Pharmacy and the impact of Covid-19

Background

Since April 2013 NHS England has held responsibility for commissioning NHS primary care services, including community pharmacy services. Clinical commissioning groups (CCGs) and local authorities are also free to commission further services from community pharmacies over and above those commissioned by NHS England.

Community pharmacies in England provide services under the NHS Community Pharmacy Contractual Framework (CPCF), and can include a range of services categorised as ‘Essential’, ‘Advanced’, ‘Enhanced’ and ‘Locally Commissioned’:

• Essential services include dispensing medicines and appliances, providing advice on self-care and promoting healthy lifestyles.
• Advanced services could include the provision of Medicine Use Reviews, or offering NHS flu vaccinations.
• Enhanced services could include services such as anticoagulation monitoring.
• Locally commissioned services might include public health services commissioned by local authorities, such as smoking cessation services.

While pharmacy contractors must provide Essential services, they can choose whether they wish to provide Advanced and Enhanced services.

The ‘CPCF for 2019/20 to 2023/24’ came into force from 1 October 2019.

Paragraph 4.21 of the NHS Long Term Plan (January 2019) noted that pharmacists will have a key role in delivering the objectives of the NHS in England over the next 10 years, and provided the following on community pharmacy:

• In community pharmacy, we will work with government to make greater use of community pharmacists’ skills and opportunities to engage patients, while also exploring further efficiencies through reform of reimbursement and wider supply arrangements.[1]

The National Pharmacy Association report ‘Impacts of current funding, policy and economic environment on independent pharmacy in England’ published in September 2020 provides the following summary:

There are 11,539 community pharmacy premises in England, with around half of those being independently owned. […]

• NHS England accounts for c. 87% of revenues received by pharmacy services in the UK, with other income coming from additional services commissioned by local authorities and OTC [over the counter] sales.[2]

The ‘Community Pharmacy News – February 2021’ published by the Pharmaceutical Services Negotiating Committee (PSNC) includes the following comments on the impact of Covid-19 on community pharmacies:

• Alongside health advice, over the past 12 months community pharmacies up and down the country have each dispensed thousands of NHS prescriptions (over 1 billion in total in England) and carried out other patient-facing NHS services for tens of millions of patients – all in a COVID secure environment and racking-up a costs bill of over £400m. […]
• The year (perhaps years?) ahead will likely need pharmacies in every community in England to be able to support COVID-19 testing and vaccinate their local populations as GP colleagues get pulled back to deal with the tsunami of patients with undiagnosed illnesses waiting at their doors. […]
• But in the last five years we have seen c.600 pharmacy closures, with more than half of those in the most deprived areas of the country.[3]

The ‘Community Pharmacy News’ also sets out how community pharmacies are offering new services to support wider health services, including the Discharge Medicines Service [4] The Discharge Medicines Service became a new Essential service within the CPCF on 15 February 2021. From this date NHS Trusts have been able to refer patients who would benefit from extra guidance around new prescribed medicines to community pharmacies, with the aim of reducing avoidable harm from medicines and hospital readmissions.[5]

Community pharmacies have also been involved in initiatives during the pandemic, such as supporting victims of domestic abuse. The Ask for ANI (Action Needed Immediately) scheme was launched on 14 January 2021. The GOV.UK website sets out that “by asking for ANI, a trained pharmacy worker will offer a private space where they can understand if the victim needs to speak to the police or would like help to access support services such as national or local domestic abuse helplines.”[6]

The press release states that the scheme will initially be available through the 2,300 Boots stores across the UK as well as 255 independent pharmacies, with an on-going sign-up process open to all pharmacies.

[1]     NHS, NHS Long Term Plan, page 82, last updated 21 August 2019

[2]     National Pharmacy Association, Impacts of current funding, policy and economic environment on independent pharmacy in England, September 2020, page 7

[3]     PSNC, Community Pharmacy News – February 2021, page 2

[4]     PSNC, Community Pharmacy News – February 2021, page 2

[5]     PSNC, Discharge Medicines Service

[6]     GOV.UK, Pharmacies launch codeword scheme to offer ‘lifeline’ to domestic abuse victims, 14 January 2021