Royal Pharmaceutical Society
In early February 2024, all three Royal Pharmaceutical Society (RPS) national pharmacy boards held meetings to discuss the Society’s work plan for the coming year, the possible reclassification of emergency hormonal contraception (EHC) and preparations for the anticipated general election in 2024. The meetings were held in person and over Zoom.
English Pharmacy Board meeting: 2 February 2024
The English Pharmacy Board (EPB) held its meeting at the Society’s London office on 2 February 2024.
Opening the board meeting, Erutase Oputu, chair of the EPB, introduced new member of staff Asra Ahmed, engagement lead for England at the RPS.
Apologies were received for Paul Summerfield and Emma Boxer.
Emergency hormonal contraception
There was a discussion about the possible reclassification of EHC to improve accessibility for women.
Currently, EHC is available as a prescription medicine or over the counter (OTC), but the Faculty of Sexual Health and Reproductive Health (FSRH) released a position statement in January 2024, calling for EHC to be reclassified from a Pharmacy (P) to a General Sales List (GSL) medicine to make it available more widely in retail outlets.
James Davies, director for England at the RPS, said: “To date, as an organisation, the RPS has always opposed the reclassification of P to GSL on the basis of patient safety.
“Our argument is that if purchasing this medicine as GSL, there won’t be the opportunity for the counselling and advice that is provided at the point of supply when it happens in a pharmacy.”
Michael Maguire, a member of the EPB, said that Middlesbrough, North Yorkshire, has the highest rate of teenage pregnancy in England and, when working in a pharmacy, he had often given advice to people seeking EHC who were “really vulnerable and in very difficult situations”.
Maguire said he was in favour of keeping EHC as a P medication because of the support that pharmacists could provide to service users and believed it should be made free of charge through a nationally commissioned service.
Claire Anderson, president of the RPS, said that “pharmacy hasn’t always done a good job” of providing consultations on EHC, referring to a mystery shopping exercise carried out in 30 pharmacies in 2020, which recorded whether advice was given about the importance of ongoing contraception.
“It [EHC] was just being sold. There were no privacy and no questions asked and no support given. I think pharmacy has really shot itself in the foot in this country,” she said.
Anderson did not support a reclassification of EHC to GSL but said there was a need for new guidance for pharmacies on providing the medicine.
Board member Sibby Buckle said that requiring people to pay for EHC caused “inequity of access” and the medicine should become part of the Pharmacy First service.
“We have an EHC pill for £10 and I have some people who cannot afford the £10 and go away crying. I’m not just talking about young people either. I think it’s outrageous that we don’t have a nationally-commissioned service,” Buckle said.
Summarising the debate, Oputu concluded that there was “a very strong feeling that we want to keep this as a P medicine on the basis of safety and being able to provide advice to people”, adding that there was “a clear opinion” that the RPS should advocate for a nationally-commissioned service in England.
Paul Bennett, chief executive of the RPS, pointed out that pharmacists were the largest provider of EHC and that the RPS should work with other professional bodies to “educate their understanding of the circumstances that patients and service users are in”.
2024 workplan
Davies highlighted four main themes of the RPS’s 2024 workplan: implementing country visions; strengthening pharmacy governance; addressing professional policy issues; and supporting the workforce.
He said that the focus in implementing country visions would be on pharmacist prescribing, environmental sustainability, the expanded role of pharmacists in pharmacogenomics and reducing inequalities through the removal of prescription charges.
The theme of strengthening pharmacy governance would focus on consultations and legislative changes around supervision, standards for chief pharmacists, RPS standards and possible changes around hub-and-spoke dispensing.
Professional issues would focus on what artificial intelligence means for pharmacy, digital prescribing, improving access to NHS Mail for locums and access to patient records.
Davies told the EPB that the RPS would be creating a report on medicines shortages and had formed a working group chaired by Bruce Warner, former deputy chief pharmaceutical officer for England.
The RPS will also focus on palliative care this year, building on the work the Society did with Marie Curie on the daffodil standards in 2023, Davies said.
The RPS’s work on the pharmacy workforce will focus on inclusion and diversity in pharmacy, differential attainment for ethnic minority pharmacy students and trainees.
Political manifesto
John Lunny, public affairs manager at the RPS, told the EPB that a manifesto for community pharmacy had been launched in anticipation of a general election in 2024.
The manifesto partly focuses on reviewing exemptions to prescription charges or potentially eliminating prescription charges to improve access to medicine. Lunny said that the RPS had carried out a survey with the Pharmacists’ Defence Association, which received more than 1,000 responses “showing the challenges pharmacists are having around patients declining prescriptions because of the cost”.
However, in April 2024, the Department of Health and Social Care (DHSC) confirmed that the prescription charge would rise to £9.90 from May 2024.
He noted that the RPS would continue to work with the Prescription Charges Coalition, adding that the cross-party House of Commons Health and Social Care Select Committee is continuing its inquiry into pharmacy, which includes the issue of prescription charges.
Language barriers in pharmacy
Wing Tang, head of professional standards and patient safety at the RPS, gave a presentation about language barriers in pharmacy.
Tang said that language barriers “led to worse health outcomes for people”, but it was not known whether interventions, such as interpreters or translation technology, would be cost effective.
He added that the Health Innovation Network (formally known as the Academic Health Science Network) was carrying out a health economic evaluation into language barriers and a consultation was expected in 2025.
It was decided that the issue would be reviewed when the RPS’s 2025 workplan is put together, by which time the Health Innovation Network evaluation may have an outcome.
Consultation on pharmacy supervision
Davies told the EPB there was broad agreement at recent RPS engagement events that the DHSC’s proposed changes to pharmacy supervision were positive, but that the Society had expressed some concerns in its consultation response “around the competence of those staff” that might be carrying out the preparation, assembly, dispensing, sale and supply of medicines.
In a presentation to the EPB, Richard Cattell, deputy chief pharmaceutical officer at NHS England, said that the demand for pharmacy workforce “had never been higher” and that community, hospital and primary care network (PCN) pharmacists had all expressed “the challenges of getting hold of the right number of staff with the right skills”.
“Looking forward at the long-term workforce plan in England over the next 15 years and the exciting changes we’re looking to bring about to the pharmacy workforce, the supervision consultation is a key part of enabling the clinical future for both pharmacy professions,” Cattell said.
He added that the ‘Independent prescribing pathfinder programme’ would be “fundamental to building this clinical service for community pharmacy”.
Liz Fidler, senior professional advisor for pharmacy technician practice at NHS England, noted there were around 25,845 pharmacy technicians on the General Pharmaceutical Council register in England, Scotland and Wales.
“Supervision legislation is about taking this as a suite of changes around how we’re going to enable and empower nearly 26,000 healthcare professionals to deliver what it is that they can, as part of your team, to enable us to grow more clinical services and access for patients,” she said.
Fidler highlighted the need for “clear legislation and a strong professional framework” to support pharmacy technicians, expressing concern that if proposed legislation is not passed, it would be a missed opportunity for the profession.
Scottish Pharmacy Board meeting: 7 February 2024
The RPS Scottish Pharmacy Board (SPB) met at the offices of Community Pharmacy Scotland in Edinburgh on 7 February 2024.
Apologies were received from Josh Miller, Catriona Sinclair and Jacqueline Sneddon.
Emergency hormonal contraception
Fiona McIntyre, Scottish practice and policy lead at the RPS, gave a presentation about the reclassification of EHC from a P to a GSL medicine.
She said that the RPS had consulted with its Community Pharmacy Expert Advisory Group and “they were unanimous that a nationally-commissioned service in England, in line with Wales and Scotland, for free access to emergency or hormonal contraception is needed”.
She added that the advisory group was opposed to the reclassification of EHC because “they felt that healthcare advice from a pharmacist would be completely missed if it was sold as GSL”.
During the debate, Andrew Carruthers, chair of the SPB, said: “I think, if we had reclassification [to GSL], there’s a real risk in terms of health inequalities that we are increasing access for people who can afford it, which is not necessarily the groups that we’re looking to target”.
Lucy Dixon, a member of the SPB, said that it was important that no VAT was imposed on EHC to “minimise the cost implications for our patients”.
Board member Tamara Cairney also noted that having EHC only available in pharmacies could create barriers to patient access.
“Pharmacies aren’t open 24/7. A lot of them aren’t open on Sundays,” she said.
Cairney added: “There are lots of other medicines that we can self-select off the shelves that can be as dangerous [as EHC] potentially, so I suppose that’s what patient information, leaflets and warnings are for.
“It’s 2024 and I think women should be allowed to self-select what to do with their own bodies”.
The SPB was broadly in agreement with the option to advocate for the reclassification of oral EHC and a nationally-commissioned service in all three countries.
Gender incongruence
Laura Wilson, director for Scotland at the RPS, told the SPB that Health Improvement ScotIand (HIS) is consulting on its draft gender identity standards and that all three RPS board chairs will sign off a response before the consultation closes.
McIntyre gave an overview of the consultation and the feedback received so far.
“It’s an area that we’ve been asked to look at repeatedly by a number of different organisations, to try and support pharmacists who are faced with having to make decisions within their work practise around the suitability, or the appropriateness, or the legality of prescriptions that they’re presented with”, she said.
The SPB discussed the issue of providing support for pharmacists dealing with related prescriptions, with a particular focus on the educational requirements and training of pharmacists.
Members raised the need for cultural competence for pharmacy teams in relation to conversations about gender identity healthcare.
“Some of the services provided from community pharmacies are related to anatomy. How do we support pharmacy teams to have the necessary communication skills to manage those consultations competently?” McIntyre asked.
Dixon raised the issue of continuity of care for transgender people when moving between areas.
“It’s fundamental that people are treated appropriately and not missed for screenings. We should also maybe address people who are moving from England to Scotland, for example. I think that we do not want an interruption of care provision,” she said.
Wilson noted that it was important that pharmacists develop soft skills more generally.
“There are plenty of other challenging situations that you’ll come across where those skills are required that don’t have anything to do with any kind of ethical challenge,” she said.
Assisted dying
Wilson also provided an update on the Member’s Bill on assisted dying, which Liam McArthur MSP is expected to present to the Scottish Parliament in 2024.
The Bill would enable competent adults who are terminally ill to be provided with assistance to end their life if they request it.
Wilson explained that the RPS had surveyed its members, and they were split 50/50 over support for the Bill.
She said that the RPS has a neutral stance on the Bill, but is calling for Section 30, which refers to the right for healthcare professionals to conscientiously object, to be included.
“We advocate for conscientious objection where somebody would not be expected to or have to take part in an assisted dying process, so they would not be involved in discussions around it, not dispense the prescription for it, not deliver it to the patient, not be involved in any way,” Wilson said.
Although the Bill is devolved to Scotland, Section 30 is reserved to Westminster.
Wilson said that if conscientious objection could not be guaranteed, the RPS may need to consider whether it remains neutral on the Bill or whether it should object.
After debate, it was agreed that the SPB supports the RPS neutral stance on the Bill, with the caveat that it needs to include Section 30. It was decided that the RPS will work with McArthur to advocate for Section 30 to be included.
Welsh Pharmacy Board meeting: 8 February 2024
The RPS’s Welsh Pharmacy Board (WPB) met at Bangor University on 8 February 2024.
Geraldine McCaffrey, chair of the WPB, welcomed board members, staff and invited guests. No apologies were received.
Public affairs plan 2024
Iwan Hughes, head of public affairs at RPS Wales, updated the WPB on the upcoming process for candidates for the first minister position, following Mark Drayford’s announcement of his retirement in December 2023.
Hughes said that Vaughan Gething and Jeremy Miles are the candidates for first minister and that the new leadership will be announced in March 2024.
He also provided an update on the work that RPS Wales is involved in for the current health committee inquiry on supporting people with chronic conditions. The RPS gave evidence to the inquiry on 14 March 2024.
Hughes also gave an overview of an audit undertaken in 2023 to measure Senedd members’ familiarity with, and knowledge of, the RPS, and the relative position of the organisation compared to other professional bodies. He said that the RPS is seen in a favourable light, but there is still more work to do to raise the Society’s profile.
Hughes added that the RPS had engaged in a lot of pro-active activity with the Senedd in 2023, including attendance at Senedd drop-ins and arranging MS visits to pharmacies.
Elen Jones, director for Wales at the RPS, thanked WPB members and members for their attendance and support at the Senedd sessions.
Goodbye to a WPB member
Bennett thanked board member Cheryl Way for the nine years she had served on the board as a chair, vice chair and member, noting that this would be her last board meeting.
“She has been a real credit to Welsh pharmacy and it’s been an absolute pleasure having Cheryl’s input into challenging conversations, especially on the digital agenda,” Bennett said.
“It’s been really useful to be able to draw on Cheryl’s skills.”
- The dates for the next EPB, SPB and WPB meetings are set for 18–19 June 2024
