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Pharmacy cancer referral scheme announced in England

The PDA has responded to the proposal to roll out a community pharmacy-based cancer diagnosis pilot in England.

Wed 22nd June 2022 The PDA

It has recently been widely reported in the media that NHS England and NHS Improvement propose to roll out a community pharmacy-based cancer diagnosis pilot. The aim behind the pilot is that community pharmacy teams will proactively identify patients with potential cancer symptoms and refer them onwards for further tests, allowing tumours to be caught earlier and treated more successfully.

The PDA supports a widening of the services delivered from community pharmacies particularly if it helps to manage the burden on the wider NHS and makes better use of pharmacists’ clinical skills. However, numerous surveys carried out by the PDA paint a bleak picture of working life in community pharmacy with constant reports of understaffing, burnout and violence and aggression levelled at pharmacy teams.

The number of patients visiting community pharmacy for healthcare advice and information is growing all the time, and community pharmacy is a highly accessible part of primary care. It is the only one where you can walk in off the street to see a highly trained healthcare professional without an appointment, even if you are not yet registered with a GP. The PDA is concerned that announcing such a service without any details of where and how this will be delivered is setting pharmacists up to disappoint people who are concerned about their health.

Within 24 hours of the announcement, some PDA members were reporting that they had faced abuse from frustrated patients who had presented at their local community pharmacy expecting to be able to access this proposed service. Patients had to be told not only that it wasn’t available, but that no details of when and where it would be piloted were available either.

Balraj Rai, Policy Officer and Professional Advisor at the PDA said, “Over-promising of services from already overstretched teams will only succeed in making the situation worse at the frontline in community pharmacies. The overriding tone we receive from our members is that community pharmacy is on its knees right now with poor working conditions, poor remuneration and low morale in many pharmacy companies. These conditions have led to the loss of extremely talented people from working in the sector creating vacancies across community pharmacy. The focus right now should be on dealing with the core functions of community pharmacy and making the pharmacist role within the sector appealing to the brightest and best before widening the breadth of services offered.

There needs to be sufficient staffing and capacity in the system before attempting to roll out further services from community pharmacy teams. Simply adding yet more workload pressure to existing teams will likely serve to drive further talented staff out of the sector. This will be even more likely if this service becomes another NHS service which could be manipulated into becoming an arbitrary target-driven service by employers driven by profits. There needs to be proper engagement of patients, pharmacists, and the wider parts of the NHS on the receiving end of the referrals to ensure its success”.

The concept of community pharmacy providing more clinical services is supported by the PDA and they are strong advocates of a two-pharmacist model of working in the community pharmacy setting. One pharmacist would be responsible for dealing with the dispensing and counselling of medication to patients, whilst the other pharmacist would be on hand to deal with more clinically orientated queries, such as a skin cancer screening query. The PDA believes such a model is necessary if community pharmacy is to take on all the services that the NHS needs it to provide.

Rolling out the service as it is, on an already overstretched workforce, will risk poorer patient outcomes. Pharmacists already working flat out will not have the time to effectively deliver such a service, leading to over or under referring of cases as appropriate thus potentially leading to an actual increase in pressure on the NHS.


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The Pharmacists' Defence Association is a company limited by guarantee. Registered in England; Company No 4746656.

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