NPA at 100: Reflecting on a century of changes in community pharmacy

As the NPA marks its centenary, chairman Andrew Lane reflects on a difficult year for community pharmacy amid hopes for a potentially brighter future…

By Andrew Lane

The National Pharmacy Association is marking its 100th anniversary this year. Such milestones are an opportunity to reflect on the past, think about the present as well as look to the future.

Community pharmacy has seen enormous changes since 1921, the days when pharmacists created pills and potions by hand on their own premises. The intervening decades have seen, among other things, the formation of the NHS in 1948, a complete overhaul of medicines regulations in 1968, new clinical services and a massive expansion in the range of medicines available to patients.

Throughout that time, the NPA has brought community pharmacies together, to pool resources, learn from each other and deliver fantastic patient services at scale. The sector has also stood together at times of challenge, such as during the last year, surely one of the biggest health crises ever to have faced pharmacy, the NHS and the nation at large.

The sector can be proud of the way it has met the challenges of Covid-19 head-on. The response underlines how community pharmacy is increasingly a vital part of the NHS, as well as a uniquely accessible self-care and public health asset.

I am pleased at the high level of participation with the Pharmacy Collect service. It reinforces the fact that pharmacies are part of the Covid exit plan, just as they have been key to the pandemic response from day one.

An NPA survey in the summer showed that 89 per cent of people believe pharmacies are playing an essential role in the crisis. Some 81 per cent of the public hold a favourable view of the sector – up 15 per cent from 2016. The research also showed public support for pharmacies to play a greater role in the future of the NHS and a strong attachment to community-based services.

Professionally, the sector is delivering more than ever. Despite a low rate of referrals in many areas, the Community Pharmacist Consultation Service is an important opportunity to embed pharmacy in the NHS urgent care pathway. If properly implemented this service means patents will increasingly see pharmacies as the first place to go for health services and will also help to demonstrate the case for future public investment in pharmacy-based clinical care. The Discharge Medicines Service is another strategically significant service, because of the formalization of pharmacy’s place in the secondary primary care pathway. Meanwhile, the successful roll-out of the Covid-19 vaccination programme in pharmacies and a record year for flu vaccinations has cemented our position in the health protection sphere.

Unfortunately, pharmacies are being asked, with static funding (declining in real terms), to manage increased workload and absorb inflationary pressures such as increases in the minimum wage, pension contributions and new regulations.

That is one of the reasons the NPA has invested in new capacity to support independents to engage with the NHS locally, where billions of funding attached to the NHS Long term Plan will flow through Primary Care Networks. At the same time we continue to put the positive case for nationwide investment in the community pharmacy sector.

We’ve also partnered with a range of suppliers who can help pharmacies diversify their income streams and reduce their reliance on the NHS – which is now close to being a monopoly purchaser of pharmacy services.

But there is no getting away from the fact that there’s already a big hole in the sector’s finances, certainly in England. The Ernst &Young study (September 2020), commissioned by the NPA, predicts many pharmacy closures unless there is a new injection of public funds. This is madness, when you think of what pharmacies have done during the pandemic. It’s clear the NHS would not have been able to cope without an accessible network of community pharmacies near to where people live, work and shop.

Covid-19 has rapidly accelerated several developments in pharmacy business and practice. We therefore need to think about a wide range of issues for the post-crisis world, including the place of online supply. We know an increasing number of people find online pharmacies convenient and more chose to receive medicines remotely during lockdown.

The bricks and mortar network of pharmacies can compete with ‘Amazon’ style pharmacy but independents need to develop their digital offering to enjoy the best of both worlds – a digital presence alongside the faceto-face attention from pharmacy professionals that patients value so highly.

On the near horizon, possibly, is hub and spoke dispensing, on which there is to be further consultation with ministers. The NPA is sceptical about some of the grander claims made for ‘inter-pharmacy’ hub and spoke (as distinct from hub and spoke within pharmacy businesses). However, we will stay fully engaged in the debate to see proper scrutiny of the assumptions on which claims for hub and spoke are built.

There has been a raft of policy announcements in recent months about the future shape and organisation of the NHS in England. Community pharmacy can deliver most as an integral part of the system rather than being seen as an adjunct to the “main action”.

For the public to get the maximum benefit from community pharmacy, the sector needs to be embedded in decision making – both having visibility and being visible inside the system. The development of Integrated Care Systems gives us a new opportunity to ensure community pharmacy is appropriately represented in leadership and accountability arrangements.

It follows that the current national review on roles of LPCs and PSNC must deliver strengthened, not depleted, local leadership, to leverage the emerging ICS opportunities and build our primary care and PCN connections.

The pharmacy workforce is clearly a central aspect of any analysis of the state of play within the sector. It could be game-changing when pharmacy graduates are qualified to prescribe from day one, due to reforms of initial education and training. But only if there are commissioned clinical services to which pharmacist prescribers can apply their skills.

Whatever the future brings, the NPA will continue to support our members across the UK to succeed professionally and commercially for the benefit of their patients.

Our anniversary is a reminder about just how much has changed over the years and that we shouldn’t be afraid of further change. As long as community pharmacy continues to focus on people, not just pills, and given the right level of support, it will still be keeping people well and saving lives 100 years from now.

Andrew Lane is chairman of National Pharmacy Association.