Community pharmacy funding that fairly reflects workload, inflation and the changing costs of medicines, as well as commissioned Pharmacy First, vaccination and contraception, could free up 42m GP appointments, the Company Chemists’ Association (CCA) has said.

In its Prospectus for Community Pharmacy, released today, the CCA, which represents the interests of community pharmacy multiples including Boots and Well, and describes itself as the nation’s largest providers of NHS pharmaceutical care and services, has set out the reforms it believes will be necessary for community pharmacy to play a more clinical role and ease pressure on the wider NHS.

In particular, it has called for:

  • An agile commissioning process, making use of small-scale pilots to test new services and standardising care while recognising local needs, like the new National Enhanced Service used for Covid-19 vaccinations
  • NHS services to be commissioned immediately to allow current and future pharmacist prescribers to practise and relieve pressure on their GP colleagues.
  • Reviewing and updating the regulatory framework relating to supervision, some of which pre-dates the NHS, to ensure pharmacists are empowered to deliver as much direct patient care as possible.
  • Ensuring pharmacy teams have structured access to relevant information from patient records, such as access to referrals for blood tests
  • Allowing community pharmacies to make and receive patient referrals across the NHS.

It also said that community pharmacy funding mechanisms must be urgently modernised to meet the challenges ahead. The CCA suggested that:

  • Each element of the contractual framework to be fairly renumerated and reflect the current workload
  • The access to healthcare provided by community pharmacies to be recognised separately to direct activity
  • A modular contract, underpinned by core national services, that allows local regions to rapidly commission community pharmacy services
  • A dynamic medicines reimbursement margin that reflects the changing costs and volumes of medicines procured
  • An upfront agreement to an independent measure of the increased costs of doing business, which it said would simplify the contractual negotiations.

The CCA said in January that if funding for the sector kept pace with growth in GDP since 2015/16, the value of the contract in 2022/23 would be more than £3.36bn – a £750m shortfall that ‘could be invested in frontline pharmacy staff allowing pharmacists to provide even more vital patient-facing care for the NHS’.

If implemented, the CCA said that the changes set out in its prospectus could enable community pharmacies to release over 42 million appointments from general practice, reduce hospital readmissions by 65,000 annually, and administer an additional 10 million routine vaccines every year.

The CCA estimated that:

  • Over 30.5m urgent and same-day appointments could be shifted to community pharmacies via a Pharmacy First service in England.
  • Over 10m vaccinations and 2m contraception appointments could be commissioned through community pharmacy rather than GPs
  • Over 5m people could be screened each year for undiagnosed hypertension through community pharmacies, who already deliver healthy living and weight management services The CCA said that this will likely identify over 200,000 new patients diagnosed with hypertension, which community pharmacy can manage rather than further burdening general practice.
  • Over 65,000 hospital readmissions could be eliminated and 2 million bed days could be released each year if the Discharge Medicine Service (DMS) were scaled to over 1.5m patients per year and commissioned for any change in care setting, while an expansion of the New Medicine Service (NMS) to include all new medicines would improve patient outcomes and reduce waste.

‘Taken together, community pharmacy can reduce the Covid backlog, significantly increase patient access to primary care, and allow GPs and other clinicians to prioritise their time more effectively elsewhere,’ the CCA said.

Community pharmacy leaders recently hit back at suggestions that Pharmacy First was an attempt to compete with GPs, with Pharmaceutical Services Negotiating Committee (PSNC) CEO Janet Morrison saying that pharmacists being able to operate at the top of their professional capacity would enable GPs to do so too.

However, Malcolm Harrison, CEO of the CCA, warned that ‘we are at a fork in the road’.

He said: ‘Policymakers cannot escape the fact that the current business model for community pharmacy is broken, and that the pharmacy network is no longer economically viable.

The CCA pointed to pharmacies closing, expressing concern that ‘without immediate action, closures will become increasingly common’.

The association warned that ‘fewer pharmacies will considerably diminish access to vital medicines and services, with the greatest impact on those in deprived communities’.

It warned that ‘this is no longer a situation of retaining an under-utilised sector,’ and that ‘without immediate action and funding, core services will be lost.’

‘If the Government wants to deliver a tangible difference to the healthcare of the nation, they will take forward recommendations outlined in this prospectus,’ Mr Harrison said. ‘If they are not serious, the Government will be making a conscious decision to wind down the sector.

‘With the right policy support and investment to match, the true potential of community pharmacies can be unlocked, benefitting millions of lives.’

Mark Lyonette, chief executive of the National Pharmacy Association, said the prospectus 'aligns to our own can-do approach, provided pharmacy services are fully funded'.

He said: ‘Much more NHS investment is needed to make progress possible and to bring significant benefits to patients.

‘In time, we would wish to push the boundaries of community pharmacy practice still further, so that the sector’s offer becomes ever more compelling and truly transformative.

‘Independents and multiples have a shared interest in developing a clinical future, and a shared challenge in terms of current underfunding and workforce pressures.

‘We agree that the contractual framework is in need of an overhaul, as it’s clear the contract in England is failing everyone.’

Janet Morrison, PSNC chief executive, added that the CCA’s prospectus is ‘a valuable contribution to future thinking for the sector and shares many of the ambitions that PSNC wants to see come to fruition for the benefit of patients and the NHS.’

‘However,’ she warns, ‘whilst undoubtedly many people in the sector, Government and NHS England see the potential for community pharmacy as part of the solution to NHS challenges, community pharmacies must have sustainable investment in place first.

‘The sector is on its knees and the consequences of the current funding situation, and the damage of increasing business costs, means a serious risk of collapse.’

PSNC, the NPA, the CCA and Association of Independent Multiple Pharmacies have recently joined forces to launch a Save Our Pharmacies campaign, calling for an urgent financial injection to secure the future of community pharmacies.