State of pharmacy: what’s in store for the profession under Labour?

The fifth health secretary to head the Department of Health and Social Care (DHSC) in two years has been quick to set out his mission for the NHS. On 5 July 2024, just hours after his appointment, Labour MP Wes Streeting gave a speech declaring that “the NHS is broken”.

“This government has received a mandate from millions of voters for change and reform of the NHS, so it can be there for us when we need it once again,” he said.

The prospect of another NHS reform will induce a sense of déjà vu among NHS staff.

Under the Conservative government, lawmakers passed two major legislative reforms for the NHS. Among other changes, the Health and Social Care Act 2012 notably established GP-led clinical commissioning groups, while the Health and Care Act 2022 later abolished them for integrated care boards. 

Frontline staff have also been subject to changing targets in response to a rapid cascade of strategic plans: first, the ‘Five-year forward view’ at in 2014, superseded by a follow-up plan in 2017, regional ‘sustainability and transformation plans’ in 2016, the ‘NHS long-term plan’ in 2019, and the ‘Long-term workforce plan’ in 2023.  

What Labour’s ten-year plan for the NHS will mean for pharmacy is still unclear. Save for the loose plans to set up a ‘community pharmacy prescribing service’ in the party’s general election manifesto and a broad aim to “shift resources to primary care and community services”, clear expectations for pharmacy have yet to be expatiated upon. 

However, Labour’s track record — and the demands from pharmacy representatives — can provide some clues to what changes may be on the way.

Pharmacist prescribing

Although light on detail regarding its plans for pharmacy, the Labour manifesto indicates the new government intends to continue with what it started. In 2006, the party oversaw the implementation of the NHS Regulations that permitted pharmacists to prescribe independently. Now, Labour wants to “create a ‘Community pharmacist prescribing service’, granting more pharmacists independent prescribing rights where clinically appropriate” in an effort to take pressure of GP surgeries.

The work on this is already underway in the NHS in England, with 14 of 180 independent prescribing pathfinder sites up and running. Independent prescribing services in community pharmacies have also been running in Scotland and Wales since 2020 and 2016, respectively.

Pharmacists in settings outside of the community have also been prescribing more over the past five years. In answer to a written parliamentary question from Streeting in May 2024, former pharmacy minister Andrea Leadsom provided data showing an increase in the proportion of items prescribed by pharmacists from 1.97% of the total number of items prescribed in England in 2019 to 3.80% in 2023.

The proportion will only grow as changes to the initial education and training for pharmacists come into effect from 2026. However, if the Labour government wants to increase pharmacist prescribing, it will also need to increase workforce capacity to teach the new prescribers and funding to pay them.

“We need to see commensurate increases in remuneration for new activity, such as becoming a designated prescribing practitioner,” says Nathan Burley, president of the Guild of Healthcare Pharmacists. “As the bare minimum, protected time for pharmacists to undertake this additional responsibility must be incorporated into job plans if they are to perform this role well.”

On 9 July 2024, Community Pharmacy England (CPE), the National Pharmacy Association (NPA), the Company Chemists’ Association (CCA), the Independent Pharmacy Association (IPA) and the Royal Pharmaceutical Society (RPS), warned in a joint letter to the health secretary that a community pharmacist prescribing service would only be possible with further investment in the sector to deliver NHS care and prevent further pharmacy closures.

Funding increases

To this end, CPE is already in the process of securing “early meetings with new government ministers to discuss the pressures on community pharmacy,” it said in a statement published on 5 July 2024. Concluding negotiations on the 2024/2025 ‘Community pharmacy contractual framework’ (CPCF) is “one of the first tasks for the new government health team,” says Janet Morrison, chief executive of Community Pharmacy England (CPE).

“Building on the work we have already done with the Labour health team… we are seeking very early meetings with new ministers on this topic,” she continues, but adds that, “even in a best-case scenario”, the start of formal negotiations could still be weeks away. 

“This is always the case with a new administration who will need briefings from civil servants and time to form their own views,” she says.

Historically, the Labour government does have a history of increasing pharmacy funding year on year in England. Between April 2005 — when a new contract was agreed in England and Wales that rewarded provision of services as well as dispensing volumes for the first time — and 2009/2010, funding increased from £1,766m to £2,318m.

However, the new government intends to follow the previous government’s fiscal rules, meaning public finances will remain very challenging. 

For example, on 3 July 2024, Community Pharmacy Wales (CPW) informed contractors that funding was frozen at £165.1m for 2024/2025 — the same funding package agreed in 2023/2024 — because the negotiators from Welsh Labour “simply did not have the authority to put more money on the table at this time”. In 2022/2023, the funding was set at £158.8m.

Without the additional funding, CPW warned that “pharmacies will be unable to continue the successful delivery of the provisions of ‘Presgripsiwn newydd — a new prescription’ without a significant increase in funding going forward”.

Pharmacy closures

Presgripsiwn newydd — a contract agreed between CPW and the Welsh government — was published in December 2021, setting out a new ‘National clinical community pharmacy service’ that combines an emergency contraception service, common minor ailment treatment service, emergency medicine supply service and annual flu vaccination service to make the most of the “accessibility of Wales’ more than 700 community pharmacies, providing care when and where people need it”.

However, since then, an increasing number of pharmacies have had to close down, with the latest data from NHS Wales showing that there are now 693 pharmacies in the country — the first time that the number has dipped below 700 since at least 2004/2005.

In England, community pharmacies have fallen to their lowest number since 2015/2016, with NHS data showing 11,414 active community pharmacies as of October 2023.

The joint letter from pharmacy representative bodies called for urgent funding to put a stop to this “very worrying trend”, which disproportionately affects areas of higher deprivation, widening health inequalities. 

Having noted in Parliament that 670 community pharmacies had closed during the Conservative government, owing to the “party’s appalling record of under-investment and failure to reform”, Streeting told The Pharmaceutical Journal in April 2023 that he was already considering how to “support and expand community pharmacy — both in terms of number and also the range of support they’re able to provide”.

In March 2023, Taiwo Owatemi, hospital pharmacist and re-elected Labour MP for Coventry North West, gave some indication to the Pharmaceutical Journal about what that support may include. She said that pharmacists should be able to refer patients directly to secondary care. “We can look at somebody and [say] ‘OK, your dermatological condition is worsening, you’re going to need to see a consultant and to deal with this situation.’ Pharmacists could easily help that,” she said. 

At the time, Owatemi was also feeding into Labour’s health policy, with Streeting later announcing in April 2023 that he would like to see pharmacists provide health checks and signpost patients. “Pharmacists are pretty well placed to help patients navigate the system and tell them where to go,” he said.

Morrison argues that community pharmacy “can — and already does — provide easily accessible healthcare support to the public and could be enabled to do more”.

“Our proposals include an early focus on public health services and measures that could help to reduce pressure on GP practices,” she says, adding that this is in line with the Labour Party’s renewed focus on “public health and prevention” to improve the economy. 

Hospital pharmacy

Signs of what the future holds for pharmacists working outside of community pharmacy have been negligible so far. 

“We support Streeting’s laser focus on prevention, but urge the new health secretary and his department to recognise the vital role pharmacy teams play in secondary care,” says Burley. 

“Pharmacy professionals are integral parts of multidisciplinary teams which manage high-risk, high-cost therapeutics such as biologics, gene therapies, cytotoxic medicines, and more. The expansion of pharmacists into advanced clinical areas has been an incredible success and we need to nurture these roles rather than neglect them with atrophying funding.”

The funding of aseptic services and provision of systemic anti-cancer therapies (SACT) in hospitals have been a particular concern in recent years.

Joseph Williams, chair of the British Oncology Pharmacy Association (BOPA), is urging the new government to pick up where old ministers left off when it comes to improving their provision in hospitals.

“BOPA is a board member of the UK SACT board where we have been advocating for the cancer healthcare professional community for many years,” he says.  

“We would urge the new health secretary and the DHSC to continue working with the board and recognise and action the urgency of the [multidisciplinary team] reports we have published.”

The reports highlight a rising demand for SACT that is combined with overstretched oncology departments, compromising patient safety.

In May 2023, Williams wrote to former health secretary Steve Barclay to highlight that oncology departments “are having to make difficult decisions over whether to withhold access to approved treatments or prioritise which patients can receive treatment within a safe time at the expense of others”, owing to a lack of capacity.

To Streeting, Williams says: “We look forward to working with you and the wider DHSC team to improve cancer care for our patients in the UK.”

On 9 July 2024, the RPS said it was already engaging with ministers about investment in hospital pharmacy and aseptic services, among other challenges facing the sector, such as medicine shortages and student access to the learning support fund.

“Our joint report with The King’s Fund highlighted how pharmacists across healthcare will be central to reducing health inequalities, managing the growing cost of long-term conditions, and delivering best value from medicines for patients and the NHS,” says Tase Oputu, chair of the RPS English Pharmacy Board.

“There are some key enablers to make this a success, including workforce planning to ensure a pipeline of pharmacists to meet demand, commissioning new pharmacist prescribing services, and much-needed investment in electronic prescribing and interoperable patient records.”

These issues were highlighted by the House of Commons Health and Social Care Select Committee in its final report published following its inquiry into pharmacy services in May 2024, which Oputu says the new government should “consider closely”.

Where the new government starts as it untangles this interconnected web of issues that pharmacy finds itself in, remains to be seen. But there is certainly no shortage of problems to choose from.

“Politics is about choices,” says Burley. “And we hope that the new government makes the right choice to put pharmacy at the forefront of its health agenda.”