GUEST COLUMN: How does ‘pharmacy first’ in England measure up?

By Jeremy Meader

In a recent interview with The Telegraph, health secretary Steve Barclay stated that he has asked his officials within DHSC to look at a “pharmacy first” approach to alleviate pressures on A&E departments in order to avoid the widely predicted NHS winter crisis.

On the face of it, this a welcome if long overdue recognition that community pharmacy is an essential part of our national healthcare infrastructure alongside our GP and A&E colleagues. But let’s not get carried away – we have had lots of praise from politicians in the past which have not then been backed by firm commitments for a sustainable future for the network.

Could this be a turning point? I hope so, but I am not confident it will be. I fear this may turn out to be another emergency stop-gap measure which does nothing to secure the long-term viability of the sector in England.

The role of community pharmacy during the recent Covid pandemic demonstrated clearly how important we are to ensure people have easy access to essential healthcare support, advice and services. The NHS winter crisis can only be avoided or at least mitigated if the potential of the community pharmacy network to provide more patient care services is unlocked and that Barclay requires you to end pharmacy funding austerity and start investing.

The Treasury will no doubt say there is no more money, but what then the alternative other than a NHS winter crisis? And, of course, treating people in secondary care settings is far more costly than community pharmacy based interventions.

A pharmacy first approach has worked in Scotland for several years and the Scottish government has committed to further expanding that service because it is successful and popular. It delivers results for patients, at the heart of their local community, in the most cost-effective way for the NHS. It relieves pressures on other parts of the NHS.

Why is England being so slow to adopt a similar approach? What exactly does Steve Barclay mean by ‘pharmacy first’? Will he still be health secretary in a few weeks’ time after the new PM reshuffles his or her cabinet?

If DHSC does want a pharmacy first approach for winter, then time is not on our side: DHSC needs to be clear right now what exactly it wants and how it intends to fund it. New services cannot be introduced overnight: colleagues need to be trained; SOPs need to be written; and changes to IT systems need to be made.

If ministers and DHSC officials are serious about promoting a pharmacy first approach then they need to accept that they created a funding crisis in community pharmacy in the first place and demonstrate a solid commitment to address the issue by investing in our sector with a plan for service provision which stretches over several years, not the next few months.

I fear ministers will ask us to do more without any new investment: that is unrealistic and a recipe for disaster. It will do nothing to prevent an NHS winter crisis.

Steve Barclay needs to look at the attrition across the pharmacy network: over 650 pharmacies have closed in the last six years because they are no longer commercially viable. That should be a clear red warning light.

The 2019 community pharmacy funding framework is no longer fit-for-purpose if it ever was. Inflation was a mere 1.79 per cent back in 2019; now we are facing inflation rates of 10 per cent plus; that was never factored into the original contract.

We face workforce retention challenges as the NHS recruits thousands of pharmacists and pharmacy technicians into primary care roles and locum rates have risen to ludicrous levels.

Even if additional funding is provided you cannot ask the pharmacy network to provide more services unless you have alongside it a practical workforce strategy covering community, primary and secondary care. As part of that, the DHSC needs to urgently review supervision regulations as those are causing temporary closures due to the current shortage of pharmacists.

CPCS is another area the DHSC team need to consider. It is fine in principle, but bureaucratic and clunky in practice. GPs tell me it is often quicker just to see the patient than fill out the form to refer them to their local pharmacy. It needs to evolve into a fully funded walk-in service otherwise it’s time-consuming for GPs when it was meant to create more time for them and it’s confusing for patients.

And Barclay, or whomever succeeds him, needs to understand the current NHS crisis does not begin and end with the winter months. According to a recent survey over 40 per cent of GPs intend to retire or quit in the next five years.

That surely has to be a wake-up call. There is a clear and present danger that as currently structured there is a serious risk of systemic failure in the English care system. That is what should be keeping government ministers awake at night.

Forget tinkering around the edges, start thinking fundamental reform. Now more than ever is the time to reinvent the role of community pharmacy and provide it with the financial support it needs to meet evolving patient needs. That requires vision and commitment: is Steve Barclay up for that?

The government in England created the funding austerity which has made more and more pharmacies uneconomic to operate, hence the closures we have seen having created the problem it is their responsibility and within their powers to fix it.

The health secretary needs to decide if community pharmacy is a core national healthcare asset worth investing in or an add-on extra to call upon when the government finds itself in difficulties like winter pressures or Covid.

(Jeremy Meader is managing director of Numark.)