The introduction of the Additional Roles Reimbursement Scheme (ARRS) in general practices has resulted in ‘more exhaustion’ for community pharmacy teams who have been faced with increased staff shortages, an influential committee of MPs has been told.
During the first sessions of the Health and Social Care Committee’s pharmacy inquiry this morning, it was suggested that ARRS funding should be opened up to support roles in the community to help retain pharmacists in the sector.
Representatives from the Association of Independent Multiple Pharmacies (AIMp), National Pharmacy Association (NPA), Company Chemists’ Association, the Royal Pharmaceutical Society (RPS) and the Primary Care Pharmacy Association (PCPA) gave evidence to the committee’s inquiry exploring the challenges community, general practice, primary care network and hospital pharmacy earlier today.
The introduction of the ARRS scheme – which funds roles including pharmacists in general practice – and the long-standing concerns about its impact was a key topic in today’s first session focused on community pharmacy.
AIMp chief executive, Dr Leyla Hannbeck, told the inquiry that while the sector had been ‘under a lot of pressure’ since the Covid-19 pandemic, the ARRS scheme had worsened workforce issues.
‘We have been trying to recover [from the pandemic] as months have passed by, but obviously, the ARRS scheme coming in kind of led to more exhaustion for our teams because you end up losing your experienced pharmacists,’ she said.
In recent months, pharmacy leaders have issued several warnings over the increasing number of pharmacists moving from community to general practice settings in wake of the ARRS scheme.
The community pharmacy sector was not consulted on the scheme, which was launched in 2019, and had created a ‘lack of a level playing field’ across the two settings, said Dr Hannbeck.
‘It was something that landed on us without any discussions with us, without any forewarning that this was going to happen,’ she added.
‘And had there been any discussions with us, perhaps we would have the opportunity to say, “look, if you invest in community pharmacy, we are very accessible, we get 1.6 million people coming through the doors of community pharmacies, we can very well host a multidisciplinary team within community pharmacy environment and deliver those sorts of services to pharmacies”.’
Vice chair of the NPA, Jay Badenhorst, suggested ARRS money ‘should be open to community pharmacy as well’.
‘For me, the ARRS money – instead of stopping it, I think we should open it up and allow community pharmacy to also play in that part as well,’ he said.
‘Because that would inevitably have maybe caused a pharmacist that we employ to actually stay in position within the community pharmacy, and actually expand their role within the community pharmacy rather than having to step out of this role into another role.’
He added: ‘For me, that's more of migration, it's not integration – integration is about [everyone having] equitable access to all of the funding, so that we can all play in the same part within the global health system we've got within the UK.
‘But actually, just isolating a funding source into a silo unfortunately means that the workforce are moving from one silo into another silo rather than opening it up and people working together.’
Mr Badenhorst, who is also a superintendent pharmacist for Whitworth Chemists, said when the ARRS scheme was announced, 'a lot' of the company's pharmacists decided to move to work in general practice.
'Up until about a year and a half ago, we were fortunate enough to have pharmacists working permanently in all of our pharmacies,' he said.
However, following the launch of the scheme, they were now 'currently running about a third of our pharmacies without a permanent pharmacist in'.
CCA chief executive Malcolm Harrison suggested that even if community pharmacies were able to access funding from ARRS, damage done to the workforce would last for a while.
‘I think unfortunately, you can't put the genie back in the bottle,’ he told MPs.
‘Those roles have been created, which means for a number of years, there will continue to be a shortage of pharmacists.’
Mr Harrison, who previously called for an immediate stop to the recruitment of pharmacists into general practice, said the introduction of the ARRS scheme was ‘a case of unintended consequences’.
‘In an attempt to fix one part of the system – which is a shortage of GPs – the government [and] the NHS found a lot of money and created a lot more roles for pharmacists in general practice, which is brilliant for the patients that need to… access primary care there,’ he said.
‘The problem we had, though, [was] that there wasn't a good understanding of the availability of pharmacists.
‘So, they've created up to 8,000 new positions out there and there weren't any extra pharmacists in community pharmacy – they weren't pharmacists sitting at home thinking “I need to do some work, please can someone find a job for me”.’
‘So, they've robbed Peter to pay Paul.’
A second inquiry session this morning heard from the PCPA and RPS on general practice and hospital settings.
As part of this, PCPA president Dr Graham Stretch said he recognised the negative impact the ARRS scheme had had on community pharmacy, though he stressed that funding for the scheme had been negotiated for within general practice funding.
He also suggested that while ‘a significant number’ of ARRS pharmacists had moved from the community sector since 2019, the pharmacy register had also grown by more than 7,000 in that time period.
When asked whether he would be in favour of opening up the scheme to community pharmacy or to modify it in some way, Dr Stretch said: ‘Primary care networks should be exactly that – they should be networks of the whole of primary care.
‘So, it isn't around necessarily where this ARRS staff sits, it is about delivering primary care and we do need to ensure that community pharmacy is part of that network.’
While more money was needed across the system, Dr Stretch added: ‘I actually think that the best way of delivering services is as close to the patient as possible and I recognise community pharmacies as being a place to do that.
‘The work that ARRS delivers, the general practice work, can very often be done from a community pharmacy, I’ll accept that.’
Dr Stretch said he was keen to work in ‘an integrated way’.
He added: ‘So yes, I would be entirely content with the ARRS monies being used to deliver those services from wherever is best place to deliver them.’