Having a responsible pharmacist in every pharmacy is not something that is likely to change, nor does it need to, the chief executive of the Company Chemists’ Association (CCA) has told The Pharmacist in an exclusive interview reflecting on recent supervision discussions.
Instead, he said that the pharmacist would be present in the pharmacy but could be freed from ‘supervising every single transaction’ to deliver clinical services.
And Mr Harrison called for the NHS to commission more clinical services from community pharmacy, enabling employers to invest in their staff, as well as to reform dispensing payment given increases in prescribing volume and low reimbursement prices for category M items.
Supervision changes would allow the pharmacist to do more
This summer, a cross-sector working group on supervision recommended that responsible pharmacists should be allowed to delegate aspects of the preparation, assembly, sale and supply of medicines to appropriate members of the pharmacy team in defined circumstances.
It proposed that legislation be amended to allow the preparation and assembly of medicines to take place outside of the pharmacy’s opening hours, without a responsible pharmacist signed in.
In an interview with The Pharmacist this week, Mr Harrison doubled down on the group’s agreement that having a pharmacist physically present in the pharmacy was ‘an important and defining element of community pharmacy’.
‘I think we need to be mindful that the world is changing and how people do things is changing,’ he said.
‘But the law is very clear. You have to have a responsible pharmacist for every pharmacy, you can't have a responsible pharmacist for more than one pharmacy.
‘And the [regulations] are very clear that you can only be absent for two hours at a time, which kind of implies you have to be there for the rest of time. The NHS Terms of Service mean you can’t be absent for two hours either.
‘So, there's an awful lot there that says that there's a pharmacist in the pharmacy, and I don't think that's something that will change, or needs to change – what we need is the pharmacist in the pharmacy doing things differently,’ he added.
‘We recognise that there is a greater need now for pharmacists than ever before, to be doing more clinical care and to be helping patients and to take some of the burden away from the NHS,’ Mr Harrison said.
‘And that's always been the challenge, that pharmacists and pharmacies have long wanted to take on more clinical roles but have been unable to because they'd had to be supervising individual transactions in the pharmacy,’ he added.
The recommendations made by the pharmacy supervision group are due to be consulted on by the Department of Health and Social Care (DHSC).
Mr Harrison said that he hoped that the government and NHS England’s (NHSE) support of ‘exploring what needs to change around supervision’ was because ‘they would like the clinical capacity of pharmacists to be released to something else’.
Need for commissioned clinical services
If the changes to pharmacy supervision are passed, Mr Harrison said that the ‘key to unlocking’ the potential of community pharmacy depends on the NHS commissioning more clinical services from the sector, as well as adequate reimbursement for the dispensing of medicines.
He said that if the government and NHSE was ‘going to be asking pharmacists and pharmacy teams to do more’, then it needed to ‘be prepared to commission and pay’ for clinical services.
‘There needs to be sufficient volume and value of those to make it viable for the pharmacist to let go of the individual transactions of supply, and to get them to employ somebody else,’ added Mr Harrison.
He also said that recruitment, training and backfill pay for the wider pharmacy team to support the pharmacist to deliver clinical services needed to be factored into the remuneration for NHS commissioned services.
‘We need a new model of funding now’
Mr Harrison also called for the NHS to improve the way it pays for medicines supply.
‘Running a business at a loss is not sustainable,’ he said.
‘If the NHS could find a way to make supply of medicines equitable, so we're not supplying at a loss, so businesses aren't losing money, then [pharmacy businesses will] be able to start to afford to invest in more staff, in staff training, in facilities, which they haven't been able to do,’ he said.
And he added that the current pharmacy contract was ‘not fit for purpose’.
‘It's very difficult for businesses to operate, not knowing what their income is going to be. You can do the same amount of work month in month out, week in week out, year in year out, and get paid a very, very different amount. How can you forecast cash flow? How do you know you've got enough money to pay your salaries going forward?’ he said.
‘Businesses small and large really struggled, because they don't know what they’re earning.’
‘We're in a situation where there's been a significant over-earn, where people are doing more services than the NHS can afford. So [the NHS is] saying, ‘we'll take it away from the money we give you for supply’ – that’s hardly fair, is it? That’s hardly right,’ he told The Pharmacist.
With the number of items dispensed increasing by 3.4% between 2021/22 to 2022/23, but the global sum remaining the same, Mr Harrison said that reimbursement for medicines should be more closely linked to volume of supply.
‘We need a new model of funding supply, and we need a new model of funding services from pharmacies. We need it now,’ Mr Harrison said.
Last month Community Pharmacy England warned that the ‘long term restriction of Drug Tariff prices’ was ‘driving significant dysfunction within the medicines supply chain’.