By Malcolm Harrison
The Delivery Plan for Recovering Access to Primary Care was undeniably a vote of confidence in the sector. Whilst the plan was positioned as a package of measures to end the 8am GP scramble, the major announcements within the plan focused on community pharmacy.
Last year the CCA produced its ‘Prospectus’ for community pharmacy. This was a single document that brought together the details of all that community pharmacy has to offer patients and the NHS. Our Prospectus also set out how this could be achieved, through funding reform, ambitious commissioning, and addressing the key legislative and regulatory barriers we currently face.
I spent much of the second half of last year engaging key stakeholders in government, the NHS, the Department and Treasury on the details contained with our prospectus and I was pleased to hear that many of the people I met supported our proposals.
It was therefore great to see many of the proposals from our Prospectus, including a Pharmacy First service and expansion of the blood pressure and contraception services, included in the Delivery Plan. These, together with promised investment in the development of digital infrastructure, will go some way to realising the increasingly clinical future that we have all talked about for so long.
However, I am acutely aware that until Pharmacy First launches, and the services are expanded, pharmacy businesses will not be able to earn against the promised £645m.
Earlier this year, we found that there has been a net closure of 720 pharmacies since 2015, with 41% of those in the 20% most deprived parts of England. Until the money starts to flow, further pharmacy closures are sadly inevitable.
Since it was announced last month, some have labelled the plan ‘just a sticking plaster’. It is true, the plan does not address any of the underlying challenges facing the sector, such as core funding for supply and workforce shortages.
The funding announced in the plan is clearly ‘new money for new activity’. However, if it is launched correctly and we can deliver against it, this could be more than just a ‘Band-Aid’. In my view, what was announced in the plan is a small step in the right direction.
But what could the Giant Leap look like?
For a start, Pharmacy First should be launched at pace and scaled up quickly. We don’t need pilots, trials, or proof of concepts. There is already a bucket load of evidence from Scotland and Wales proving that pharmacy can deliver these services. We estimate that the service, as planned, will free up just over 6m GP appointments every year – which is only fifth of the 30m+ we estimate could be delivered.
We believe there is a unique opportunity to use the 11,000 pharmacies in England to create a network of minor urgent care centres across England. In so doing, pharmacies would become the destination for urgent care and minor ailments, unlocking potential GP capacity and building lasting resilience in primary care.
Once Pharmacy First is up and running attention must be turned to the next Contractual Framework. It is clear for all to see that the current funding arrangements are not fit for purpose. Year 5 of the current deal fails to address the historic funding blackhole facing contactors large and small.
The current annual shortfall is equivalent to more than £67,000 per pharmacy. We need action to address this, and to address the spiralling costs that pharmacy businesses of all sizes are facing. Commissioners, regulators, and the government must work with us to remove cost from supply and to ensure that any future funding, for what is still our core business, is equitable and fair.
Whilst we must learn the lessons of the past, before we consign the current 5-year ‘deal’ to the bin, we must hold the Department to account on delivering the ‘efficiencies’ promised way back in 2019. Hub & Spoke, Supervision and changes to Original Pack Dispensing must all be addressed. Continued dithering and delaying will only mean that pharmacies and patients suffer.
When reflecting upon the plan, and what it does and does not do for pharmacy, I realised that for the first time in a very long-time pharmacy finds itself in a position where it has investment whereas other do not.
It has been disappointing to read of the scepticism in some quarters as to whether pharmacy teams can deliver what is asked of them. There has been false concern expressed by some about risks to anti-microbial resistance when there is considerable evidence to the contrary. Others worry that pharmacists lack the clinical skills – which is a disappointing slight against the profession.
Meanwhile, some question what the sector can deliver amidst the current workforce crisis (one hugely exacerbated by NHS policy, I hasten to add!).
Let me be unequivocally clear – I believe the sector can and will make a success of opportunities presented by the plans. The naysayers should look no further than the Covid-19 pandemic to see what this great sector, and profession, can achieve.
Proving our metal once again however may not be enough. Pharmacy First must be launched as soon as possible, to allow time for it to bed in before winter pressures hit. Moreover, the service needs to be scaled up quickly, with commensurate additional funding, so we can free up even more GP appointments.
Separately, Ministers need to address the funding blackhole once and for all. It shouldn’t fall to pharmacy businesses to subsidise a broken NHS.
Both DHSC officials and the NHS must also recognise that additional workload cannot be delivered by community pharmacy unless we have the people to deliver it. Having hit their target a year earlier, it’s now time for the Government to pause, reflect and re-evaluate the Additional Roles Reimbursement Scheme’s (ARRS) impact on community pharmacy. A holistic workforce plan for primary care is urgently required.
If the NHS is looking for quick wins, then the remaining ARRS funding should be used to commission ‘packages of PCN care’ via community pharmacies. Furthermore, future Independent Prescribing must be underpinned by ambitious commissioning.
So, as the new funding takes us up to the next election, I am quietly confident that community pharmacy will showcase, once again, its immense value to the nation.
I am also confident that Pharmacy First and the expanded services will be a success, and that come what may at the next general election, politicians of all colours will recognise the importance of pharmacies in building enduring capacity and resilience in the NHS.
Malcolm Harrison is the Chief Executive of the Company Chemists’ Association.
