In May of 2024, the Health Select Committee of which I was then chair, published what is widely accepted as a hard-hitting report on the pharmacy sector.
We discussed community pharmacy (of course) but also hospital pharmacy, the workforce and medicine shortages.
We spent many months collecting evidence, making visits, hearing from guests representing a wide range of organisations and writing up a series of recommendations (around thirty of them) to Government.
I say ‘Government’ because one of the final acts of our Committee work in the last Parliament, before members scattered far and wide to contest their seats, was to get this piece of work out the door. We knew it would be responded to by the new Minister and this week that finally happened.
Whether it said anything to hold the front-page is another matter. Let’s take a look …
The Minister, Stephen Kinnock started well; thanking the workforce for its “hard work, professionalism and dedication” and underlining the sectors work as “vital to the health and prosperity of our population” no less.
Acknowledging the report was submitted to his predecessor he wanted to respond (fact: Government has to respond) because pharmacy is a “key priority for this government.” So far so good.
On community pharmacy funding, which is rightly where we began, we recommended that the Community Pharmacy Contractual Framework (CPCF) is completely overhauled.
The test for that must surely be that there IS a new framework and, above all else, it closes the gap in funding that community pharmacy has experienced over the course of the current one.
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We said it should focus on “reducing complexity and ensure pharmacy owners can clearly understand and predict their cash flow, including de-risking the purchasing price of medicines” and ensure any funding is explicitly available for both dispensing services and clinical services, to avoid the current situation where one activity pays for another, to the detriment of both.
And we were clear it ought to include the capacity for flexibility in the event of increased demand, greater activity or inflationary pressures, for example through indexation.
In a very Whitehall way, the response to our report is punctuated with ‘accept’, ‘partially accept’ or ‘reject’.
The good news on funding is we got a ‘partially accept’.
The bad news is, the rest of the response simply quoted Darzi, said how awful the inheritance was and told us NHS England are currently undertaking an economic analysis of the sector.
All we know therefore is it joins a long list of reviews (at least this one is not being led by Louise Casey!) that will “inform future proposals for funding and contractual arrangements”, and of course everything must wait for the 10 Year Health Plan.
Secondly, we said the Government should commission an independent review of the medicines supply chain given the impact that shortages are having.
This one got partial acceptance with the note medicine supply chains are “highly regulated, complex and global” and a reminder that “supply disruption affects many countries around the world and is not specific to the UK.”
While the Minister said they are working closely with NHS England to take forward a “range of actions to improve our ability to mitigate and manage shortages and strengthen our resilience” we didn’t get any detail on what they are and sadly we don’t yet have a commitment to commission an independent review of the medicines chain. That is merely being kept under consideration.
On future services, we did recommend that the Government and NHS England publish a long-term vision for the further development of clinical services in community pharmacy settings.
This vision should, we said, include consideration of examples of success within locally commissioned services, and how these could be offered across England plus build on the seven health conditions covered by Pharmacy First.
Read more: Pharmacy First consultation payment caps rise up to 94%
While we still don’t of course have any new pharmacy contract in place, this was marked ‘Accept’ in the Government response but in reality simply refers back to engagement on the Ten Year Health Plan which they say “provides opportunity for gathering ideas and evidence to shape future clinical service models in community pharmacy.”
Very much a personal commitment of mine, we did also say in light of the large body of evidence and long-running calls for these services to be offered in community pharmacy settings, that NHS England commissions community pharmacies to provide the HIV-prevention medication PrEP and all routine and seasonal immunisations for adults and children.
While this appears to find favour in the response, it does only reference the new HIV Action Plan for 2025-30 which it says is being developed by DHSC, UKHSA and NSHE in close collaboration with local government.
Interestingly, it also makes reference to the Government being “committed to moving to a Neighbourhood Health Service, with more care delivered in local communities”. Sounds good but, as I’ve written before in Political Pills, we’re not sure what that means or if it looks over the heads of community pharmacy or works with it.
On hospital pharmacy - so often forgotten but a vital cog in the wheel and key to timely discharge of course - we ask that an independent review is commissioned to explore hospital medicines management; again to report within one year.
The review should make recommendations, particularly around how the potential of automation and technological systems like connected medication management could be realised and how learning from Global Digital Exemplars can be built upon in Trusts across England.
Again, this was partially accepted as the Minister said he was “committed to exploring opportunities to make use of technology as we look to develop and support our NHS in line with the shift from analogue to digital”, as part of the (you guessed it) 10 Year Health Plan.
On workforce, we talked about lack of access to placements, supervisors and adequate financial support. We talked about the list of healthcare professionals able to access the Learning Support Fund being updated to include pharmacists and technicians.
We covered the criteria connected to the Additional Roles Reimbursement Scheme being urgently reviewed to understand whether any additional flexibility could reduce the drain of community pharmacists into primary care networks.
And we reiterated that an integrated and funded workforce plan for pharmacy must be developed and laid before Parliament “within 12 months”.
Read more: Place ARRS ‘under constant regional review’, report recommends
The Minister said they are committed to growing the pharmacy workforce, agreed he would consider the professions eligible for the learning support fund and look at ARRS as part of the consultation on the 2025/26 GP contract arrangements.
But another review, this time of the Long Term Workforce Plan, will be published as a refreshed version “this Summer”.
Finally, we know community pharmacy can do all manner of things to support the NHS and keep us healthy. Well, it can if it exists.
That is why we recommended (controversially for some) the creation of a new form of “Establishment Payment” to be paid to eligible community pharmacies to support the development of consultation spaces for patients.
We said that funding should be targeted at pharmacies that are the most reliant on NHS work as their main source of income and could be linked to a commitment to provide an agreed level of NHS service.
It was rejected and quotes the £1000 monthly fixed payment participating pharmacies receive as part of Pharmacy First. I can’t help thinking this missed the point given the trajectory we’re on and the stories we hear day after day from the front-line.
Readers can access our full report and the full Government response but, in summary, it’s largely a story of future promise - not promises made. Some may feel this is a movie we’ve seen before.
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I really hope we did produce a report that’s stood the test of time and will genuinely inform and help the Minister as he contributes to the Long Term Plan.
Truth is though, as I have said many times, none of this looks like being fulfilled outside of that process scheduled for “Spring 2025” which is now largely accepted to be June or even July.
That continues to be where the pharmacy rubber hits the reality road.
How far the sector, community in particular, falls between now and then is the everyday challenge faced by the hard working, professional and dedicated workforce Mr Kinnock is right to praise in the first line of his response to my former Select Committee’s report.
Steve Brine is a former pharmacy minister and chaired the cross-party Health & Social Care Select Committee from 2022-2024. He was MP for Winchester 2010-2024.
