Urgent need for clarity as government suspends pharmacy cut plans

The government has suspended plans that would have put thousands of community pharmacies at risk of closure – but there is an urgent need for clarity, according to experts at a recent QuintilesIMS webinar.

When David Mowat, the Parliamentary Under Secretary of State for Community Health and Care, announced at the beginning of the month that cuts to community pharmacy funding would not be implemented in October, the initial reaction from those affected was one of relief. However, this reaction may be short-lived, as the minister said the government has only decided to put on hold cuts that would probably lead to closure of thousands of pharmacies across the country, while the plans are reviewed.

Mowat’s announcement at the Royal Pharmaceutical Society conference in Birmingham that the government would “take some time” to ensure it is making the “right decision” followed a petition signed by more than two million people opposing the plans.

So the fight is on to secure the future of the small pharmacists that were threatened by the proposals, with one option being to increase their value within the community. Methods to achieve this include being the first point of care more frequently and offering a greater range of patient services, such as disease prevention education, adherence programme delivery and lifestyle advice.

At a recent webinar conducted by QuintilesIMS, in collaboration with pharmaphorum (which took place prior to Mowat’s announcement), QuintilesIMS estimated that proposed cuts of £170 million, from a pharmacy budget of £2.8 billion, could put 2,400 pharmacies at moderate-to-high risk of closure, with 269 of these deemed at very high risk.

John Carney, senior principal, supplier services at QuintilesIMS said that the proposals could lead to “significant disruption” to between 110,000–600,000 people, assuming each pharmacy served around 4,500 people.

The webinar’s expert panel proposed that the government saw pharmacy as an easy target for efficiency savings, but made it clear that the cuts were not the only issue that caused them significant concern.

Hub and spoke

The panel said the government was also attempting to re-engineer the way pharmacies serve patients, and was using the cuts as an opportunity to impose a ‘hub and spoke’ infrastructure. This model is based around a central ‘hub’ where prescriptions are prepared – and patient-facing ‘spoke’ pharmacies that hand out treatments.

The system is already used by some larger chains and is seen by the government as a more efficient way to meet patients’ needs. But, although it works in some instances, this ‘one-size-fits-all’ approach may not be suitable for all areas and populations, and the panel warned it could result in serious reductions in the extra patient services provided by pharmacists that patients rely on, which frequently serve to relieve pressure on other areas of the NHS.

In an announcement in July, pharmacy minister Alistair Burt said hub and spoke would not be introduced in October as planned – but the uncertainty over the direction of travel remains.

There are also fears that the government is attempting to introduce more online pharmacies through the back door – even though this does not suit the needs of many patients who rely on community pharmacists as a first port of call if they feel unwell.

Sandra Gidley, community pharmacist and chair of the Royal Pharmaceutical Society’s English Pharmacy Board, told the panel that she was concerned about the trajectory of governmental policy around community pharmacy. While the drive towards online services may suit some patients, those who are older and less likely to adopt new technology are the types of patient who need pharmacists the most, she argued.

Gidley said: “The depressing thing in all of this is that we see a drive to separate the supplies we make from the clinical services that pharmacists can deliver.”

Not just dispensing

Perhaps offering a crumb of comfort to Gidley, and those who have broader concerns about the wider role of pharmacists, Mowat in his speech said the pharmacy profession “rightly recognises that it needs to go further away from just doing dispensing into the service area.”

A Pharmacy Integration Fund, worth £20 million this year and rising to £300 million by 2020–21, was included in the government’s plans, and is intended to help pharmacists and their teams align more closely with GP practices. But details of whether this will still be implemented and, if so, how the scheme will work, are still unclear.

There are also concerns that the cuts to pharmacy will exacerbate problems caused by financial pressures on the NHS. Around three quarters of hospitals are operating in the red, and ran up a deficit of £461 million between April and June. Patient waiting times have increased, with 89.31% (vs. 95% target) of patients being seen within four hours in over-stretched A&E departments.

Services such as community pharmacies could, and should, become more important as hospitals and GP surgeries come under pressure, providing extra capacity that could deal with less serious illnesses.

John Smith, chief executive of the Proprietary Association of Great Britain (PAGB), said: “Our research shows that one-in-five visits to A&E and also to the GP are for conditions that could be self-treated.” The PAGB strongly backs raising the profile of pharmacists as expert healthcare providers. “We believe that, in the role of a high-street healthcare professional, not only will pharmacists enable people to obtain faster treatment but, in reducing the load on the NHS primary – and secondary – providers, they can also deliver savings to the taxpayer,” added Smith.

Changes needed, not cuts

The consensus seems to be that change – but not cuts – is needed to ensure pharmacy services meet patients’ needs and reduce pressure on the busiest NHS wards and A&E units. A recent poll by QuintilesIMS found that 79% of respondents across industry and pharmacy said there was a need for an increased range of patient services in order for them to succeed in the changing environment.

Professor Rob Darracott, chief executive of the umbrella group Pharmacy Voice, said that “most innovation comes through interaction with patients” and argued that community pharmacists were well placed to question patients, identify other health problems and give public health advice, at no charge to the NHS.

Pharmacists already contribute with innovative services such as medicines optimisation, discussing ‘wellness packages’ and improving compliance with prescribed medication. Given that there are a billion transactions a year in community pharmacies, a relatively small change in practice across all pharmacies could yield significant results, Darracott argued.

However, pharmacy has been in turmoil since the government announced its plans in a letter to the industry’s negotiating body late last year.

Deliberations

The sector is awaiting Mowat’s conclusions following his period of deliberation. Although nothing has been officially announced, those involved with community pharmacy will listen intently during Theresa May’s first Autumn Statement, dedicated to NHS funding, for any news.

The panel of experts at the webinar concluded that the government must provide clarity on its plans. There is also a need for an end to the siloed thinking that has proposed swingeing cost cuts, with little thought about the wider implications for patients, the health service and society as a whole.

The PAGB’s John Smith concluded that the government must learn from the response to its proposals and the opposition from pharmacists and patient groups. He said: “We need a strategic approach to building the future between the sector, government and the NHS, which is aligned to the goals of the NHS, but does not leave implementation and delivery to chance.”

Ultimately, though, whatever the government’s next move is regarding these cuts – this is a clear message to the pharmacy sector that its role within the NHS must be more visible to patients and more extensive. As with many of the issues the UK health sector faces, a large part of the solution lies in stakeholder and patient collaboration/education and a clear, measured understanding of the value that the pharmacy sector brings to both the care pathway and the NHS budget.

Click here to listen to the full on-demand webinar ‘What do the upcoming changes to England’s pharmacy funding mean?’

About the author:

Richard Staines is Senior Reporter at pharmaphorum. Contact him via:Richard.Staines@pharmaphorum.com