Amid media speculations that a large pharmacy multiple was putting all its stores at risk of closure, PSNC supremo Janet Morrison said the sector was in crisis and in danger of a significant collapse.
Addressing delegates via a video link at Sigma Pharmaceutical’s 13th Annual Community Pharmacy Conference held last week (March 4 -9) in Punta Cana, Dominican Republic, she said while “a lot of consolidation or sales” would continue, a lot of the smaller, independently-owned community pharmacies – which had to work harder and harder to make ends meet – were just “hanging on in there”.
“But I don’t know how much longer people can go on,” she said, adding that the risk of actual closure was rendering the remaining pharmacies so fragile that “they may not be able to pick up the slack of many thousands of patients” who would need repeat prescriptions.
“The disruption is frightful and awful. We have got 53 per cent of the population on repeat prescriptions, so that matters.”
Her comment on the opening day of the conference was a sober reminder that the sector – which relies heavily on income from prescriptions – couldn’t afford to “carry on with the current format of a contract and the current amount of money” it was paid to deliver numerous tasks which have been heaped on it to share the burden of a crippling NHS.
In a blunt admission, Ms Morrison told 250 delegates, which included community pharmacy contractors and other stakeholders, any urgent funding uplift on the basis of the current five-year contractual framework was unlikely to materialize and that the only way pharmacy could get more money – if at all – would have to come from other NHS pots.
But she warned that the operational instructions for officials in the health service as well as the incoming Integrated Care Boards – a statutory NHS organization responsible for developing a plan for meeting the local health needs of the population – was to work towards “reform and greater efficiency”, meaning there was no extra money to be had.
Launching a brutal attack on government apathy towards the sector, Dr Layla Hannbeck, CEO of the Association of Independent Multiple Pharmacies, called the current state of affairs in community pharmacy a national disgrace.
“What is happening to pharmacies in England at the moment is a national disgrace.” She argued that there has been a culture of imposing things on pharmacy rather than consulting with the sector.
Dr Hannbeck argued that when the NHS was set to get a funding boost of £6 billion from the Treasury nothing was earmarked for community pharmacy.
“We should move away from accepting that there is no money in the pot. There is money in the pot. But where this money is going is another question. Is this money being spent where the taxpayer gets most benefit,” she asked?
Pharmacies are choked
Andrew Lane, chair of the National Pharmacy Association said, “pharmacies in England are being choked” by the national contract, calling it “unfit for purpose after years of underfunding”.
He argued that rather than allowing contractors to be the master of their own destiny, the contractual framework put them at the mercy of circumstances beyond their control – be it wholesale price rises or the reluctance of some family doctors to refer into NHS services into pharmacies for minor ailments.
Mr Lane lamented the basic idea that pharmacies would be viable by taking on new services was not supported by the contract’s structure or its associated funding. “A fundamental rethink is needed if the sector is to recover, thrive and deliver for patients,” he added.
Flavour of the month
There was a note of cautious optimism when Ms Morrison said the “most likely thing we will get funded for is Pharmacy First” – a scheme that provides professional healthcare advice, treatments, and medicines for common illnesses in local pharmacies.
“Pharmacy First is the flavor of the month”, she said of the scheme which has proven quite successful in Scotland and Wales and is well-received by both patients and pharmacists. She added Pharmacy First, as part of the primary care recovery plan, was the most realistic and viable solution and that “it’s the closest we can get to core funding”.
Ms Morrison said she believes in a quiet, behind the scenes diplomacy to make the case for community pharmacy when she is working with government ministers, who operate on a ‘with us or against us’ basis. “We have to make the case as a professional, competent, analytical, smart sector that has solutions, not just problems and that we can align to make things work better.”
But she reminded delegates of the gargantuan task of leading a negotiating team: “We are fighting against the parameters that are already set,” she said, clarifying that officials at the Department of Health and Social Care have clear instructions from the Treasury to balance the books and work only within the final five-year funding envelope, which is fundamental to them.
Answering to a question on whether the sector should consider taking industrial action, she said while she would leave individual contractors and their unions to decide what is right for them, she warned such an action could be seen as confrontational and should therefore be used only as a last resort.
Recognizing that the UK could very well see a change in government after the next general election, she said her team at PSNC was trying to build relationships and alliances with the opposition party – talking to shadow health secretary Wes Streeting’s team as well as with people behind party manifestos and Labour-leaning think tanks.
“The economic situation we are in is very pressing, but it will not be any better or different” with a change in political dispensation in Westminster. Therefore, she said, the sector will need to be able to make its case for “better patient care and health outcomes” no matter which political party is in government.
Steve Brine MP, chair of the parliament’s Health and Social Care Select Committee, told delegates via a video message that despite many challenges community pharmacy had “a very bright future” but that it needed proper funding. He said he was truly impressed by “so many inspiring, innovative examples” community pharmacy had showcased “to change the health and social care landscape” of the country.
“Although there are undoubted challenges ahead, many of them related to workforce, I feel very confident that community pharmacy, if funded properly by the government, has a very bright future indeed.”
Announcing that his committee would be launching a ‘pharmacy inquiry’ towards the end of the year, he spoke of the sector’s great potential towards meeting the objectives of the government’s prevention agenda, built around the NHS Long Term Plan, in areas such as obesity, alcohol and smoking and mental health.
Mr Brine – who was pharmacy minister between June 2017 and March 2019 – said community pharmacy will play a crucial part to boost prevention as one of the government’s top priorities. “We intend to set a clear direction on what steps ministers must take now to achieve a new goal by the end of the decade.”
He revealed that in just three weeks, his committee received 600 proposals in which community pharmacies came up repeatedly, noting that many of the submissions called for more recognition of the importance of community pharmacy to the NHS.
In future, he said, pharmacy teams should be able to enhance opportunities for early detection of ill health, through interventions used in population health data and maximise ongoing advances in technology such as wearable tech and point of care testing – something that his committee was already looking into as part of its ongoing inquiry into the digital transformation of the NHS.
There were also suggestions that pharmacy teams should be able to link seamlessly into services such as social prescribing, social care, housing, and the voluntary sector.
Mr Brine also spoke of suggestions giving community pharmacists access to referral pathways and their potential to reduce obesity rates through nutrition, education, weight management, counselling, and medication therapy management.
Another proposal suggested the involvement of community pharmacy into the inquiry to prevent oesophageal cancer with a particular focus on the modifiable risk factors of obesity, smoking and alcohol. It suggested more upstream prevention work with pharmacists giving advice “to help reduce the prevalence of heart burn before it develops into oesophageal cancer”.
David Webb, the chief pharmaceutical officer for NHS England, told the conference via a video message that he fully recognises the pressures that pharmacists and they teams are having to deal with but added that the sector was now at a significant juncture.
“Our future success as pharmacy professionals will be shaped by our ability to collaboratively work and continue to live at high standards of professionalism as we play our part in delivering our NHS’s priorities and continued excellence in patient care.”
He said Integrated Care Boards (ICBs) are due to take over the commissioning of pharmaceutical services by April 2023 and to make the most of it, community pharmacy teams will need to be collaborators with each other and with other primary care networks and social care teams to deliver joined up services for ICB populations as part of formalised pathways of care.
“ICBs are all about possibility of local commissioning to meet patient needs and community pharmacy will need to drive this at place and neighbourhood level,” he said, adding that a key priority for ICBs would be to address health inequalities across populations.
Mr Webb also spoke of the creation of community pharmacy independent prescribing pathfinders in every region to inform future commissioning for NHS community pharmacy clinical services from 2024. These pathfinders will be supported by local ICBs testing different models and allowing for local variations in clinical design and delivery responding to local need and the availability of pharmacist prescribers.
As part of the programme, patient safety, governance, digital, reimbursement processes will all be tested and evaluated, including informing future digital requirements, to enable and share patient information between general practice and community pharmacy settings.