To borrow Harold Macmillan’s famous phrase, the UK pharmacy sector has “never had it so good” — at least, in rhetorical terms. We can scarcely move from hearing about Pharmacy First from our political lords and masters. First, it was from leaked WhatsApp celebrity and ex-health secretary Matt Hancock in January 2020, highlighting the UK government’s Community Pharmacist Consultation Service (CPCS) initiative to enable same-day appointments with pharmacists.
At the time, Hancock said community pharmacy was an “integral and trusted part of the NHS and we want every patient with a minor illness to think ‘pharmacy first’”.
Then, writing for the Daily Mail in October 2021, his successor Sajid Javid trailed a Pharmacy First service, before promising in June 2022 that his primary care reforms would be “starting with pharmacy”. It is warm words all the way: what an exciting time for implied promises of priority for the pharmacy sector.
But, as the eight-month gap between those two quotes from Javid shows, the achievement/delivery bit of the equation hasn’t been given the same priority.
Indeed, current health secretary Steve Barclay said in November 2022 that the ‘Department For Health But Social Care’ was “looking at how we can progress Pharmacy First”.
As for Therese Coffey (a chemistry PhD), health secretary during the disastrous 49-day Liz Truss interregnum, she may have been “focusing relentlessly” on the ABCD in her ‘Plan for Patients’, but scarcely had time to get the ‘PF’ words out. Coffey’s prescribing credentials might not be regarded all that highly, given her high-profile regifting of her leftover antibiotics to a friend, though.
So what does this show us, apart from UK government ministers consistently talking a spectacular game, but not delivering in the real world?
NHS Pharmacy First was launched in Scotland in July 2020 and exists in some parts of England. It provides a contractual service for patients with minor illnesses to get NHS-funded advice and care in their local pharmacy, unlike the CPCS, its overly bureaucratic equivalent in England, where patients have to be referred and stump up the cash for any treatment.
The unspoken reality is that the pharmacy primacy — real in Scotland, but still rhetorical in most areas south of the border — is being proposed as a solution to the poor state of primary and community care everywhere in the UK. Pharmacy First runs the risk of being a simplistic solution to a longstanding and much wider problem.
The House of Commons health and social care committee’s report on ‘The future of general practice’, published in October 2022, observes bluntly that “there are not enough GPs to meet the ever-increasing demands on the service”, with an estimated 2 million more GP appointments than in 2019. And, over the same period, it pointed out the drop in the number of qualified, full-time equivalent GPs working in the NHS of nearly 500, from 28,094 to 27,627.
“This gap between demand and capacity leaves GPs working harder and facing more burnout as patients find it harder than ever to see them,” it said.
Claire Fuller’s ‘Stocktake report’ for NHS England, published in May 2022, found likewise: despite reported record numbers of GP appointments, the 08:00 Monday morning scramble for an appointment “has now become synonymous with patient frustration”.
“Primary care teams are stretched beyond capacity, with staff morale at a record low. In short, left as it is, primary care as we know it will become unsustainable in a relatively short period of time,” the report said.
The British Medical Association’s continual analysis of GP workforce data is truly striking, showing reductions in senior GP numbers and in working hours; however, as we all know, primary care is about more than just GPs. In May 2018, NHS Providers research revealed that the community nursing workforce had contracted by 14% since May 2010, amounting to a loss of 6,000 posts. Similarly, the number of district nurses had reduced by 44% in the same period.
But is the pharmacy sector ready to come to the rescue? In December 2022, the Royal Pharmaceutical Society’s ten-year vision for pharmacy observed that there were “so many opportunities for pharmacy teams to provide better support to patients and the public to prevent ill health, improve health and reduce health inequalities… Some of this potential has been realised in examples of innovation across England before and during the pandemic, but more is needed at scale to realise the full potential of pharmacy in supporting the healthcare system.”
The reality that many in the sector have been experiencing is that the Community Pharmacy Contractual Framework did not adequately deal with longstanding issues, resources being a big one. This national contract has not seen an increase in funding since 2014.
The five-year 0% contract, published in July 2019, came after significant cuts from 2017 to 2019. The attraction of the putative financial stability of this multi-year deal faded fast in the face of the COVID-19 pandemic and rampant inflation hitting so many prices, including those of utilities.
Closures and cost base reductions are becoming realities. In February 2022, the Company Chemists’ Association revealed “a worrying shortfall of over 3,000 community pharmacists in England”, and pharmacies are closing down, which will further reducing their capacity to help GP practices.
Since January 2023, more than 250 in-store supermarket pharmacies were put at risk of closure across the UK as multiples cut costs, streamline operations and begin to move services online.
Pharmacy is a vital sector and it is perfectly plausible that the pharmacist workforce could do more to help ease system pressures across the NHS primary and community care sector — provided it is resourced to do so.
The government’s revealed preference over a long period of time has been to expand NHS resourcing only when they’re staring down the barrel of a political gun. It isn’t clear whether they yet feel under the requisite pressure to fund pharmacy to work more and differently. Further warm words certainly won’t cut it.
Andy Cowper is editor of Health Policy Insight and a journalist who has written about health policy for 22 years.