Ministers failing to reform ‘restrictive’ primary care rules

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Government promised laws to allow better use of skill mix in pharmacies in 2019
CCA chief executive says government has not led on work to fulfil promises
Changes needed to realise full potential of primary care recovery plan

The government has failed to change ‘restrictive’ legislation which would enable primary care reform – despite repeated announcements – a pharmacy leader has said.

Currently, pharmacy technicians cannot take on dispensing tasks without supervision from a pharmacist but the government promised in 2019 to look at how legislation can be updated to allow pharmacy technicians to take more of a role in dispensing, as part of the current five-year Community Pharmacy Contractual Framework, which ends next year.

The government has repeatedly announced and reannounced over the past five years that it wants to remove restrictions to give community pharmacy an expanded role.

But in a new report shared exclusively with HSJ, the Company Chemists’ Association – the trade body with members including Asda, Boots, Lloyds Pharmacy and Superdrug – highlights that government has failed to make progress.

Malcolm Harrison, CCA chief executive, said changes to supervision would help free up pharmacists and realise the full potential of last month’s primary care recovery plan, which envisages “expanded services” for community pharmacies, starting with allowing pharmacists to supply prescription-only medicines for seven common conditions.

Mr Harrison said: “The issue of supervision in pharmacy is one that the Department of Health and Social Care said they would start to try and address back in 2019. But they haven’t. They’re talking about consulting on it, but it is the sector that is pushing this forward. It’s not being led by the government in any way, shape or form.”

The CCA – along with the Association of Independent Multiple Pharmacies, the Association of Pharmacy Technicians UK, the National Pharmacy Association, the Pharmacists’ Defence Association, Pharmacy Forum Northern Ireland and the Royal Pharmaceutical Society – formed a working group to produce recommendations on the question in January.

The primary care recovery plan also said DHSC will consult on the law of pharmacist supervision in the summer.

Asked why the government has been slow to pursue the changes, Mr Harrison said: “The frustration here is that when you level this accusation at the department, they will say there was a pandemic, but then won’t recognise the need for financial support for the sector – also because there was a pandemic.

“If we want to really unlock the potential of pharmacy and realise the potential of the primary care recovery plan, we need to be able to afford to recruit the support teams around the pharmacist so they can be freed up to spend their time doing these things. This means the government needs to address restrictive legislations [as promised in 2019],” he added.

The CCA report, called The Pharmacy Paradox: Matching Ambition and Reality, also called for the Pharmacy First programme – which allows pharmacists to treat common conditions – to be expanded beyond the seven conditions mentioned in the recovery plan.

In addition, the CCA said it was unfortunate that other legislative changes mentioned in the 2019 contract “have not yet materialised”.

It pointed to a hub and spoke dispensing, where parts of the dispensing process are undertaken in separate pharmacy premises to support efficiency; and original pack dispensing, where pharmacists can dispense more or less of a medication than has been prescribed in order to dispense the medicine in its original pack, to ensure patients receive information leaflets and save pharmacy time.

A DHSC spokesperson said the department “remains committed” to changes around a hub and spoke dispensing and original pack dispensing, and is “progressing legislation following consultations”. However, it did not comment on changes to pharmacy supervision.

‘Inadequate, static funding pot’

The report criticised the “inadequate, static funding pot” for community pharmacy, which was cut by around £200m a year in 2016, with the current contract not adjusted despite the pandemic and inflation, while at the same time, the government expanded its clinical services.

It warned: “Unless the conflict between ambition and capacity is addressed there is risk that community pharmacies will not only not meet their potential, but their existing offer will be compromised.”

The CCA calculated that 720 pharmacies have closed since 2015, with Mr Harrison warning that the CCA expected “that number to jump significantly in the next six to 12 months”.

In addition, the report raised concerns that the NHS is “actively recruiting workforce into other settings”, such as primary care networks. Mr Harrison told HSJ that “the last thing we want them to do is recruit more pharmacists into PCNs, when we are absolutely on our knees”.

Mr Harrison summarised: “We can all buy into the recent announcements from the primary care recovery plan, so it was definitely a move in the right direction and a vote of confidence for pharmacy. However, there’s still an elephant in the room, which is what they’re doing with workforce, as well as the erosion of funding made available for supply medicines to patients.”

In 2022-23, community pharmacies dispensed around 1 billion NHS prescription items - around 60 million items more than in 2017-18. At the same time, 11 new clinical services have been commissioned, without any money, since 2016, such as contraception services, smoking cessation and blood pressure checks, while patient contacts associated with national services grew from 5.7 million in 2017-18 to 10 million in 2022-23.

As part of the primary care recovery plan, the government committed £645m to “expand community pharmacy services” in England.

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