With GPs you generally hear that capacity is quite a challenge. If there is going to be shift to community and home and self-care, pharmacies have got to play a pivotal role in that but only if they are fairly remunerated.
“Pharmacists themselves have got to know that they can invest in their business without it all being at risk for a future income.”
Last month, the Government said it will consult on new measures to allow pharmacists to supply a different quantity, strength or formulation against a prescription to improve patient access to medicines.
At present, patients have to return to their GP to get their prescription amended. This delays access to medication and increases pressure on an already overburdened system.
The new move would recognise the clinical expertise of pharmacists and their vital role in maintaining continuity of care during disruptions to medicine supplies.
“It’s a really sensible recommendation, giving pharmacies some more powers to switch product, be it dosage form or pack size when there is a sort of perceived shortage,” said Kelly.
He also reflected on the fact that all newly qualified pharmacists will automatically become independent prescribers upon registration from September 2026. This will lead to an estimated 2,600 pharmacists joining the NHS as independent prescribers.
“I can see a future where pharmacy will play much broader role in the healthcare system but it's got to be funded correctly. The network's got to be there so that communities don't have black spots where there just isn't a pharmacy available.”
Sandoz is leading the way in generics and biosimilars
Sandoz are global leaders in both biosimilars and generics and Kelly believes community pharmacies have a big role to play in the evolution of biologic medicines.
“Biosimilars are instrumental in ensuring and expanding patient access to potentially life-changing biologic medicines and are indispensable to the long-term sustainability of healthcare systems. ”
“Half of all medicines that are in development now are biologics and will turn into biosimilars. Many of those are losing patent over the coming years and that’s an area of growth for Sandoz and for other companies,” said Kelly.
“Traditionally, biosimilars that have come off patent, have been products that are dispensed in a hospital setting. However, a number of the disease areas and drugs that are losing patent over the coming years, are likely to end up in a community setting and so pharmacy is likely to have a bigger role in biosimilars than it has done previously.
“I'm a massive fan of pharmacy. I've worked closely with pharmacy for a long time in my career and I really hope that the opportunity that I believe is there can be exercised in the next contract and see pharmacy play an important part in helping the UK become a healthier place because I know they can deliver on that.”
