The Future of Community Pharmacy

“Pharmacy at the heart of the NHS: There is a real potential for far greater use of community pharmacy and pharmacists” It is strange for any official letter – even one from the Department of Health and NHS England – to start with these words and conclude with a 6% cut in funding. The associated dialogue from ministers mentions that between 1, 000 and 3, 000 community pharmacies would close and that automation will bring the necessary efficiencies. The changes in legislation that allows sub-contracting of dispensing services to a hub will be accelerated to help pharmacies lower their operating costs. Call me a cynic, but there is not a shred of supporting evidence or a robust impact analysis. Needless to say, this action stirred up a hornet’s nest and the ‘save my pharmacy’ campaign has achieved huge support from MPs and members of the public. Several organisations including the NHS Alliance has asked is this a ‘wise move’ when all of primary care is under great strain – not just general practice, but NHS111 and emergency and out of hours care as well. Community Pharmacy is one of those services where a lot comes free – advice, signposting, adherence support, home delivery and general sorting out of prescription issues at a time when the medicines supply chain has frequent issues. These are highly valued by members of the public and others in primary care, but not highlighted in the current contract. Turning the Tanker For many years the NHS has supported community pharmacy to deliver a procurement driven dispensing orientated services. It has stood the test of time, saved the NHS billions and ensured that the UK has some of the lowest prices for generic medicines in the world. Many pharmacies will tell you that their business is 95% NHS and this cut will put their business into difficulty, however, out of adversity, true leaders will step forward. There is a great need for diversification of income streams as core NHS income dwindles. Community Pharmacy is in a great position – 1.6m people visit a pharmacy every day and 1.2 million of these have a health related reason for their visit. Improved responding to symptoms, increased proactive clinical community pharmacy and private service provision may all help to fill some of the gaps in the creaking NHS. GPs may start to say – I can’t do that, but the community pharmacy can. Some people will expect the associated charge, but as usual the poorer people in our society will suffer. There is a requirement for local collaboration. Chains with their vertical management structure and independents will join to form local federations. Just like General Practice there are benefits in sharing resource and expertise and working together. Together community pharmacy could provide an alternative service provider for commissioners. Choice and convenience already means that I can choose whether I get my flu vaccine at the GPs or the Community Pharmacy. There is a requirement for greater community integration. The community pharmacy is often the anchor business in small high streets attracting a significant proportion of the footfall. A whole new focus on creating health in local communities will give community pharmacy the opportunity to be the focal point for health. ‘Hard to Reach’ populations visit community pharmacy and a new focus on public health will put increasing service responsibility on community pharmacy engagement. For some, change comes easily, but for larger others, failure to change and adapt to the threats opportunities may lead to financial failure and closure. There is precious little time to turn this tanker around. Owners, front line pharmacists, technicians and counter assistants have the opportunity to work together to drive change, but we have to start soon.   Written by Mark Robinson GPhC,  Pharmaceutical Consultant and Pharmacy, Medicines Optimisation Advisor,  NHS Alliance.