NHS England (NHSE) does not understand the pressures facing community pharmacy and must do more to support the sector if pharmacies are to deliver more patient services, the president of the National Association of Primary Care has said.

Speaking to The Pharmacist in response to the launch of NHSE’s campaign directing patients towards community pharmacies as a first port of call for minor ailments, Ash Soni, who is also a community pharmacist, said ‘I don't think they understand the really severe financial challenges that pharmacists are facing’.

The campaign features a ‘movie-inspired’ series of adverts that highlight how community pharmacies can provide advice, over-the-counter medicines for minor ailments, and signpost to other health professionals when needed.

‘Helping to recognise the value that pharmacy brings is a great thing,’ said Mr Soni.

However, he said that despite the praise of community pharmacies during the pandemic, ‘at the same time, there is a complete lack of understanding about the financial position that the vast majority of pharmacies are in and the consequence that has on their ability to provide these things.’

Should overwhelmed pharmacists refer to GP?

In response to the NHSE campaign, Mr Soni tweeted: ‘Without resource there is no capacity in community pharmacy. Either we need a properly funded Pharmacy First service or our lack of capacity makes us redirect these patients to A&E or GP surgeries or 111 who can then refer back. Crazy’

He told The Pharmacist that his tweet was ‘deliberately provocative’, explaining that currently the only mechanism for pharmacists to be paid for patient consultations is via the Community Pharmacy Consultation Scheme (CPCS).

If pharmacists refer patients to a GP or NHS 111, then those services can refer them to community pharmacy, ‘then pharmacy gets paid and therefore there will be an income which then helps to drive the ability to provide the service’, he said.

‘Whereas if they come straight to the pharmacy, they get advice for free, nothing, there's no recognition of the cost and time and everything else that that takes and there's no benefit [to community pharmacy]’ he said.

Where is Pharmacy First?

Mr Soni said that while there was a place for referrals to ensure patients get the most appropriate help, a ‘properly funded Pharmacy First scheme’ for the whole of England would encourage patients to think of visiting their pharmacy, while also ensuring that pharmacies are ‘properly funded for that delivery of care’.

‘Go to pharmacy first, that's what effectively the campaign is saying. But it's doing it without the service model to support it.’

He added: ‘We keep getting told there are plans for a Pharmacy First service – where is it? What is going on? You wouldn't think that it was that difficult to implement.’

Pharmacies can’t afford to provide services for free

Mr Soni suggested that in the past, community pharmacy was able to provide patient support for free ‘within the fact that there was sufficient income coming from the contractual framework’ and the dispensing business.

However, he said that a lack of sufficient funding was causing pharmacies to make staffing cuts and leading to a reduction in capacity.

Mr Soni added said that while other professions were striking over below-inflation pay increases, ‘pharmacy is not even close to that, [funding increases are] at zero.’

However, he said that ‘community pharmacy can’t strike because it won’t work. The consequences that would have on patients and their access to medicines would be intolerable.’

Impact on patients and primary care

He added that the lack of capacity in community pharmacy was likely to impact on the rest of primary care because ‘the whole thing knocks on through the system’.

He added: ‘We understand that general practice is under pressure just as much, but unless we find ways to be able to provide suitable funding for all elements of primary care, that recognise the value that primary care brings in delivering care to the population, we will not achieve the goals of impacting on health needs of our population’.

Mr Soni said that the way that integrated care systems are set up does not recognise the financial requirements needed to provide integrated care to patients but added: ‘if you funded the [Pharmacy First] service, you'd then be able to create the integration which enables that tool to work’.

He added that a commitment to funding the service would mean that community pharmacy could commit to employing more staff, thereby creating the capacity required to deliver the service – particularly with a 10% increase in minimum wage beginning in April.

NHS England has to do more

Mr Soni said that pharmacists ‘need to do the best they can, and they need to support the patients’ but ‘there has to be a recognition by NHS England that it has to do more to support community pharmacy to enable it to do the things that they want it to do.

‘If they are serious about better utilisation of community pharmacy, then they have to recognise that requires additional resource.’

He added: ‘Whether that comes because it needs to be released by the Treasury, whether it needs to be because more funding needs to be shifted across into primary care as a whole, it has to happen.’

He said: ‘If you look at the inflationary pressure that we’re under, that is unsustainable.’

Closures will happen suddenly and in large numbers

However, he said that while pharmacy closures might not seem like an imminent problem to some, ‘you won't see is the attrition that you're going to get until it's happened’.

‘The challenge that we face at the moment is that for many independent pharmacies, they don't necessarily realise how financially challenged they are until we get towards year end. Apart from that they just suddenly look at it and go: Well, I haven't got I haven't got as much money as I used to, or I'm working seven days a week.

He added that contractors tended to take on the additional work themselves, saying ‘the gaps that are being created are having to be filled by people who are effectively doing it unpaid’.

‘The problem is that people are keeping going because that is what they do. Until they fall over and then when they fall over, it'll happen suddenly and then it will happen in large numbers.’

Closures will increase health inequalities

Mr Soni warned: ‘Some communities will end up losing their pharmacy services.’

This would place more pressure on general practice and other parts of primary care, as well as A&E, meaning that people would have less access to services – particularly in deprived areas which have a higher percentage of pharmacies than GPs.

He said that the physical presence of pharmacies within communities, such as on housing estates or local parades of shops, was ‘critical’, particularly for people who are elderly or disabled,

If pharmacies start to close on a widespread scale, ‘it will be those [deprived] communities that will be the first to lose’, he said.

‘That will increase health inequalities and lead to the reverse of what the what everybody says they're trying to achieve,’ he added.

‘I really think somebody somewhere at the senior level has to recognise the consequences of their actions at this time,’ Mr Soni said.