Open access article
The Royal Pharmaceutical Society has made this article free to access in order to help healthcare professionals stay informed about an issue of national importance.
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Source: Leyla Hannbeck / Mclean
In the weeks before The Pharmaceutical Journal sat down with Leyla Hannbeck, the chief executive officer of the Association of Independent Multiple Pharmacies (AIMP), pharmacy closures, workforce shortages and underfunding were already contentious issues. This formed the background to the five-year contractual framework for community pharmacy in England, which was announced in 2019. It meant that pharmacists would be on track to deliver more clinical services as part of a move to position them as the front door to the NHS through the Community Pharmacist Consultation Service.
However, the arrival of COVID-19 reversed any progress made almost overnight and pharmacies were thrown into the very forefront of the battle with the pandemic. Huge increases in dispensing were seen; Public Health England introduced confusing advice on when personal protective equipment (PPE) should be used in pharmacies, a largely volunteer-led medicines delivery service for use during the pandemic was introduced; and community pharmacies were given a £300m advance payment, although this will have to be paid back.
And while some of the issues are similar — trying to keep pharmacies open, fully staffed and appropriately funded — it is now a matter of life and death for both patients and pharmacy teams. Three pharmacists and one pharmacy technician are known to have died during the COVID-19 pandemic.
Hannbeck has long called for pharmacy to cut the humility and “shout a bit more” about its good work, arguing that if the profession values itself more, others might start to see the value of community pharmacy too. Now, she hopes, the profession’s actions will speak for themselves.
The Pharmaceutical Journal spoke with Hannbeck on the phone to discuss the COVID-19 pandemic’s impact on community pharmacy — from the day-to-day challenges to pharmacy’s future role in the NHS.
How much extra do you think individual pharmacies have spent to keep their doors open and core services running during the pandemic?
The COVID-19 pandemic has been such a hit to the sector that contractors were frankly shell shocked. It meant that with all of the big volumes coming in, they were struggling with wholesaler bills. While that £300m funding loan is welcome, obviously it’s not enough. We needed an extra £10k per pharmacy in the April payment, and the same amount again in May 2020 — so in total it was about £200m short.
What we want is that £300m to be written off
This funding also needs to be extra and on a regular basis to help with the additional costs and cashflow impacts. The sector has been cash-starved for years. The funding has not reflected the inflation and costs going up, and with all the extra workload related to the unprecedented situation with COVID-19, many are struggling to keep their heads above the water. They desperately need funding.
Do you expect the pandemic to accelerate closures?
If pharmacies don’t get the sort of cash that they need, yes of course. If you cannot pay your wholesaler bills, if you cannot manage your day-to-day costs, despite having tried so hard to manage them, then what other choice do you have? A lot of pharmacies are already behind with their wholesaler bills and, on top of that, this scenario has put many pharmacies in a very bad position.
Is it really possible for pharmacies to pay that £300m back?
What we want is that £300m to be written off.
And if that isn’t agreed to?
Well it’s going to make it very difficult for a lot of people. It’s been a very difficult period for pharmacy.
Is the government going to be able to continue with its plans to shift from dispensing to clinical services this year?
We are looking at this and discussing it with NHS England, in terms of the plans in place to reintroduce services. A lot of the services were put on hold because of COVID-19, so now there’s talk around how we can reintroduce some of these services as part of the future planning and contingency planning. It definitely is on the agenda. It’s one of those things that will be gradually brought back in when the timing is right, but that’s part of the contingency planning that NHS England will be looking into.
The ‘pandemic delivery service’ partly relies on volunteers who have not been checked by the Disclosure and Barring Service. Is it fit for purpose?
We would have liked to have seen more of a move towards a service for all vulnerable patients
The delivery service at the moment is for shielded patients, and while that is a welcome move, we would have liked to have seen more of a move towards a service for all vulnerable patients. That would have been more in tune with the sort of care that pharmacies are providing in the local community.
I understand that there have been a lot of worries among pharmacy teams and there are some legal implications — I completely understand that. No pharmacist wants to get into a situation where anything bad may happen to the patient, so you always put the patient first. It’s important to remember that pharmacists are doing everything they can in the best interests of their patients, and a lot of them have already been providing a delivery service to their patients under very difficult circumstances.
Do pharmacies have capacity to deliver to all vulnerable patients?
If it’s funded accordingly. This is what we have said from the beginning — pharmacies are willing, but the reality is that they are struggling with less funding to deliver anything, or do anything, because there is so much pressure. If the service is funded for patients in the vulnerable category, it’s better from a patient support and care perspective.
What’s your assessment of the Public Health England guidance on the use of personal protective equipment in community pharmacy?
It is absolutely heart-breaking to see healthcare staff, including pharmacists, having lost their lives
It is good to have some guidance. However, like all other frontline healthcare professionals, we have highlighted the great risk to pharmacy staff as the two-metre distance in a pharmacy setting is not always achievable. AIMP members tell me that at least three members of staff are customer facing in most pharmacies, with the rest coming into regular close contact — less than two metres — with them. There is fear and anxiety among pharmacy teams — they want to be protected and to protect their patients.
It is absolutely heart-breaking to see healthcare staff, including pharmacists, having lost their lives. As a sector, alongside our colleagues in the NHS, we have been highlighting the need for PPE of a higher specification, owing to the proximity and, more importantly, the quality of patient care.
There’s a disconnect between what pharmacists say they need and what the government is offering — who should be held accountable for that message not getting across to Public Health England?
I know NHS England has been making the case for community pharmacy. They have raised issues about PPE so that pharmacy could get appropriate equipment. We, as a sector, have been telling them what the problems are. So, the government knows what everyone has been asking for. The message has gone out — this is all we have been able to do: it’s up to them now.
Was testing for community pharmacists rolled out in the way you expected it to be?
The pandemic has crystallised the role of community pharmacy in society
Back in March 2020, when Simon Stevens, the chief executive at NHS England, sent a letter to primary care managers talking about testing, we highlighted the importance of pharmacy teams being included. It is good to know that NHS England made the case for this for pharmacy. We hope with antibody testing that pharmacy does not have to wait and is considered a core healthcare service.
We are still monitoring the feedback that we’re getting on access to testing. Our pharmacies know this is available to them and how to go about getting tested. It’s a little bit early to say how pharmacists are moving with it.
Is the mental health support on offer to pharmacies enough considering all the pressure and abuse that the profession is facing at the moment?
It’s been a very tough period for pharmacy teams — being worried about coming to work and catching something, and the whole stress of having to do so much. Anything more that can be done to support healthcare professionals on the frontline should be done.
What impact will the pandemic have on the role of community pharmacy in the NHS after it ends?
The pandemic has crystallised the role of community pharmacy in society. It’s largely agreed now that there is a basic need for community pharmacies. If anything, this pandemic has demonstrated the role that community pharmacy can play in the healthcare system, without which it would have been very difficult to care for patients. Will this change the role of pharmacy going forward? Definitely. What we have achieved as a sector in this period has been nothing short of amazing; how pharmacists have gone over and above for patients. We’re hoping that after everything settles, all of this is looked at in terms of how vital pharmacy is in people’s lives, and that it can be trusted and supported to continue delivering that level of care for patients.