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Hewitt review recognises ‘damaging consequences’ of ARRS on community pharmacy

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The recruitment of pharmacists in Primary Care Networks (PCNs) has exacerbated a general shortage of pharmacists, revealed an independent review of Integrated Care Systems (ICSs) published on Tuesday (4 April).

The review, Rt Hon Patricia Hewitt, highlighted the impact that the Additional Roles Reimbursement Scheme (ARRS) roles for pharmacists are having on the community pharmacy sector.

Contracts with national requirements can have unintended consequences when applied to particular circumstances. For instance, the national requirements and funding of Additional Roles Reimbursement Scheme (ARRS) roles for community pharmacists within PCNs, has on occasion exacerbated the problem of a general shortage of pharmacists, with some now preferring to work within primary care rather than remain in community pharmacies or acute hospitals, compounding the problem of community pharmacy closures and delayed discharges.”

It set out to consider the oversight and governance of ICS in England and the NHS targets and priorities for which Integrated Care Boards (ICBs) are accountable, including those set out in the Government’s mandate to NHS England.

As part of this work, Hewitt and her team engaged with a wide range of stakeholders representing various local health and social care settings, including LPCs.

Ms Hewitt, Chair of the Norfolk and Waveney ICS and a former Health Secretary under Labour, was commissioned in November 2022 to advise the Government on how to make sure the new ICBs operate efficiently. Following the publication of her report, it will now be for Government and the NHS to consider the recommendations made.

Responding to the report, PSNC Chief Executive Janet Morrison said: “The Hewitt Review is an important report for the future of ICS and the commissioning of local healthcare services. For community pharmacy, the review recognises the damaging consequences that ARRS has had on the sector, exacerbating workforce issues, which has left many pharmacies forced to close their doors temporarily to patients.

PSNC has been warning Government and NHS England about for some time, including calling for a stop to recruitment of pharmacists to PCNs or allowing the money to be spent funding collaboration with community pharmacies. The policy of solving one workforce problem by worsening another is absurd – it has increased vacancy rates and caused spiralling locum costs.

Morrison added: “The report is clear that action should be taken to carefully consider the best use of the limited pharmacist workforce going forwards, and that the new ICS should be instrumental in this. However, local action will need to be joined up nationally, so it will be important for the Government to realise these issues, with solutions in their upcoming long-term NHS workforce plan by ensuring that it covers the entirety of the pharmacy workforce across the NHS, including community pharmacy. We would welcome the opportunity to discuss the issues in the Hewitt Review, as Government considers the recommendations.”

NPA Director of Corporate Affairs, Gareth Jones, said: “Hewitt has called this out as an example of silo thinking and we urge system leaders to respond accordingly by reviewing the wider workforce impact on their patch.

The association has suggested that there should be a workforce risk assessment at system level before any new recruitment via ARRS.

Jones added: “We have also asked ICBs to think creatively about what more they can do to optimize community pharmacy staffing for the delivery of locally identified priorities. We were pleased to take part in the consultative stages of the Hewitt Review and we welcome it’s straight-talking conclusions.”

Malcolm Harrison, the Chief Executive of the CCA said: “We know that this funding has contributed to a significant rise in vacancy rates across the community pharmacy and hospital settings, and has resulted in a 90% increase in the hourly rates paid to locums, as demand has outstripped supply.

For the past year the CCA has been calling for a co-ordinated pharmacy workforce plan, to span the whole of primary care, so that in the future patients can access a pharmacist whenever and wherever they need to.

“We welcome the opportunity to work with the health systems to develop solutions to enable patient care to be effectively and safely moved from PCNs and into community pharmacies, thus reducing the need to pull pharmacists away from the communities they serve.”

Brian Duggan, ABPI Strategic Partnership Policy Director said: “Patricia Hewitt is right to focus on the creation of health value to ensure that patients receive the highest quality of care available to them. Investment in innovative medicines can transform a patient’s life, while also bringing significant productivity benefits to the NHS and the wider UK economy and society.

“The review’s focus on preventative care is critical in sustainably promoting the health and wellbeing of the nation. Secondary preventions in the form of accurate diagnosis and treatments can improve individual patient outcomes, while long-term, such interventions will pay dividends for the NHS by reducing repeat use of services.

“The ABPI strongly supports the review’s recommendation to develop a minimum data sharing standards framework to be adopted by all ICSs. This will play an essential role in establishing consistent and meaningful data flows across NHS organisations. This would ensure that ICBs can be accountable for a specified standard of clinical recording, while also leading to better, high-quality data, that could be used for clinical decision making, service planning and innovation, improving patient outcomes.”

RPS Director for England James Davies said: “This review highlights the potential for Integrated Care Systems to drive collaboration and rightly recognises that supporting prevention and tackling health inequalities are key to a sustainable NHS.

“The report considers a number of key issues to make ICSs a success, including the need to improve data sharing and interoperability of patient records. It is vital that any future discussions around primary care reforms include pharmacy alongside other key partners.

“Just as ICSs are taking over commissioning of local pharmacy services, I hope the Government and NHS leadership listen to the warning that the scale and timing of cuts to ICB funding risk diverting time and energy from staff who are essential to transformation to improve patient care.

“The report acknowledges significant pressures on the pharmacy workforce. With other pharmacy bodies we called on the Government to ensure the NHS Long-Term Workforce Plan considers the whole of pharmacy and we are still waiting to see what is published. The workforce plan must support a future pipeline of pharmacists backed by investment in education and training.”

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