There was a 'missed opportunity' to make use of the community pharmacy sector during the early stages of the Covid-19 vaccination programme roll-out, an inquiry has been told.

Speaking on behalf of the National Pharmacy Association, lawyer Deirdre Domingo also asked the UK Covid-19 Inquiry to consider whether there was 'a broader tendency' to overlook existing NHS resource and expertise.

Community pharmacy premises under-utilised

Firstly, Ms Domingo suggested that the physical community pharmacy estate was under-utilised, with temporary large vaccine clinics created rather than making use of the community pharmacy network.

And she said the 'gap-in-service' role community pharmacy initially played was a 'missed opportunity', and that pharmacies should have been involved from the beginning of the planning process.

'The NPA considers that it is more effective and efficient to build and deliver healthcare services such as a vaccination programme through existing health infrastructure, which includes the extensive community pharmacy network,' she said.

'The inquiry is invited to examine and consider whether the creation of mass vaccination centres was a further example of a broader tendency to overlook existing NHS resource and expertise in favour of the creation of expensive, temporary systems and services with last little lasting utility,' she said.

Ms Domingo also highlighted restrictive requirements on vaccine providers for the initial stage of the roll-out, which she said prevented many community pharmacies from being able to deliver vaccinations at the time.

'Participation in phase one in England required the administration of at least 1,000 vaccination doses per week and opening hours of between 8am and 8pm seven days a week,' she said.

'This unnecessarily prevented the participation of smaller pharmacies who did not have the physical space to deliver this volume of vaccinations or the staffing capacity to administer them.

'Largely because of these restrictions, there were only six community pharmacy-led contributors to the first wave of phase one of the programme.'

'As requirements were relaxed, community pharmacy was able to make a much broader and more effective contribution,' she added, highlighting that by June 2021 over 500 community pharmacies had delivered more than five million vaccines in England.

Diversity of pharmacy sector under-appreciated

Ms Domingo suggested that there was 'a delay in recognising the positive role' that community pharmacy was able to play in addressing vaccine hesitancy.

She noted: 'Approximately 50% of the NPA's membership are from [an] ethnic minority background.'

And she said: 'The role of community pharmacies as trusted healthcare professionals at the heart of their communities means they are ideally placed to respond to the needs and concerns of their patients and to address health inequalities and vaccine hesitance within communities.

'Community pharmacies play a particularly important role in deprived communities, which often have less access to other healthcare services. Over a third of the vaccinations provided by community pharmacy were delivered in the most deprived communities in the country.'

While she acknowledged that 'lessons were learned over the course of the programme', she said that the role of community pharmacy in reaching remote, rural and hesitant communities 'should be key learning for the future'.

'The experience of the pandemic demonstrates that community pharmacy can play an expanded role in this area [of vaccinations], drawing on the network's accessibility and ability to reach communities that often find it harder to receive health services,' Ms Domingo told the inquiry.

Dual booking system 'adversely impacted efficiency'

Ms Domingo also drew attention to the difficulties of general practices generally using a different booking system to community pharmacies and vaccination centres for Covid-19 vaccinations.

'The NPA's view is that having a dual booking system was, in effect, inefficient and wasteful.

'The two systems did not share information, allowing for duplicate bookings, which resulted in missed appointments and adversely impacted efficiency.

'This situation would have been worse, but for the flexibility and resourcefulness of frontline healthcare workers in sharing and sourcing unused vaccination supplies,' Ms Domingo said.

She also highlighted 'poor communications with vaccinators' who sometimes found out about changes on the national news the evening before they needed to be implemented.

Maintaining and improving routine vaccination infrastructure 'fundamental' to any future pandemic response

Also at the Covid-19 inquiry, Bilal Rawat, speaking on behalf of the UK Health Security Agency (UKHSA), highlighted the 'highly effective' local delivery of vaccinations through general practice and community pharmacy.

'Routine vaccination work in peace time provides the bedrock from which to scale in a pandemic. The Covid-19 vaccination programme benefited from the infrastructure already in place for the delivery of routine immunisation programs,' he said.

'Sometimes being able to receive a vaccine in a familiar environment can support public confidence,' Mr Rawat added.

'Maintaining and improving the infrastructure for routine immunisation would be fundamental to mitigating potential harm from a future pandemic, because it provides a starting point for any scaling up of a vaccination program,' he said.

Malcolm Harrison, chief executive of the CCA, commented that 'against a backdrop of nationally falling uptake for many vaccines' pharmacies could play an even greater role in delivering NHS vaccination programmes 'including pneumonia, shingles, meningitis, RSV and other routine childhood vaccinations'.

Taken together, this would free up 10 million GP vaccination appointments each year, he said.

But he stressed that this would only be possible 'if pharmacies receive the funding they urgently need to stop further closures and protect the network'.

'Contract negotiations must begin at once and pharmacies must receive the funding they have been starved of for so long,' Mr Harrison added.