Regional healthcare systems could help address pharmacy workforce issues, finds review

Integrated care systems (ICSs) in England can provide an “important opportunity” to resolve staffing issues in community pharmacy and primary care, an independent review has found.

The review, commissioned by the government in November 2022 and published on 4 April 2023, aimed to “consider how the oversight and governance of ICSs can best enable them to succeed,” including how ICSs can build “a sustainable and skilled workforce”.

The 42 ICSs in England became statutory bodies on 1 July 2022, replacing clinical commissioning groups and taking on responsibility for commissioning community pharmacy services from 1 April 2023. Each ICS is governed by an integrated care board (ICB).

The review found that ICSs “need to pull down some of the barriers that currently exist for primary care,” to promote “the kind of integration, collaboration and autonomy we want to see”.

“Contracts with national requirements can have unintended consequences when applied to particular circumstances,” it said.

“For instance, the national requirements and funding of ‘Additional roles reimbursement scheme’ (ARRS) roles for community pharmacists within primary care networks (PCN), has on occasion exacerbated the problem of a general shortage of pharmacists… compounding the problem of community pharmacy closures and delayed discharges.

“The new responsibilities for ICBs provide an important opportunity, at place or system level, to integrate the whole primary care offer for communities, making the best use of both the staffing resource available and the premises.”

In October 2022, Janet Morrison, chief executive of the Pharmaceutical Services Negotiating Committee (PSNC), called on the government to stop the recruitment of pharmacists into PCNs, instead suggesting the government “look at workforce planning across primary care”.

According to the latest data, published by NHS England in January 2023, there were 3,880 full-time equivalent pharmacists recorded as working in primary care networks (PCNs) in December 2022 — an increase from 2,552 in June 2021 — which community pharmacy leaders said was “having very damaging consequences for community pharmacies”.

Commenting on the review findings, Morrison said in a statement to The Pharmaceutical Journal: “The report is clear that action should be taken to carefully consider the best use of the limited pharmacist workforce going forwards, and that the new ICSs should be instrumental in this.

“However, local action will need to be joined up nationally, so it will be important for the government to realise these issues, with solutions in their upcoming long-term NHS workforce plan by ensuring that it covers the entirety of the pharmacy workforce across the NHS, including community pharmacy.

“We would welcome the opportunity to discuss the issues in the Hewitt Review, as government considers the recommendations.”

Responding to the report, Malcolm Harrison, chief executive of the Company Chemists’ Association (CCA), said he was pleased that it had “recognised the challenges presented to the community pharmacy workforce by the funding of ARRS roles for pharmacists within PCNs”. 

“We know that this funding has contributed to a significant rise in vacancy rates across the community pharmacy and hospital settings, and has resulted in a 90% increase in the hourly rates paid to locums, as demand has outstripped supply,” he said.

He added that the CCA has “been calling for a co-ordinated pharmacy workforce plan, to span the whole of primary care, so that in the future patients can access a pharmacist whenever and wherever they need to”. 

“We welcome the opportunity to work with the health systems to develop solutions to enable patient care to be effectively and safely moved from PCNs and into community pharmacies, thus reducing the need to pull pharmacists away from the communities they serve,” he said.

Patricia Hewitt, former health secretary and chair of the independent review, said: “ICSs represent the best opportunity in a generation for the urgently needed transformation that we need in our health and care system. Everyone wants them to succeed.

“To fulfil their potential, however, we need not only to back our new structures, but also to change our culture. Everyone needs to change, and everyone needs to play their part.”

A report published by the NHS Confederation on 3 April 2023, which looked at nine ‘early adopter’ ICSs where commissioning of pharmacies services was underway before the 1 April 2023 deadline, found that “generating high-quality data is important to demonstrate the impact of new [community pharmacy] services in reducing pressure in other parts of the primary care landscape such as general practice” (see Box).

“This is a vital component of ICSs’ ability to look at the financial impact of interventions across the whole system and drive NHS productivity,” it said.

However, the report added that access to such data in pharmacy “is a mixed picture”.

“Some pharmacy groups have their own systems for generating data, whether individually as a collective of local pharmacy committees, or as a group of companies. In other areas, health systems have data systems in place, but in some areas, data generation is less well developed.”