Chief Executive’s blog: February 2021

By Chief Executive Simon Dukes

In England, thousands of pharmacies are now ready and able to carry out the Discharge Medicines Service (DMS). Alongside talking to all the patients who walk through their doors, from this month pharmacies are standing-by to support patients who are being discharged from local hospitals and who would benefit from a discussion about their medicines. Pharmacists and their supporting teams are trained and waiting to deal with the clinical needs of this cohort of patients in partnership with general practice and Primary Care Network teams. This is a fantastic development for patients, for the NHS and for NHS community pharmacies and we hope it takes off quickly.

In a further sign of pharmacy’s willingness to support the wider health services, pharmacies are also ready and waiting to receive referrals to the Community Pharmacist Consultation Service (CPCS). Already receiving referrals from NHS 111, they hope also to start receiving patients
from GP practices, thereby reducing pressure on stretched surgeries.

But only a trickle of patients are arriving through the (almost permanently open!) pharmacy doors referred from 111 and GPs. There are actually only a few dozen practices even signed-up to make referrals into the CPCS. This is incredibly disappointing.

Hundreds of thousands of patients every day are walking into their local pharmacy to seek the advice, guidance and clinical expertise of the pharmacist and the pharmacy team. Many of them do so because they have been unable to access other primary care providers, or (in most cases) because they prefer the efficient and convenient service that community pharmacy provides.

But these consultations are unremunerated, leaving many pharmacists to work far more hours than a junior doctor and well beyond the hours outlawed in the Factory Act of 1833 merely to keep their businesses afloat.

Alongside health advice, over the past 12 months community pharmacies up and down the country have each dispensed thousands of NHS prescriptions (over 1 billion in total in England) and carried out other patient-facing NHS services for tens of millions of patients – all in a COVID secure environment and racking-up a costs bill of over £400m.

But despite the fanfares and plaudits for our network of community pharmacies from politicians and officials, the Government has not been willing to cover the sector’s bill for this service provision, and it is expecting every community pharmacy in England to subsidise the NHS.

The year (perhaps years?) ahead will likely need pharmacies in every community in England to be able to support COVID-19 testing and vaccinate their local populations as GP colleagues get pulled-back to deal with the tsunami of patients with undiagnosed illnesses waiting at their doors. Pharmacies will also be pivotal in helping to deal with the utterly unacceptable health inequalities our country faces.

But in the last five years we have seen c.600 pharmacy closures, with more than half of those in the most deprived areas of the country.

What do all these issues have in common? The silence of NHS England and NHS Improvement. If community pharmacies did not exist, they would need to be invented. Our pharmacies are a critical part of the NHS as they have proved over the years. They have much more to offer to benefit patients, local communities and local healthcare systems. As we look towards recovery from coronavirus, they can provide a key tenet in the focus on prevention and tackling major public health issues such as obesity.

NHS community pharmacies want to be able to continue to offer the informal face-to-face healthcare advice and clinical services that so many people want from them – but they need the support of the NHS to do so. There are several things that the NHS can do to show this support:

  • The NHS needs to mandate GPs to formally refer patients to their local pharmacies.
  • The NHS needs to help influence Government on our behalf to pay the COVID costs we are owed.
  • The NHS needs to go on the record to say that every local pharmacy has value to its community. And the NHS needs to remunerate pharmacists for every walk-in patient requiring a consultation.

So far, I’m not hearing any of these things happening.