The Company Chemists’ Association (CCA) has called on the government to introduce a ‘new framework’ for pharmacy supervision, alongside other measures to increase capacity within the community pharmacy workforce and improve access for patients.
In a new report released today – ‘The future of community pharmacy: moving from theory to reality’ – the CCA also called for an acceleration in independent prescribing training and an increase in the number of designated prescribing practitioners. It also sought a clarification of the future roles and responsibilities of pharmacists and pharmacy technicians.
And it said that instead of recruiting pharmacy staff into general practice and primary care network (PCN) roles under the Additional Roles Reimbursement Scheme (ARRS), integrated care boards (ICBs) should commission community pharmacies to deliver specific ‘packages of care’ on behalf of PCNs.
The CCA also called for ‘clarity and confidence’ around what community pharmacies will be funded to do in the future, in order to incentivise pharmacy businesses to invest in increasing capacity through automation or supervision changes, and in training their workforce as prescribers.
Since the 2019 NHS Long Term Plan outlined an ambition for community pharmacy to do more, ‘the sector has been beset by challenges, rooted in significant real term funding cuts’, claimed the report.
And it added that ‘delays in the rollout of promised efficiencies to increase capacity’, as well as commissioning of services that ‘lack the necessary scale and ambition to incentivise further investment in training or infrastructure’, have resulted in ‘massively increased workload for staff’, without delivering the potential benefits for patients.
While recent commitments from the government, such as the workforce plan and promised legislative changes, ‘represent a blueprint for change’, the CCA warned these were not ‘the finished product’.
It added: ‘If any of the key building blocks are missed than ultimately the sector will fail to achieve its full potential.’
‘Remove the requirement for direct pharmacist oversight of each individual task’
The CCA called for the government and NHS England (NSHE) to ‘introduce a new framework which allows teams to work differently’.
‘Removing the requirement for direct pharmacist oversight of each individual task, undertaken by other members of the team, would allow the bulk of dispensing (which is repeat medication) to be delegated to the most appropriate member of the pharmacy team. This would free up pharmacist time for the delivery of direct patient care,’ the report continued.
And it added that this would require a ‘cultural change in pharmacies’ as ‘teams will have to work differently’.
‘Government, NHS England, and employers must work together to empower professionals to use legislative changes to their full potential,’ the CCA said.
The CCA also called for NHSE to work with Community Pharmacy England (CPE) to amend the drug tariff to underpin changes to original pack dispensing (OPD), and for more education for patients and prescribers about why OPD and the extension of automated dispensing might impact medicines or the timeframe for delivery and collection.
Commission packages of care through community pharmacy
The CCA said that instead of recruiting pharmacists and pharmacy technicians under ARRS, ICBs should commission community pharmacies to deliver ‘packages of care’, such as reviewing high risk medications, Structured Medication Reviews, or long-term condition clinics.
‘Whilst this would require changes to the DES to enable funding to commission community pharmacies directly for service provision, it is already supported by the digital changes outlined in the Primary Care Delivery Plan and the rollout of prescribing in community pharmacy,’ the report said.
The CCA added that the future role of the pharmacy technician should also be clarified, so that employers would be incentivised to train their staff and retain them amid attractive career progression in other sectors.
It also said that NHSE should work with pharmacy employers as well as pharmacy schools and other training providers, ‘to build its understanding of the current supply of [pharmacy] technicians, understand demand, target geographic need and market courses’.
Urgently address challenges to training and education
The CCA highlighted a number off challenges to pharmacists’ education ‘which must be worked through, as a matter of urgency’.
This included issues with the provision of undergraduate clinical placements hindered by ‘funding restraints, inconsistency in approach of pharmacy schools, and additional workload on pharmacy employers’.
The number of applicants to undergraduate pharmacy courses increased by more than a quarter in the last year, with 32,850 pharmacy applications submitted in 2023, up from 25,670 in 2022.
The CCA said that NHSE must work with employers to ensure adequate placement provision and address concerns around the use of the Oriel placement application system as the only route to funded training places as well as the introduction of multi-sector rotations.
In addition, the CCA said that ‘without concerted efforts’ to increase the numbers of Designated Prescribing Practitioners (DPPs), ‘there is a risk that lack of supervision will inhibit the roll out of changes to pharmacy education’.
Under current plans, it will take until 2040 to train the entire workforce as independent prescribers, the CCA suggested.
To ‘capitalise on the opportunities that IP bring’ the CCA said 95% of community pharmacists should be trained as IPs by 2030, and that ‘the government and employers should take shared responsibility for this’.
‘We would like to see an approach which both accelerates the existing commitment to train approximately 3,000 community pharmacists and sets out a clear plan for future services to support businesses invest in training,’ it added.
In a recent interview with The Pharmacist, CCA chief executive Malcolm Harrison said that a clear plan from government and NHSE for what services would be commissioned and funded in the future would help employers invest in training and infrastructure.
The Pharmacist has approached NHSE and DHSC for comment.