Andrea Leadsom: ‘Pharmacy First is such a big win’

Previously the government’s early years advisor, Andrea Leadsom replaced Neil O’Brien as health minister with responsibility for community pharmacy in November 2023, putting her in charge at a time of significant change for the sector.

Shortly after assuming the role, the Department of Health and Social Care (DHSC) published proposals to allow pharmacists to delegate supervision responsibilities to pharmacy technicians, as well as confirming plans to enable pharmacy technicians to administer and supply medicines under patient group directions.

The most notable change came on 31 January 2024, when community pharmacy began offering the highly anticipated Pharmacy First service, which provided patients with more than 125,000 consultations in its first month.

However, the sector has also continued to shrink under her leadership, while medicine shortages are an ongoing problem for many patients. The Pharmaceutical Journal pressed Leadsom for her view on these growing concerns.

You recently referred to community pharmacy as ‘a thriving sector’. Do you not feel concerned about pharmacy closures?

Well, from the start of 2023 to 2024, there have been around 1,500 closures and about 1,100 new pharmacies opened. I think that demonstrates that yes, there have been net closures, but actually a significant number of changes.

Obviously, the government’s key priority is to ensure that all citizens can access pharmacy services and medicines. The government’s role in this is to make sure that there are enough community pharmacies and, at the moment, 80% of all people in England can walk to a pharmacy within 20 minutes.

Local authorities will do an assessment every three years of local need for a pharmacy, and then the integrated care board (ICB) will look at providing licences to new pharmacists to meet the local need. Also, the ICB can provide a licence to a GP practice, for example, if there isn’t a pharmacy within a reasonable distance.

There are lots of measures in place, including around 400 direct dispensing pharmacists that deliver medicines through the post, for which they don’t charge anything.

And so access to medicines is actually very strong. In fact, in the most deprived areas of England there are around twice as many community pharmacies compared to the least deprived areas.

You mentioned that 80% of people are within a 20-minute walk of their pharmacy. For the 20% of people that aren’t, are you saying that distance-selling pharmacies would be a way to plug the gap?

Obviously, medicines by post is one way and, equally, 80% of people can walk to a pharmacy within 20 minutes if they have the mobility to do so.

So actually, for lots of elderly people who may be less able to walk, or indeed drive to a pharmacy, they may well benefit from the many different pharmacies that provide a home delivery service, and the online pharmacies that will deliver straight to your door. Having that online availability is really important for all those reasons.

Do you think that one of the main reasons community pharmacies are closing is because of funding?

There are three types of pharmacy: there are the big chains — the likes of Boots — and other major stores that have pharmacies in store. Then you have groups of chains of pharmacies, which might be owned by one pharmacist who built a business with perhaps 10 or 20 pharmacies within it. And then you have the owner/manager, which is the independent store, and all sorts of things in between.

So there are different reasons why stores close, such as moving home, retirement, perhaps cutting out one pharmacy that wasn’t profitable enough, etc.

Of course, pharmacies will ultimately — because they are private businesses — be looking at making it pay, so the government has a contract with pharmacies, which effectively provides a payment to pharmacists for each bit of activity, plus the medicine margin that enables them to take the margin on every medicine that they dispense.

Plus, the new initiative Pharmacy First, which provides £645m over two years to pay pharmacists providing treatments for seven common conditions, including sore throat, sinusitis, infected insect bites, impetigo, etc.  

There is also the pre-existing work on oral contraceptive prescriptions and on blood pressure assessments. All of those new activities being covered by community pharmacists are generating income for those pharmacies.

What’s the government doing to address worsening medicine shortages?

It is an issue. There is something like 14,000 different medicines prescribed in England each year and we have seen about, over a period, I think 2022 to 2023, around 1,600 reports of possible shortages. It’s a relatively small percentage but if that is a medicine that you are looking for, that is obviously very inconvenient for you.

There are many substitutions possible. The DHSC has a team that specialises in sourcing medicines where there are shortages.

What the pharmacist will do is re-prescribe if there is a prescribing pharmacist available, or to seek the new prescription from the GP where there is a shortage of a particular medicine, to swap it for another that is a particularly suitable alternative.

Now all of that obviously creates friction in the system. And something I am really keen as minister to look at, again, is how can we actually improve that patient access, if not to the medicine that there is a shortage of, then to a very similar alternative?

So that is something I am looking at now. But the team who specialises in that within the DHSC says that there are risks with allowing pharmacists to prescribe an alternative themselves, which is that you can create shortages elsewhere, which the department will not necessarily be aware of, because it will happen very fast.

In addition, you could end up in a position where other healthcare professionals may not know exactly what you have been prescribed and so there are risks associated with it.

It is a really important area and undoubtedly, it does create frictions, but it is the result of some of the shortages we have seen globally, as a result of some of the supply chain problems during COVID-19. Obviously, we are working as hard as we can to keep those to a minimum.

You will also be aware of the serious shortage protocols where pharmacists are encouraged to use an alternative which is very similar, where it is known that there is a severe shortage.

Can you say more about what that you are doing around this?

I think there are the obvious potential solutions, such as providing more leeway to pharmacists. But as I say, the risk of that is that you create shortages elsewhere, so we need to understand the pros and cons before going down that path.

I think that the potential solutions are obvious, it would be basically inviting pharmacists to make more decisions for themselves.

But you would need to be very sure that you will not just create another problem, like the aliens game where you bang one on the head and another problem pops up somewhere else. You need to make sure that you are not actually worsening the overall position.

Is there a review or a piece of work looking at this issue?

Well, as a minister, I have some priority areas, of which access to primary care is pretty much up there as one of my top priorities. So, everything that creates friction that potentially worsens patient access, I am looking at all the time on an ongoing basis. I have very regular meetings with the pharmacy team to make sure that I am covering all of those bases.

You said that you are glad there is a prescription charge in England because it has saved the NHS £670m, but surveys show that patients are declining medicines because of the cost. What would you say to a patient who has to choose between eating or paying for their prescription?

Obviously, the cost of living has been a real challenge, as a result of Vladimir Putin’s aggression in Ukraine and the energy crisis that ensued, which put up the costs of everyday living, so it has been a very real issue for lots of people.

Where prescription charges are concerned, 89% of all prescriptions are not charged for, and 60% of all people don’t pay any prescription charges.

Actually, there are many exemptions for some long-term conditions, for children, for pregnant women and for people on very low incomes etc. There is lots of support in place for people on low incomes or who have particular issues.

But really importantly too, we have put in place lots of measures for those who need regular prescriptions to have pre-payment certificates, which really reduces the cost of their annual prescription needs to around £2 a week maximum.

I totally understand calls for making all prescription charges free, but let’s be clear, the £672m that’s generated from prescription charges each year is a thousand nurses’ salaries; it is thousands of interventions in cancer treatments in diagnostics and so on.

To simply say ‘let’s just make it all free’, that isn’t a free choice — you are then making a decision about other priorities that you will downsize, so I feel we’ve got the balance right.

People on very low incomes are able to access their prescriptions free, so anybody in that position should be given the advice by their pharmacists to look to what more support can be given to them. And, of course, everybody should be told about the possibility of their pre-payment prescription charges.

Is there anything else you’d like to add or mention?

I would just love to say that I think Pharmacy First is such a big win. I have been so impressed that over 98% of all pharmacists have signed up to Pharmacy First. And it is about convenience for patients.

We expect that the payment that has been made to pharmacists to provide these consultations, with the quite strong targets to deliver that care is going to have significant benefits for patients.

This is really good news for patients and it is really good news for relieving the pressure on GPs. We expect that it will relieve about 10 million GP appointments a year, which is a win/win. It is a win for patients, a win for GP access and, of course, it’s a win for the sustainability of pharmacies.

Of course, that’s just the beginning of the journey. We will be bedding that down and then looking to see what else pharmacists will be able to do to provide that better access to care for patients.