A report released today by the parliamentary Health and Social Care Committee (HSCC) found that the government’s progress on its commitments to support pharmacy ‘require improvement’.
The HSCC commissioned six pharmacy experts including National Pharmacy Association (NPA) chief executive Mark Lyonette, to evaluate the progress made on nine specific commitments made by the government – seven relating to community pharmacy and two relating to hospital pharmacy.
The panel asked whether the commitment had been or was on track to be met, whether it was effectively funded or resourced, whether it was an appropriate commitment to make and whether it achieved a positive impact for patients.
Pharmacy Access Scheme: Requires improvement
While the panel found that the government had met its commitment to maintain a Pharmacy Access Scheme (PhAS), it suggested that support for the scheme required improvement.
In particular, it raised concerns about increasing numbers of community pharmacies closing, as well as the reduction in opening hours potentially restricting patient access out of hours and at weekends, particularly in deprived areas with high healthcare needs.
There was not enough data to sufficiently determine the impact of PhAS on maintaining pharmacy access, the panel found.
But given that PhAS funding was fixed within overall funding for community pharmacy (the global sum), and that the government’s commitment to maintaining PhAS did not address ‘the major funding challenges faced by community pharmacy providers that are leading to closures’, the panel said that the PhAS was ‘likely to be insufficient to protect access to local pharmaceutical services in areas with fewer pharmacies’.
Funding review: Requires Improvement
The Department of Health and Social Care has said that the fixed five-year funding agreement for community pharmacy is ‘constantly under negotiation and review’.
But the expert panel said that the evidence it received was ‘clear’ that ‘most stakeholders did not consider that an appropriate review has taken place, with two describing the funding model as “broken”’.
And it expressed concerns that the flat funding model, unreviewed and unadjusted to take into account additional demands, increased costs and workforce pressures, had resulted in ‘community pharmacies being unable or unwilling to deliver additional clinical services; patients being unable to access some medications; and reduced access to community pharmacies, particularly in deprived areas’.
The panel also noted that the Community Pharmacy Contractual Framework (CPCF) had assumed efficiencies in dispensing, which had not yet taken place.
The Community Pharmacist Consultation Service (CPCS) has been delivered, and was enabling community pharmacists to support more people with minor health conditions, as well as freeing up capacity within the wider health service, the panel said.
But it added that while referrals from 111 were well established, referrals from general practice were ‘uneven across the country’, limiting the service’s potential.
This was largely due to ‘uneven provision of IT systems’ that made implementing the service ‘cumbersome for some organisations’, and then compounded by workforce issues, the panel found.
And ‘some evidence’ suggested that the funding to resolve these issues was insufficient.
A survey conducted on behalf of drug manufacturer Sanofi in June last year found that more than a third of pharmacists (34%) think that the CPCS is not fit for purpose, with nearly half (46%) of those blaming GPs for failing to refer patients to community pharmacy.
The panel also raised concerns that people who are exempt from prescription charges ‘may not benefit from a service that refers them directly to community pharmacy if they then need to purchase medication over-the-counter from the pharmacy, rather than obtaining it on prescription free of charge’.
In May, Community Pharmacy North East London chair Shilpa Shah told The Pharmacist that patients who were eligible for free prescriptions were being sent ‘around the system for no reason’ through CPCS, and suggested that a minor ailments service, funded through community pharmacy, could enable access to over the counter medication without the need for a GP appointment.
Discharge medicines service: requires improvement
In 2020, the government announced a new essential service that pharmacies must deliver: to support patients with medications when they left hospital, under the discharge medicines service (DMS).
But the HSCC expert panel found that the commitment around DMS ‘has not been fully met’, with ‘considerable variation’ in the number of referrals pharmacies receive from hospitals in different areas or trusts.
One reason for this was ‘because IT systems in hospitals are often incompatible with the systems used in community pharmacies’, while incentives for trusts to refer to pharmacies were ‘insufficient to overcome the barriers to uptake’, noted the panel.
The panel also ‘worryingly’ identified ‘little evidence’ about governance of the DMS and processes for ensuring risks and errors are reported, monitored and fed back.
Training and education: requires improvement
NHS England is planning to launch a further three-year programme of education and training for primary care network and community pharmacy professionals, including independent prescribing training for existing pharmacists.
But the panel found ‘significant challenges’ preventing the training from being taken up, including ‘high demand for Designated Prescribing Practitioners (DPPs) to supervise training, high pressure on services leaving little time to dedicate to training and development, and lack of funding to backfill roles when employees are away to undertake training’.
And it was ‘concerned’ about the lack of training planned for community pharmacy professionals beyond just pharmacists, in order to meet future service needs.
Meanwhile, independent prescribing training had ‘highlighted the specific issues of retention in community pharmacy’, the panel found, with pharmacists trained in prescribing then leaving community pharmacy to work in other settings.
Legislative changes around skills mix: inadequate
‘Inadequate’ progress had been made on proposing legislative changes that will allow for better use of the skill mix in pharmacies and enable the clinical integration of pharmacists, the panel found.
And they said that it was ‘challenging’ to monitor progress and to hold the government to account because the legislative changes needed were not clearly set out, with uncertainty in the sector about what to expect and when.
The delay in introducing the legislative changes promised in the CPCF, when pharmacy providers have already begun introducing the services agreed at the same time, ‘risks having a negative impact’, the report said.
And the panel was concerned that the commitment in isolation ‘will not deliver the skill mix it envisions’.
Piloting extended services: Good
As promised, three prevention and detection services have been piloted through the Pharmacy Integration Fund (PhIF) and subsequently rolled out through the CPCF, the panel found.
But while funding and infrastructure for pilots was ‘adequate’, the panel was concerned that adding services to the global sum budget ‘“dilutes” the global sum and reduces the payments available for dispensing’.
And it said that it was difficult to demonstrate the positive impact of these pilots on patients as evaluations were not readily available.
A Department of Health and Social Care spokesperson commented that since the period covered by the report, it had announced ‘£645m of funding as part of the Primary Care Recovery Plan and thousands more training places as part of the [NHS] Long Term Workforce Plan, on top of the £2.6bn we provide every year to the sector’.
‘This will further bolster the role of community pharmacies to supply prescription-only medicines for seven common conditions without the patient needing need to see a GP, alongside supporting more blood pressure checks and oral contraception consultations,’ they added.