The PDA has long championed the cause of the community pharmacist who we believe is fundamental to an integrated and effective pharmaceutical care service provided across all care settings. Without making full use of the 11,500 community pharmacy locations and the unique skills of pharmacists, we do not believe that the NHS will be able to meet the health needs of our ageing population.
You can read our policy documents here:
Read about the PDA’s 2010 vision and strategy for pharmaceutical care in the community here.
Read about the PDA’s 2018 long-term strategy for the pharmacy sector here.
The PDA is pleased to see that the government is finally making a significant move towards providing more clinical services from community pharmacy and has stopped short of the further swingeing cuts which were originally planned. We believe that community pharmacists could provide a whole range of valuable patient-facing and patient supporting activities in a well-planned framework underpinned by appropriate resource. We are also pleased to see some resource being provided to support community pharmacies in making links into Primary Care Networks – we firmly believe that these links are essential to facilitate effective local healthcare.
However, a reality check is in order and the PDA has the following concerns:
- Resources. The financial package of £13bn over 5 years, whilst apparently ‘guaranteed’ amounts to a real-terms cut of over 9%. This comes on top of the cuts during 2016-7 and 2017-18. It is hard to understand how pharmacies are meant to deal with increased demand from dispensing and new clinical services (particularly small independents without the ability to use vertically integrated wholesalers to cushion resource reductions).
- Workload. There is no explanation of how pharmacies are meant to navigate through the transition period which will begin as soon as October 2019 with the start of NHS 111 referrals at a time when they will still have to manage increasing dispensing volume having cut staffing to the bone as a result of previous contract cuts.
- Training. Staff are meant to undergo training to enable them to spot the early signs of sepsis:
- When is this supposed to happen?
- How will the effect on staffing levels be mitigated?
- How will DHSC ensure that any money paid to contractors for training is used for its intended purpose?
- Legislative changes. It is clear that two changes which were put out for consultation and dropped due to widespread concerns are now back on the agenda: hub and spoke dispensing and pharmacy technician supervision (potentially in the absence of a pharmacist). We are not aware of any new evidence to support these changes having emerged in the interim – in our view, all of the original concerns remain.
- Patient safety. Whilst steps to reduce the incidence of look-alike, sound-alike (LASA) errors are welcome, our surveys and members contacts have consistently highlighted the issue of staff shortages and increased workload as key factors in errors. It is hugely disappointing that the effect of the new contract will be to increase pressure upon staff with new workload whilst freezing resources, thus making any increase in staffing levels unlikely and in some cases impossible. We believe this will reduce patient safety.
- Opening hours. The PDA is concerned regarding this statement: “we will look to remove any unnecessary administrative requirements to reduce the regulatory burden on service providers. For example, looking at current prescription endorsing requirements to examine whether these could be simplified and ceasing routine opening hours and complaint declarations.” We would seek assurance that it is the declaration rather than the requirement for routine opening hours which would cease.
What do community-based pharmacists think?
We have circulated a short-life survey to PDA members to find out their thoughts on the contract. Whilst we have received several hundred responses so far, we would urge members who have not responded to consider doing so. We really want to know what you think, as you will be the pharmacists tasked with providing these new services. This information is of real value when the PDA lobbies NHS E & I and parliamentary colleagues. We plan to make a further statement showcasing our members’ views later in the summer.
Conclusion
Whilst the PDA is genuinely pleased to see the introduction of more clinical services into community pharmacy, we are disappointed that the scope and ambition are somewhat limited and that activities which (given the right resource and support) could be provided via community pharmacists are potentially to be confined to “clinical pharmacists” in PCNs. We are concerned that this could be a lost opportunity but look forward to seeing the results of test bed pilot schemes and what further services might be implemented in due course.
Please click on the link to go to the survey….