Pharmacy crises highlighted in 'honest' NHS review
Pharmacy bodies have highlighted funding, workforce and medicine supply concerns to an independent review intended to 'diagnose' the challenges facing the NHS.
Health and social care secretary Wes Streeting has commissioned the Darzi review to deliver 'a raw and frank assessment of the state of the NHS' next month.
'This is the necessary first step on the road to recovery for our National Health Service, so it can be there for us when we need it, once again,' Mr Streeting said when the investigation was announced.
Several pharmacy bodies, including Community Pharmacy England (CPE), the National Pharmacy Association (NPA), the Independent Pharmacies Association (IPA), the Royal Pharmaceutical Society (RPS), the Company Chemists' Association (CCA) and the Pharmacists' Defence Association (PDA) have confirmed to The Pharmacist that they have submitted evidence to the review.
Community pharmacy 'at breaking point'
Several submissions highlighted the critical funding challenges facing the community pharmacy sector, including the urgent concern around pharmacy closures.
In its submission, CPE said the community pharmacy sector was 'at breaking point', and called for the government to halt pharmacy closures.
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It also submitted a range of evidence to the review, including CPE analysis, independent surveys, and an independent economic analysis.
CPE called for community pharmacies to be placed 'at the centre of delivery of the Government’s primary care priorities', and for long-term investment into the stability of the community pharmacy sector.
Janet Morrison, CPE chief executive, said she hoped that the Darzi review would 'foster a realistic and honest conversation about how to improve the outlook for community pharmacy'.
Ambitious commissioning 'key'
Several submissions also highlighted the need to commission further services in community pharmacy.
The CCA said that independent prescribing, 'with ambitious NHS commissioning', was 'key to relieving pressure from other parts of the NHS, particularly general practice'.
It suggested that an independent Pharmacy First service could be introduced, alongside cardiovascular disease (CVD) screening and treatment, contraception and vaccinations being provided through community pharmacy.
And CPE called for open access to Pharmacy First, the free supply of over-the-counter medications for low-income individuals, expanded vaccination services, open access smoking cessation services, the addition of long-acting-reversible contraceptives to the Pharmacy Contraception Service and an Emergency Contraception Service to be commissioned as a high priority.
As a medium priority, it suggested that additional services could be introduced, including further case-finding and referral services, such as for COPD, health checks, weight management, menopause advice, and the ability for community pharmacists to amend prescriptions and deprescribe where necessary.
Safe and effective use of medicines must be prioritised
Some submissions highlighted the need to ensure the safe supply of medicines.
The PDA highlighted that medicines were the second highest cost to the NHS after salaries, at 13.5% of the annual NHS budget.
But it said that there 'has not been enough focus on the safe and effective use of these medicines', evidenced by the levels of illness relating to medical interventions and the increasing number of hospital admissions caused by adverse drug reactions.
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'The PDA is keen to highlight the investigation of the role that pharmacists can play in ensuring better outcomes for patients and for the NHS by prioritising this critical area,' it said.
Meanwhile, Tase Oputu, RPS England board chair, warned of the 'fragility of the medicines supply chain', saying: 'Medicines are a vital part of patient care and, with ever increasing prescription volumes, pharmacy services need to be integrated across NHS systems now more than ever.'
And she called on the government to act on the findings of the Health and Social Care Select Committee's inquiry into pharmacy.
Medicine supply shortages must be tackled
In its submission to the Darzi inquiry, the IPA asked for a review of the retained margin mechanism and emphasised the need to tackle medicine supply shortages, its chief executive Dr Leyla Hannbeck told The Pharmacist.
It also called for policymakers to recognise 'the unique and crucial role' of independent community pharmacies, close the funding shortfall, and 'provide appropriate funding for the Pharmacy First scheme', Dr Hannbeck said.
She also said the IPA's submission 'emphasised the need to shift NHS investment and resources to primary care' and 'called for the creation of a primary healthcare taskforce'.
Workforce, recruitment and retention
Some submissions called for a focus on steps to support the pharmacy workforce.
The NPA highlighted a reduction in the numbers of pharmacy technicians, a decline in full-time-equivalent (FTE) employed pharmacists and an expansion in FTE locum pharmacists, with figures indicating that locum pharmacists were working fewer hours on average.
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The NHS figures it highlighted also suggested that numbers of foundation pharmacists and pre-registration trainee pharmacy technicians had also declined in recent years.
The RPS submission said that with the workforce under continued pressure, and as pharmacists were being asked to do more, this must be backed by steps to support recruitment and retention, including:
- Workforce planning.
- Staff wellbeing.
- Protected learning time.
- Diverse leadership and inclusion.
- Investment in education and training.
The pharmacy profession in the United Kingdom is facing a troubling crisis that threatens its very fabric. For years, the bodies tasked with representing the interests of pharmacists have failed to adequately advocate for the sector, leading to a series of feeble increases in funding and substandard deals that have driven the profession to its knees.
The root of the problem lies in the lack of a strong, unified voice for pharmacy. The representative organisations have repeatedly prioritised short-term concessions over the long-term sustainability and wellbeing of the profession. This has not only resulted in stagnant or declining incomes for pharmacists, but has also undermined the entire ecosystem that once allowed the profession to thrive.
Compounding this issue is the role played by pharmacists themselves, many of whom have been tasked with implementing cost-cutting measures within the National Health Service (NHS). In an effort to reduce expenditures, these pharmacists have inadvertently compromised the very revenue streams that once sustained the profession. By cutting costs in areas where pharmacists could previously generate income, they have effectively "shot the profession in the foot," further exacerbating the financial challenges facing the sector.
The cumulative effect of these factors has been devastating. The once-vibrant pharmacy landscape in the UK is now characterised by dwindling profits, diminished job security, and a growing sense of despair among practitioners. The lack of adequate funding and the erosion of traditional revenue sources have left many pharmacies struggling to stay afloat, with some being forced to close their doors entirely.
The implications of this crisis extend far beyond the pharmacy profession itself. Patients across the UK are now facing reduced access to essential healthcare services, as the decline of the pharmacy sector threatens the availability of crucial medical advice, medication management, and other vital services. The ripple effects of this crisis are being felt throughout the healthcare system, undermining the overall quality of care and the wellbeing of the broader community.
It is imperative that urgent action be taken to address this crisis and restore the vibrancy and sustainability of the pharmacy profession in the UK. This will require a concerted effort from policymakers, regulatory bodies, and the pharmacy community itself to implement meaningful reforms, increase funding, and re-establish the profession's central role in the healthcare landscape. Failure to do so will have dire consequences for pharmacists, patients, and the entire healthcare system.