The Health and Social Care Committee’s highly anticipated report into pharmacy in England has been published today (May 29) and lays out a series of recommendations to support a community sector under pressure including the complete overhaul of the contractual framework.

The report, based on the Committee’s inquiry into the issues impacting community, hospital and primary care pharmacy, which examined the views of key witness over nine months or so, concluded community pharmacies’ funding must be improved and they should be helped to expand their services. It also said pharmacies’ workforce problems and medicines shortages must be addressed.

The report came to the damning but not unsurprising conclusion that the community pharmacy contractual framework (CPCF) is “evidently not fit for purpose” and insisted it was “overly complex and has contributed to the financial pressures that pharmacies are facing.”

It called for the CPCF to be “completely overhauled in close consultation with the community pharmacy sector” and insisted any new deal must close the funding gap that occurred over the course of the 2019-2024 framework. Community Pharmacy England is currently in talks with the government over a deal for 2024-25 but there are concerns those discussions will be delayed until after the general election.

The Company Chemists’ Association, who gave evidence to the inquiry, said community pharmacy had suffered an annual shortfall in funding of more than £750 million, equating to more than £67,000 per pharmacy.

The report said the CPCF should reduce its complexity to allow pharmacy owners to “clearly understand and predict their cash flow including de-risking the purchasing price of medicines”. The report also said funding must be made available for both dispensing and clinical services so one does not pay for the other and pharmacies should have the flexibility to deal with increased demand, workload and inflationary pressures through indexation.

The report painted a picture of how out of touch the government is on medicines shortages, insisting the health secretary Victoria Atkins told the inquiry that 14,000 medicines were “licensed for supply in the UK” and “the overwhelming majority of those are in good supply”. The report said the Committee heard “those medicines which are in short supply are having a substantial impact” on patients and pharmacy teams who are spending significant time sourcing stock.

Generic substitution can help address shortages

The report urged the government to review the effectiveness of serious shortage protocols, “with a focus on their timing and their administrative burden” and update the regulations within three months to allow pharmacists to make dose and formulation substitutions for out-of-stock medicines “subject to the safeguards set out in the Royal Pharmaceutical Society’s medicines shortage policy”.

The report also said generic substitution “would be an important way of reducing the need for patients to return to their GP for out-of-stock medication”. However, it said generic substitution should be introduced after a Government consultation to ensure patient safety is maintained and “unintended impacts on the supply chain” are avoided.

The Committee challenged the Government to set out how it believes National Patient Safety Alerts impact private prescribing and what measures are in place to ensure private prescribers adhere to those alerts. The report also called on the Government to commission an independent review of the medicines supply chain, which should be completed within six months of its launch.

Independent review on supply chain and medicines prices

That review, the Committee said, should make it clear how the resilience of the supply chain can be improved, scrutinise the performance and role of the Medicines and Healthcare products Regulatory Agency and examine the impact of medicines prices and reimbursement mechanisms on pharmacies.

“We recommend a particular focus on the availability and use of generic medicines, though the review should not be limited to these,” the report said.

It insisted there was widespread enthusiasm within community pharmacy to provide more patient-facing services but highlighted “barriers hampering this,” including a lack of funding underpinning potential services to support self-care and urgent care, promote health and wellbeing, help patients manage long-term conditions and improve patient safety.

Clinical services vision must be published within a year

The report called on the Government and NHS England to publish a long-term vision for the further development of community pharmacy clinical services within one year. The vision, the report added, should include examples of successful locally commissioned services and how they can be offered across England and how Pharmacy First can be expanded beyond its seven conditions.

The report also called for pharmacists’ roles in managing long-term conditions and carrying out medication reviews as well as supporting medicine adherence to be expanded. It said all of that must be supported by a plan “setting out timeframes for the delivery of new services” and commit to “realistic levels of funding” for the expansion of services.

The Government was urged to introduce a new “establishment payment” to help smaller pharmacies, particularly independents, develop consultation spaces for patients.

 Pharmacy must have access to Learning Support Fund

The report highlighted concerns around staff shortages in community pharmacy and challenges in meeting the NHS Long Term Workforce Plan’s ambition of increasing training places for pharmacists by 50 per cent to around 5,000 places by 2031-32. The Plan said education and training places for pharmacy needed to increase by 31 per cent to 55 per cent by 2032-33 to meet demand for pharmacy services.

The Committee heard pharmacies facing financial and administrative burdens were unable to take on pharmacy students and the report warned a lack of access to placements, supervisors and adequate financial support posed “a serious challenge which could undermine efforts to meet the pharmacy targets” as set out in the NHS Long Term Workforce Plan.

The report called for “a greater focus on the availability and quality of necessary placements” and pharmacists and pharmacy technicians to have access to the NHS Learning Support Fund, which offers healthcare students a training grant of £5,000 per academic year. It is not available to pharmacy students.

The report also called on NHSE to review funding under the Additional Roles Reimbursement Scheme within three months “to understand whether any additional flexibility could reduce the drain of community pharmacists into primary care networks”.

Pharmacy workforce plan must be developed within 12 months

The report said “an integrated and funded” pharmacy workforce plan must be “developed and laid before parliament” within a year and ensure all pharmacists have “adequate access to supervision, training and protected learning time along with clear structures for professional career development.” That, it said, will support anyone wanting to complete independent prescribing courses.

Reaction

Welcoming the report, National Pharmacy Association chief executive Paul Rees said whoever is in government after July 4 “must pay heed to the Committee’s stark warning that pharmacies are creaking under the strain of funding pressures and staff shortages”.

“The Committee tells it as it is: pharmacies have huge potential to improve local health care and cut GP and hospital waiting times. Yet they have suffered a decade of cuts, hundreds upon hundreds have closed and those that remain open face a financial cliff edge,” he said.

The CCA’s head of public affairs Neeraj Shah said it welcomed the report’s “wide-ranging and robust recommendations” and, concurring with its suggestion the CPCF is not fit for purpose, said: “With record levels of pharmacy closures, funding is in urgent need of an uplift.” He said the CCA supports the report’s call for a workforce plan and independent review of the medicines supply chain.

Numark chairman Harry McQuillan said community pharmacy needed “a CPCF which represents modern day realities and patient requirements aligned with a strategy for professional development for our sector”.

He added: “Pharmacy First funding is not a solution to underfunding the core community pharmacy contract. The report is absolutely correct when it states that the current funding and contractual framework for community pharmacy is not fit for purpose and must be updated urgently.”