A recent shift in a community pharmacy got me thinking about how long it will take for the sector to realise it is exposing its problems for all to see. But where there are problems, there are also solutions.

Read more: 'Community pharmacy's decline reminds me of The Emperor’s New Clothes'

I have been thinking about the current state of play in community pharmacy and where, as a branch of a healthcare profession, we should be.

Community pharmacies remained open to patients and their carers throughout the pandemic, while many other organisations completely shut down or operated on remote consultations only.

It was tough working through the COVID-19 pandemic and various lockdowns. Nevertheless, pharmacy teams worked through it and did the profession proud.

Did pharmacy contractors get sufficient recognition and reward for their endeavours? But more to the point, does the community pharmacy profession do itself justice and aspire to be where it could and should be?

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When I qualified as a pharmacist after studying at Bradford University, I was privileged enough to graduate and qualify on the Saturday and plunge straight into full-time locum work the following Monday morning.

Pharmacists were transitioning from the traditional chemist in a white lab coat – modelled by my trainee tutor – working in a raised dispensary to the modern open-plan retail outlets of today.

The future was bright for community pharmacy, with patient group directions (PGDs) on the horizon and the profession primed to move boldly into the 21^st century.

Sadly, though, it feels like the bubble has burst for community pharmacy.

This has been exaggerated and exacerbated by the brain drain of pharmacists and technicians to primary care under the additional roles reimbursement scheme (ARRS), and there have been many calls from senior figures to stop recruiting pharmacists and technicians.

Read more: ‘Short-sighted at best’: PSNC blasts recruitment of 4k PCN pharmacists

I would argue that community pharmacy, afflicted with decades of chronic underfunding, an archaic quantitative reimbursement model, limited integration with the wider NHS and poor working conditions, has been self-sabotaging for decades.

One could argue that various professional bodies have been furiously re-arranging the deck chairs as community pharmacy steams towards the iceberg.

A better longer-term strategy would be a root-and-branch rethink and overhaul of community pharmacy to ensure all staff – not just pharmacists and technicians – have improved working conditions, appropriate salaries and are fulfilled in all aspects of their roles.

Community pharmacy has a lot of green shoots of life and hope is shining through.

New and innovative PGDs have sprung up across the country for emergency hormonal contraception, contraception, urinary tract infections, skin conditions and eye infections, alongside with the hypertension case-finding service.

Vaccination services – COVID-19, flu and private travel – are blossoming once more.

Read more: Why you should set up a travel clinic in your community pharmacy

Most of the large multiple pharmacy chains now have private PGDs in-store and private prescribing services for minor ailments, period delay, weight loss and contraception.

Easier access to some hormone replacement therapy (HRT) and contraceptives has opened up access to these medicines for many female patients.

The Community Pharmacy Consultation Service (CPCS) has the potential to be a game-changing service for the NHS, relieving pressure on 111, out of hours services and overstretched GP surgeries.

Surely a pragmatic extension of this should be an NHS prescribing procedure for existing pharmacist independent prescribers (IPs) based in the community?

Establishing a process for community-based pharmacists to prescribe for NHS patients will be very complex.

It will also be fraught with issues such as IT compatibility, access to full patient notes and ethical prescribing and dispensing considerations.

The need to free pharmacists up from checking prescriptions and the basic elements of the essential services contract need to be factored in.

Appropriate support must be provided through assertive community treatments and/or second pharmacists.

It has been well publicised that pharmacists graduating from 2026 will leave pharmacy schools as qualified IPs.

Health Education England (HEE) continues to provide funding for IP courses and advanced practitioner courses to encourage pharmacist development.

Read more: 'The push for independent prescribing must not just be a tick box exercise’

Not all newly qualified pharmacists will move into hospital or primary care roles, where they can currently fully utilise their IP accreditation.

Many of those wishing to develop a career in community pharmacy will be unable to exploit their IP qualification to full effect without a seismic shift.

Discussions with colleagues across England indicate that progress with the CPCS is slow, with fluctuating levels of engagement across the regions.

Anecdotes I've heard from many GP surgeries and pharmacies are that some locum pharmacists aren’t qualified or confident enough to engage with the scheme and pharmacies frequently have to decline the referrals, making a mockery of the service in doing so.

So what now for the future of community pharmacy?

How can the relevant professional bodies unite to make the community branch of the profession more fulfilling, more healthcare-focussed, less about retail and more attractive to newly qualified pharmacists?

Read more: Taking the pressure off: What do pharmacists want their future to look like?

There are numerous options and pathways for improving community pharmacy.

First of all, there should be a unified approach and single voice to promote the profession akin to the British Medical Association (BMA) or Royal College of Nursing (RCN) models.

There should also be a subtle and continuous change in public and patient perception of the role of community pharmacy.

Pharmacists provide healthcare services, not retail services. A Pharmacy First scheme or minor ailments scheme as an essential service should be rolled out across England.

Ongoing education campaigns to promote community pharmacy as the first point of contact for all minor ailments should be provided too. This would divert demand away from NHS 111, out of hours and GP surgeries.

Additionally, there should be legislation and a framework to sanction prescribing by IPs with appropriate consultation fees.

The regulations around supervision should also be relaxed and modified to free up time for extended services. There should be read and write access to NHS patient records as well.

Read more: The (supervision) elephant is still in the room

Community pharmacy entries can then appear in the same way as extended access or district nurse consultations in SystmOne or EMIS Web.

Finally, there should be improved funding. This should be linked to quality of service rather than item numbers.

It's not too much to ask, is it?

 

Chris Grahame is a senior clinical pharmacist, independent prescriber and a Centre for Pharmacy Postgraduate Education (CPPE) pathway mentor