The House of Commons Health and Social Care Committee’s expert panel has concluded that the government’s progress on four out of nine pharmacy commitments in England has been ‘inadequate’.
The panel’s ‘Evaluation of the government’s commitments in the area of pharmacy in England‘, published on 25 July 2023, said that the least progress has been made on promised legislative changes that would allow for better use of the skill mix in pharmacies and enable the clinical integration of pharmacists.
This commitment — to enable original pack dispensing, and a wider use of hub and spoke dispensing — was made in the ‘Community pharmacy contractual framework’ (CPCF), published in July 2019.
“The legislative changes needed are not clearly set out, and there seems to be uncertainty in the sector about what to expect and when,” the report said, going on to express concerns about delegating more tasks to community pharmacy without legislation enabling them to use staff more efficiently.
“Even if, and when, these legislative changes are made, they are unlikely to achieve the desired aims without other additional actions to tackle the workforce challenges experienced within community pharmacy and, importantly, without additional legislation in medicines regulation.”
Other commitments deemed ‘inadequate’ included eliminating paper prescribing in hospitals; optimising NHS aseptic services and reviewing the balance of funding between dispensing and other services in community pharmacy.
Progress on each commitment was assessed by set criteria: funding, impact, appropriateness and ‘overall’.
The expert panel was assembled by the select committee in 2020 to assist its work in scrutinising health policy and services.
For this report, the panel comprised several extra additional members with pharmacy expertise, including Mark Lyonette, chief executive of the National Pharmacy Association, and Raliat Onatade, chief pharmacist and director of medicines and pharmacy at NHS North East London.
The expert panel’s work ran concurrently with the House of Commons Health and Social Care Select Committee’s broader inquiry into pharmacy services in England, which accepted written evidence up until 6 July 2023 and is expected to hold in person evidence sessions later in the year.
The expert panel report said “most stakeholders” did not feel an appropriate funding model review had taken place, despite the government’s commitment to review the balance between spend on dispensing and new services within the CPCF.
The evaluation added that it was concerned that this had resulted in community pharmacies being unable or unwilling to deliver additional clinical services; patients being unable to access some medications; and reduced access to community pharmacies, particularly in deprived areas.
The review also concluded that a government commitment to introduce digital prescribing across the NHS by 2024 was “overly ambitious” and would not be achieved, with only 3% of hospital trusts having achieved the commitment so far.
The report said that even a delayed deadline of 2026, which was given to the panel in supplementary evidence from the Department of Health and Social Care, was unlikely to be met, with digital capabilities and infrastructure “not ready for this radical change” owing to lack of investment.
Similarly, the government’s commitment to optimise aseptic services, including a target of automation via hubs increasing capacity to 40 million units of aseptic preparation, “is still some way off from being met”, the panel’s review found.
The review did identify good progress on the ‘Pharmacy access scheme’, ‘Community pharmacist consultation service’, and the Pharmacy Integration Fund, while progress on a medicines reconciliation service and independent prescribing training ‘required improvement’.
James Davies, director for England at the Royal Pharmaceutical Society, said the report was a “wake-up call for the government”.
“The current funding model for community pharmacy does not support the most disadvantaged in society,” he said. “Poor digital maturity and lack of investment within hospital trusts and community pharmacies have further hampered progress.
“Outdated paper prescribing is still the norm in too many settings and the lack of integration and ability for IT systems used in community pharmacy and hospital pharmacy to exchange and make use of information holds back further progress in removing prescribing errors and improving patient care.”
Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, said: “The report does not say anything that we have not said before, that our sector’s core funding is in desperate need of cash injection as it’s got a shortfall of £1.1bn and rising, that community pharmacies have for years not had a level playing field around support for our workforce as GP surgeries have had.”