Patients will soon be able to get prescriptions for medicines to treat seven minor illnesses under Government proposals designed to relieve pressure on the GP sector.
It is hoped that the service, known as Pharmacy First, will be launched this winter after further discussions with industry bodies.
The conditions targeted are sinusitis, sore throat, earache, infected insect bite, impetigo, shingles, and uncomplicated urinary tract infections in women. In addition, pharmacists will take on more work checking blood pressure and in prescribing the contraceptive pill.
Both the pharmacy sector and GP sector welcomed the additional investment and the opportunity for pharmacists to provide more patient services and divert patients away from GPs.
Thorrun Govind, chair of the Royal Pharmaceutical Society in England, called it a ‘real game-changer’ for patients.
Mark Lyonette, chief executive of the National Pharmacy Association (NPA) said that he hoped that the new funding ‘signals a better understanding both in government and NHS England about the value pharmacies bring to the health service’.
Nuffield Trust Chief Executive Nigel Edwards said that the measures should enable pharmacists to provide more care to patients and take some pressure off general practice, but it will have ‘to be implemented carefully.’
Edwards also noted, however, that the number of community pharmacies has been falling as their workload has risen and there is a possibility that if the funding is not sufficient for the plan then patients could get ‘shuffled between two overloaded parts of the NHS.’
Furthermore, ‘Prescribing and outcomes for patients will need to be carefully monitored to ensure antibiotics aren’t overused and the right information is given about contraceptive pills.’
And Prof Kamila Hawthorne, chair of the Royal College of GPs, said:
‘We’re also pleased to see there will be a consultation on how giving our pharmacist colleagues greater prescribing powers for minor illnesses could be implemented safely, and in a joined-up way….However, whilst all these initiatives are positive steps, none are the silver bullet that we desperately need to address the intense workload and workforce pressures GPs and their teams are working under.’
The announcement included £645 million in new funding over two years, but this is not as generous as at first sight, it will have to be split between the Pharmacy First plan, and two other services offered by pharmacists – a contraceptive service and blood-pressure monitoring, plus the updating of IT systems, to allow pharmacists to more easily access GP records and update them.
The organisation which negotiates with government on behalf of pharmacists, the Pharmaceutical Services Negotiating Committee (PSNC) is continuing to negotiate with the government over details of the plan and the allocation of funding and has said that ‘the devil will be in the detail’ and that its ‘negotiating Team are deeply aware of and very focused on the immense and underlying challenges that pharmacies are still grappling with. It is not yet clear the extent to which this investment will be enough to help the sector through these pressures.’
There have been concerns over the level of funding received by community pharmacy, 90% of whose work is for the NHS, for some years.
In 2016, the government decided to reduce overall pharmacy funding, the justification being that there were too many pharmacies operating in the market.
Without negotiations with the PSNC, overall funding was cut from £2.8bn in 2015/16 to £2.592bn in 2017/18 (8% decrease), and the annual agreed funding has remained flat ever since. When inflation is factored in there has been a cumulative loss of almost £800m in funding for community pharmacy over the past five years.
In November 2022, Janet Morrison, CEO of the PSNC, told The Pharmacist that a Pharmacy First service would need an annual £350-£400m funding package.
So £645m split over two years would not cover the amount the PSNC estimated would be needed to fund Pharmacy First each year alone.
Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies (AIMp) said that ‘any measures to deliver patient care with a less cumbersome, less time consuming and easier bureaucratic burden will be welcomed by pharmacy teams [across] the length and breadth of the country.’
But: ‘The reality remains that there is currently a shortfall of £1.1bn in pharmacy funding every year and rising, and many pharmacies are struggling to pay the ever-increasing prices of medicines, the higher general costs of doing business and managing greater workforce challenges.
Pharmacists can not pass on increased costs to patients and customers under the current contract with the NHS and so many “are operating at a loss.’
A recent survey by the National Pharmaceutical Association (NPA) found that the majority of independent pharmacy owners made a net loss dispensing medicines for the NHS during 2022, with nine in ten (92%) seeing a dispensing loss for at least one month of the year.
Lack of funding has already had an impact on the new pharmacy contraception service launched in March 2023. In late April 2023, The Pharmacist reported that just 4% of community pharmacies had signed up to the scheme within its first two days.
The board of the NPA withdrew its support for the roll-out in late April. It asked members and NHS England to pause its roll-out as with no new funding for the service, and all existing funds already allocated to other pharmacy activity, it believed that any payments to the sector for delivery of the oral contraception service would ultimately be clawed back by NHS England.
In January 2023, the Company Chemists’ Association (CCA) said that community pharmacy is experiencing an annual shortfall in funding of over £750m, following the disclosure of data in parliament.
It is not just the funding that is the issue, as with other areas of healthcare, community pharmacies are struggling to stay open in the face of staff shortages. There has been a reduction in the number of students training to be pharmacists, plus workforce issues related to Brexit and pharmacists choosing to work elsewhere in primary care, rather than in the very pressured community sector, means that pharmacies are turning to locum pharmacists to fill the vacancies, but the rising demand is increasing locum fees with costs rocketing.
Even the large chains are struggling. In February 2023, Lloyds Pharmacy, the second largest community pharmacy chain, announced it will close all of its branches located within Sainsbury’s supermarkets. This will affect 230 locations across the UK where the public currently access NHS services, and they will be closed with just 3-6 months’ notice.
The closure came as no surprise to others in the industry, Nigel Swift, the deputy managing director of Phoenix UK, which owns the Numark and Rowlands pharmacy groups, commented to the Guardian : ‘This announcement is the clearest possible sign of the dire situation facing community pharmacy in England as a result of insufficient government funding. Since the start of the pharmacy contract there has been a massive cut in real-term funding, resulting in hundreds of closures.’
The day before the Pharmacy First announcement, the BBC reported that the number of pharmacies in England has fallen by 160 over the last two years. There are now 11,026 community chemists, according to data from NHS Business Services Authority – the lowest number since 2015.
A recent survey from the NPA found that 92% of independent contractors saw a dispensing loss for at least one month of the year, while nearly half (48%) said that they had lost money through dispensing for six months or more.
Pharmacists are warning that many more businesses could close.and others are taking measures to reduce costs such as reducing open opening hours and staffing. The NPA survey found that over a third (38%) had reduced or stopped some NHS services, while over half (59%) had stopped or reduced previously free services like home deliveries or introduced charges for these services.
With less staff and shorter opening hours, patients expecting faster help from pharmacists than GPs, may well be disappointed.
Organisations, such as the NPA, have campaigned for a number of years for pharmacists to do more in the area of prescribing, and the Pharmacy First plan has been broadly welcomed, but it is clear that unless the funding is sufficient, then this plan will have little impact on the over-stretched GP services.
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