Pharmacy – Report Summary

Summary

Prescribing is the most common way of treating patients in the NHS and is the second highest area of spending, after staffing costs. Covid-19 shone a light on community pharmacies - many remained open when people struggled to know where to turn for their health needs. As the health and care system continues to recover from the pandemic, changes to the way in which we all access services are being developed. Pharmacies are at the forefront of that work.

Community pharmacy has fantastic potential to improve access to healthcare and alleviate pressures on the wider health service, but the sector needs better support if that potential is to be delivered. It is currently creaking under the strain of funding pressures, medicine shortages and skill mix challenges.

The current funding and contractual framework for community pharmacy is not fit for purpose. Community pharmacy funding has fallen by over 30% in real terms since 2015. For individual pharmacy owners, this has meant an annual shortfall of at least £67,000 per pharmacy. The number of community pharmacies has reduced by over 1,100 since 2015, of which 34.9% were in the most deprived communities. A complete overhaul of the community pharmacy contractual framework is therefore needed, with a focus on reducing complexity and ensuring mechanisms to fund both dispensing and clinical service delivery, avoiding a situation where one pays for another.

We have also been deeply concerned to hear about the ongoing challenges relating to medicine shortages and the major impacts on patients and pharmacists. People living with type 2 diabetes, ADHD, epilepsy and cystic fibrosis, and those experiencing the menopause, have faced challenges accessing the vital medication they need. Many others are facing similar experiences. Pharmacy teams are dealing with medicine shortages on a daily basis, with some pharmacists spending over four and a half hours per day trying to resolve supply challenges. When purchasing medicines, community pharmacies are exposed to a fluctuating medicines market, which can result in medicine purchases being made in excess of the market cost.

While the overwhelming majority of the 14,000 licensed medicines in the UK are in good supply, the number in short supply has been growing since the start of 2022 and is now double what it was in 2021. The Government must get a grip on these shortages. It is not enough to rely on existing policies, which are clearly insufficient. An independent review of the medicines supply chain must be commissioned to assess the resilience of the supply chain, especially for generic medicines.

When items are out of stock, patients are often directed back to their GP to seek a new prescription for an alternative item. If patients struggle to get their medication, the bread and butter of community pharmacy, it cannot come as a surprise if they are then reluctant to visit for clinical services. Pharmacy First, the Government’s flagship policy to free up GPs’ time and capacity, will fail if people keep having to return to their GP. Regulations must be updated within three months to allow community pharmacists to make dose and formulation substitutions for out-of-stock items and dispense what they have available, with generic substitution to follow after consultation on implementation to avoid unintended consequences.

Dealing with supply challenges comes on top of pharmacists’ wider work dispensing medicines and providing clinical advice, across all settings. The vast majority of pharmacies are now facing staffing shortages. 86% of the pharmacy workforce is at risk of burnout. The Government is right to want to grow the pharmacy workforce, but the necessary training places, and support for those in training, are not available to meet that ambition. With the upcoming 2026 cohort of pharmacy graduates all qualifying as independent prescribers, the Government must ensure they have access to the necessary supervision and that there is work for them to do to use their new skills. There needs to be a specific workforce plan for pharmacy which ensures adequate access to supervision, training, and protected learning time. Pharmacists and technicians must also be added to the list of professions eligible for the Learning Support Fund.

Despite the challenges that the sector faces, there is great ambition to deliver more for patients. The Government and NHS England should match the sector’s own ambition and publish a long-term vision for the further development of clinical services in community pharmacy settings. NHS England should commission community pharmacies to deliver the HIV prevention drug PrEP and all routine and seasonal immunisations for adults and children. Any service expansion must be properly funded.

In hospital pharmacy, we saw some incredible innovation at Cleveland Clinic London and the potential benefits that closed loop medication systems could bring to patient care and staff productivity. In the NHS, innovation in pharmacy services is often driven by individual Trust Chief Pharmacists. NHS England needs a more strategic approach, to ensure the benefits of innovation can be felt across England and to consider whether the necessary infrastructure is included within the New Hospitals Programme. An independent review of hospital medicines management should be completed, exploring how the benefits of closed loop medication systems could be more widely realised.

We have been grateful for the positive way in which the whole pharmacy sector has engaged with our inquiry. Their willingness to share their experiences, good and bad, and their suggestions on how to improve things, have been invaluable to us. We are especially grateful to those pharmacists and technicians, from community, hospital and general practice, who joined us on 5th March for our in-person roundtable event. They really brought to life the tension we have seen in our inquiry between the enthusiasm and passion for their sector, and the day-to-day difficulties they face while under financial and time pressure.

Pharmacy professionals clearly want to do their very best for the people who walk into their pharmacy, and the Government has a duty to ensure they are properly supported to do so.