Yesteday (29/05/2024) a significant report on Pharmacy was published by the Health and Social Care Committee.

MPs hear that community pharmacy funding model is ‘broken’ – Committees – UK Parliament

The inqury had been running since 2023, had a number of sessions hearing “oral evidence” and significant number of the “pharmacy great and the good” attended to inform the committee.
This Pharmacy Report was to build upon the panel’s previous work, where it completed an evaluation of the Governement committements to pharmacy.

There is a significant amount to read and digest in this document, and on first glance, the report seems to retiterate the stance that many pharmacy commentators have stated for a great number of years – community pharmacy is underfunded, and yet has great potential to improve the health of patients given the opportunity.

The Media Response

The response in the pharmacy press was swift and consistent – highlighting the fact that the funding model was broken.

• https://cpe.org.uk/our-news/commons-health-committee-warns-pharmacy-is-creaking-under-the-strain-of-funding-pressures/
  
• CPCF should be ‘completely overhauled’, recommends parliamentary committee – The Pharmacist
  
• MPs call for urgent overhaul of community pharmacy funding model – The Pharmaceutical Journal (pharmaceutical-journal.com)
  
• BREAKING: CPCF must be ‘completely overhauled’, says HSC report (independentpharmacist.co.uk)
  
• Health Committee publishes pharmacy report (rpharms.com)
  
• ‘Get a grip’: HSCC calls for rapid change to drug substitution rules | Chemist+Druggist :: C+D (chemistanddruggist.co.uk)
  
• CCA statement: Health and Social Care Committee report on pharmacy – The Company Chemists’ Association (thecca.org.uk)
  

A Brief Summary

So here is a quick overview of the document, and I’d recommend you spend some time to review and develop your own thoughts on the output.

Overview

The report delves into the financial pressures on community pharmacies, the impact of funding cuts, medicine shortages, and the potential for expanding pharmacy services. Key stakeholders provided evidence and recommendations for reforming the Community Pharmacy Contractual Framework (CPCF) to ensure the sustainability and enhanced role of community pharmacies in the healthcare system.

Key Points

1. Community Pharmacy Funding:

• Community pharmacies are funded through various streams including fees for core services, advanced and enhanced services, other commissioned services, retained margins, and retail/private services income.
• Funding levels have dropped significantly, with real-term reductions exceeding 30% since 2015, causing many pharmacies to operate at a deficit.

1. Financial Pressures and Impact:

• One in three community pharmacies were operating in deficit in 2020.
• Estimated annual funding shortfalls per pharmacy range from £67,000 to £100,000.
• Financial strains are forcing some pharmacies to take out loans or overdrafts to afford necessary medicines.

1. Pharmacy Closures:

• Over 1,110 pharmacies have closed since 2015, with a net loss of nearly 400 in the 2023/24 financial year alone.
• Closures disproportionately affect deprived areas, exacerbating healthcare inequalities.

1. Medicine Shortages:

• Shortages are causing significant disruptions, with 99% of pharmacy staff encountering supply issues at least weekly.
• Pharmacists spend considerable time sourcing medicines, which impacts patient care and operational efficiency.

1. Contractual Framework Challenges:

• The current CPCF is deemed overly complex and not fit for purpose.
• The fee for dispensing prescriptions has not changed since 2016, despite increased volumes and costs.

1. Recommendations for Reform:

• Simplify and stabilize the funding model to provide predictable cash flow for pharmacies.
• Ensure adequate funding for both dispensing and clinical services.
• Update the retained margin mechanism to reflect current market conditions.

1. Expansion of Pharmacy Services:

• Community pharmacies have the potential to play a larger role in clinical service delivery, particularly in managing minor illnesses and chronic conditions.
• The Pharmacy First scheme, launched in January 2024, allows pharmacists to supply prescription-only medicines for certain conditions without a GP visit.

1. Role of Technology and Automation:

• Hub and spoke dispensing models are proposed to free up pharmacists’ time for patient care, though there is skepticism about their efficacy and impact on smaller pharmacies.

1. Public Awareness and Confidence:

• There is a need for ongoing public awareness campaigns to encourage the use of pharmacy services.
• Concerns about privacy and consultation space in pharmacies need to be addressed to build public confidence.

1. Regulatory and Supply Chain Issues:
   • An independent review of the medicines supply chain is recommended to improve resilience and address shortages.
   • The performance of the MHRA in licensing generics has declined, affecting the availability of medicines.

Bullet Point Summary

• Community pharmacy funding includes diverse income streams but has seen significant cuts, leading to deficits.
• Financial pressures have resulted in closures, particularly in deprived areas, impacting healthcare access.
• Medicine shortages are a daily challenge, with significant time spent on sourcing affecting patient care.
• The CPCF is complex and outdated, requiring urgent reform to ensure sustainability.
• Recommendations include simplifying funding, ensuring adequate support for dispensing and clinical services, and updating retained margins.
• The Pharmacy First scheme aims to reduce GP visits by allowing pharmacists to prescribe for minor conditions.
• Hub and spoke models are proposed for efficiency but face skepticism.
• Public awareness campaigns are crucial for promoting pharmacy services.
• An independent review of the supply chain and MHRA performance is needed to address regulatory challenges.
• Expanding the role of pharmacies in clinical services requires the right investment and support.

By implementing these recommendations, the report suggests that community pharmacies can be better positioned to deliver essential healthcare services and meet the evolving needs of patients.