A response to questions about community pharmacy given in the House of Lords ‘can only be described as utterly complacent and dismissive’ of the problems facing the sector, National Pharmacy  Association (NPA) chief executive Mark Lyonette has told The Pharmacist.

The comments were made by Lord Evans of Rainow, a Conservative peer and government whip in the House of Lords, who was speaking on behalf of the government in answer to questions raised by peers as part of a House of Lords debate on community pharmacy.

Pharmacy leaders from the the Association of Independent Multiple Pharmacies (AIMp) and the Pharmaceutical Services Negotiating Committee (PSNC) also expressed their disappointment with the comments.

Mr Lyonette said that Lord Evans had refused to acknowledge any problems relating to capacity, workforce or financing, ‘and it follows he offered no solutions either’.

The NPA chief executive said that the remarks were ‘a new low’ in terms of governmental response to community pharmacy’s funding crisis.

In particular, the NPA said that Lord Evans had insinuated ‘that his government need not care about pharmacy closures because as private businesses they are free to fail’ – which the group strongly objected to.

Mr Lyonette said that the NPA would be following up with the peer ‘to help him better understand the true value of the community pharmacy network to patients and communities across the land.’

Pharmacy closures

In response to a question about pharmacy closures particularly affecting patients in deprived areas, Lord Evans said that 80% of the population live within 20 minutes’ walking distance of a pharmacy and that there are twice as many pharmacies in more deprived areas. ‘Despite a reduction in the network in recent years, there are still about the same number of pharmacies today as there were 10 years ago,' he added.

Dr Leyla Hannbeck, chief executive of AIMp said that ‘the devil is sadly in the details’. She said that of the 850 closures of community pharmacies since 2015, 40% were in areas of deprivation, which she said ‘will inevitably add to the inequalities faced by society’.

She added that the supply of medicines is a public sector service provided on behalf of government, and asked: ‘Is it acceptable for these businesses to be set up to fail and lose such a respected and previous resource?’

PSNC chief executive Janet Morrison said that Lord Evans had failed to answer the question on pharmacy closures.

She said: 'Over 100,000 hours were lost in temporary closures between October 2021 and December 2022, and there are increasing numbers of permanent closures, consolidations and sales amongst the multiples and supermarkets. The number of pharmacies has been set back to what it was 12 years ago, despite an increase of around 20% in national prescription volumes in the same period, and a significant growth in patient demand for pharmacy services.

'We have a real concern that, if nothing changes, we may very soon see a domino effect as pharmacies close to those that have closed struggle to cope with the increased demand this creates.

'As several Peers pointed out, if the Government continue down this path then we will soon see many more pharmacy closures with medicines supply and access to all other pharmacy services put at risk.

Pharmacy First

When asked to confirm whether the Government will enter into discussions with the Pharmaceutical Services Negotiating Committee (PSNC) to look at introducing a fairly funded ‘pharmacy first’ service, Lord Evans said that although the government was ‘yet to label our service offer as “pharmacy first”’, it had already introduced and funded a range of services in community pharmacy that make use of the clinical skills of pharmacy teams.

But last week PSNC told the Department of Health and Social Care (DHSC) that even clinical services already agreed within the Community Pharmacy Contractual Framework (CPCF), such as the pharmacy contraception service, could not go ahead without additional funding.

Ms Morrison described the government's responses in the House of Lords debate as 'out of touch with the crisis that is unfolding in community pharmacy'.

She told The Pharmacist: 'Pharmacies are not currently funded to offer a comprehensive service that treats a host of minor ailments and utilises PGDs and Independent Prescribers to their full capacity.'

She added that while Lord Evans was right to say that the government had introduced a range of new services, 'the responses don’t address the fact that they are not paying pharmacies enough to deliver those services'.

Dr Hannbeck told The Pharmacist that contractors did not have the headroom or financial security to invest in developing services.

‘Community pharmacy is operating within a dysfunctional contract whose margin envelope simply does not enable the fixed costs of running a bricks and mortar pharmacy,’ she said.

She added that AIMp members were wrestling ‘horrific purchase ledgers’ and ‘cash deficits which are largely 30-day demands’ and could not ‘even comprehend the headroom to develop services’.

‘Would a construction company build a new venture 200 storeys high without a secure and dependable foundation to grow and achieve its intended purpose?’ she added.

Clinical records

Baroness Finlay of Llandaff asked Lord Evans whether the government would look at giving pharmacists access to clinical records with the patients’ permission, a lock of which she said was currently preventing pharmacists from being able to give ‘appropriate, targeted advice’.

Lord Evans responded: 'From my personal experience of pharmacies, they do have access to those records, but unfortunately that is not across the board and there is still more to be done on that front.'

Currently, most pharmacy teams have limited access to patient records.

Pharmacies were granted access to Summary Care Records (SCR) Additional Information during the pandemic, but it has not been  confirmed whether this will continue indefinitely.

In a few areas of the country, pharmacies have access to Shared Care Records (ShCRs), containing more information from GPs, secondary care, social care, local authorities and other services. Access to these records is dependent on Integrated Care Boards (ICBs) and currently only exists in limited areas.

Dr Hannbeck commented that although there are a few pioneers of shared records and access to read and write records, closer integration and trust of community pharmacy would be needed to make this more widespread. She said that ‘regrettably’, ‘integration can only progress at the speed of trust’.

PSNC added that its Community Pharmacy IT Group believes that community pharmacy teams should have access to up-to-date records information.

When will the government act?

PSNC thanked peers for drawing attention to the issues facing the community pharmacy sector.

‘What has to happen… for the Government to realise that there’s a crisis?’ asked Lord Grade during the debate, adding that ‘the Government seems to be in total denial.’

Lord Hunt former Lords deputy leader, added: ‘Many pharmacies are going to the wall and are faced with huge inflationary pressures and all we get are platitudes from the Government, when are they going to do something?’

PSNC chief executive, Janet Morrison said that the negotiating body was ‘very grateful for the support of all Peers who spoke up for community pharmacies’.

She said that the ‘abundance of political goodwill towards the sector’ as well as ‘very real concern about the future’ and its impact on patients was clear.

‘We hope Government will take note of this political will and take urgent action to preserve the network of community pharmacies, to safeguard safe and reliable access to medicines for patients and the public,’ she added.