'Requires improvement'. Expert Panel verdict on Government's community pharmacy progress
The Government’s progress with the development of pharmacy services in England has been assessed as ‘requires improvement’ in a report of the Expert Panel set up to advise the Health and Social Care Committee of the House of Commons published today.
In a hard-hitting review, the Panel recognises that significant progress has been made in some areas. “The evidence we received led us to rate the commitment to deliver a Community Pharmacist Consultation Service (CPCS) as ‘good’,” the Panel says. “We also rated as ‘good’ the commitment to pilot prevention and detection services through the Pharmacy Integration Fund (PhIF) with a view to mainstream effective services through the CPCF.”
However, the panel also recognised the current challenges to delivery of the Government’s ambitions. “It was clear from the evidence we received that demand for community pharmacy services has increased significantly and that as a result, community pharmacies are struggling to deliver services, or even to remain open, within the existing funding model (the CPCF). We conclude that the commitment to review the funding model has not been met. This, together with funding issues experienced by some community pharmacies alongside increased costs and demand, has had a negative impact on other commitments across multiple policy areas.”
Reflecting that in a prior report it had rated progress on digitalisation of the NHS in England as ‘inadequate’, the Panel added: “Poor digital maturity within Trusts and community pharmacies hampered the progress in meeting commitments. This was particularly the case for the commitments in the policy areas of Integrated care (including patient safety), Extended services, and Hospital pharmacy. We also heard evidence indicating that IT systems were typically inadequate for sharing patient information efficiently between community pharmacies and hospitals and general practice, which contributed to poor uptake of services.”
The Panel also noted that high turnover rates and workforce shortages, which may be exacerbated by general practice and primary care employment through the Additional Roles Reimbursement Scheme, and the increased costs of employing locums impacted both training and delivery. “Legislative changes aimed to improve the skill-mix within community pharmacy and thereby increase community pharmacists’ capacity to deliver clinical services, have not been made. Based on the evidence we have received we conclude that even if, and when, these legislative changes are made, they are unlikely to achieve the desired aims without other additional actions to tackle the workforce challenges experienced within community pharmacy and, importantly, without additional legislation in medicines regulation.”
In an immediate response issued with the report, Steve Brine MP, chair of the Committee, said: “This report from our Expert Panel makes for sobering reading. The Committee is holding a separate inquiry considering what the future of pharmacy could look like because there’s real potential for innovative work and to truly see community pharmacy at least as part of the primary care model. The level of detail about progress by the Government so far will feed into our work and, ultimately, help shape the recommendations we make to Ministers.”
NPA chairman Nick Kaye said: “The NPA wants to give credit where it’s due, for example the roll-out of training related to independent prescribing and urgent care service developments. But the Expert Panel’s must-do-better ratings are the best the government could realistically hope for. Cuts have contaminated the whole scene for nearly a decade, which is one reason why the recent announcement of a fully-funded common conditions service needs to mark a beginning not an end to fresh investment.”
The Expert Panel chose to rate progress – using the ratings common to system regulators like OFSTED and the CQC – across nine commitments in five policy areas: community pharmacy, integrated care (including patient safety), hospital pharmacy, workforce education and training, and extended services. The commitments were chosen to examine “progress on the Government’s delivery of its ambition, as outlined in the NHS Long Term Plan, to increase the role of pharmacies and pharmacy professionals in healthcare. Seven of the nine commitments relate to the Community Pharmacy Contractual Framework.
On the key measure of ‘commitment met’ the Panel rated the maintenance of an Pharmacy Access Scheme with the CPCS as ‘good’, the review of the funding model and the balance between spend on dispensing and services as ‘inadequate’, delivery of the CPCS was rated ‘good’ although on funding and resource the Panel assessment was ‘requires improvement’. The introduction of a medicines reconciliation scheme (the Discharge Medicines Service) ‘requires improvement’, as does education and training including for existing pharmacists. On legislative change to make use of skill mix, progress was rated as ‘inadequate’. Progress on testing additional prevention and detection services was rated ‘good’.
The Expert Panel was established in 2020 to evaluate, independently of the Committee, the progress the Government have made against their own commitments in different areas of healthcare policy. The panel, whose core members are Professor Dame Jane Dacre DBE chair), Professor Emma Cave, Professor Anita Charlesworth CBE, Sir Robert Francis KC, Sir David Pearson and Professor Stephen Peckham, are supplemented by area specialists. In this case of this pharmacy review, these were Nadra Ahmed CBE, the NPA's Mark Lyonette, Dr Rima Makarem, Dr Hamde Nazar, Dr Raliat Onatade, Ellen Williams, and Dr Michael Twigg.
Previous reports in this series have included mental health services, cancer services, the health and social care workforce and NHS digitalisation. Expert Panel: evaluation of the Government’s commitments in the area of pharmacy in England’ can be found here.