Pressures within community pharmacy and subsequent closures are having a negative knock-on effect on some NHS community services, The Pharmacist has been told.
One trust in the West of England has reported that such pressures have indirectly impacted its supply of medicines to community hospitals, clinics, nursing teams and a prison.
Susan Watkins, chief pharmacist at Shropshire Community Health NHS Trust, told The Pharmacist that when a LloydsPharmacy community pharmacy site closed earlier this year, its co-located hub also stopped supplying the trusts’ community teams with medicines.
Although the community pharmacy was eventually bought by another contractor and the trust contract was fulfilled by another supplier, Ms Watkins said that it was challenging to ensure continuity of medicines supply amid the uncertainty and sudden nature of the closure.
And the family-owned business which took over the NHS trust contract also warned that rising costs, shortages and workforce pressures were ‘universal’ to all medicines suppliers and were beginning to impact community care more widely.
Shropshire Community Health NHS Trust had contracted a LloydsPharmacy hub to dispense named patient medicines for its community hospital and prison, as well as supply medicines to teams such as district nurses, dental, podiatry, minor injury units and other clinics.
This hub shared a premises with a LloydsPharmacy community pharmacy, and when that community pharmacy was sold, the hub also ceased its operations.
And while another community pharmacy contractor took over the community pharmacy premises, there was some uncertainty over who would fulfil the contract with the NHS trust, which required licensing for wholesale dealing and controlled drugs.
The new NHS trust supplier also needed to be able to fulfil the needs of different community teams – such as the medicines that district nurses, GPs making home visits and clinics, needed to have on hand.
Named patient medications also needed to be dispensed and delivered to an 800-person prison, including a complex mixture of ‘in possession’ medications which the patient would have with them in their cell, and ‘non-possession’ medications which have to be administered in the prison healthcare centre or via the medicines room.
‘It was a challenging time, with all eyes on me to make it happen and ensure continuity of supply of medications for the entire trust,’ said Ms Watkins, adding that she had only received 12 weeks verbal notice of the closure via a video call, and did not receive anything in writing.
While Ms Watkins said that she has ‘nothing but praise’ for the staff working in the hub and that ‘the service we had from Lloyds over the years was amazing’, she described the uncertainty around the closures as ‘a difficult situation’.
A spokesperson for the Queen’s Nursing Institute, a charity which supports and promotes the community nursing sector, commented that ‘the closure of so many branches of a big retail company like Lloyds pharmacy risks having an impact on the prescribing and ready supply of medicines in the community’.
They added: ‘Community service providers likely to be affected should have contingency plans in place to take account of this, to ensure there is no interruption or delay in care for people who need their services.
‘Many people depend on the pharmacy nearest to where they live, and the potential closure of so many of them could make access to medicines more difficult.’
The NHS trust contract was eventually fulfilled by Fairview Health, which also owns community pharmacies, as well as supplying NHS trusts with medicines from its hubs, which are located separately to its community pharmacies.
Fairview Health chief pharmacist Riaz Esmail said that using separate sites was ‘much more robust’ and the smaller size of the business allowed it to be more agile in responding to challenges compared to LloydsPharmacy.
But he warned that the pressures facing medicines suppliers such as costs and shortages were ‘universal’.
‘An organisation like ours, which is agile, was able to come in and provide those services in a very, very short time,’ he told The Pharmacist.
‘But I think there could be a number of other instances like this happen, which were not planned.
‘The response has to be that we need to make sure that it's more robust in the future, so that these kinds of things don't happen again.’
Mr Esmail added: ‘We need to be looking at why this these supply issues arise, and trying to find a universal solution, so that these instances are better managed across the board.’
‘We don't want them to have an impact on patient care, and we're very, very close to that now,’ he warned.
In particular, he said that staff shortages and increased costs made it ‘difficult to have the oversupply in anticipation’ of any issues, forcing supply chains to work on a ‘last-minute’ basis which could become ‘problematic’ when issues did arise.
‘You can’t really progress because you're just trying to make sure things just don't collapse,’ he said.
Ms Watkins also told The Pharmacist that the new contract with Fairview Health allowed the medicines team ‘to revolutionise some of the way we work as a service’, including digitalising stock ordering and co-creating solutions for named patient medication forward.
Mr Esmail said that the digitalisation of stock allowed the service to reduce medicines wastage and save the trust money, as it only ordered what was needed.
LloydsPharmacy declined to provide a comment.