Reform to the community pharmacy sector must come alongside investment, the pharmacy minister Stephen Kinnock has said. But what could this look like in practice? 

Ahead of the £3.073bn deal for the sector announced last week, Mr Kinnock told press: 'With all investment, reform has to come together with investment'.

And in the light of concern that the funding deal did not match the cost of delivering NHS services set out by the recent economic review, Mr Kinnock suggested that reforms would: 'help to rebuild the sector without necessarily that being about money, because reforms that improve productivity, drive up efficiency, harness the power of technology, they can actually support and help the sector just as much as funding can'.

He added: 'We are in an incredibly tight fiscal environment, so everything that we do in terms of the future of our NHS and the 10-Year Plan is going to have to be grounded in the reality of the economic picture, but that, of course, must also be balanced against the fact that community pharmacy plays an absolutely crucial role in our three shifts from hospital to community, from sickness to prevention, from analogue to digital.

'We can't do it without the pharmacy sector, so we're going to have to invest, yes, but we are going to have to reform and drive up productivity and efficiency too.’

The minister has made similar comments to GPs in recent weeks, while health secretary Wes Streeting has implemented sweeping reforms across the health service, including abolishing NHS England.

While the government did not provide any further details on Mr Kinnock's comments about reform, we know that the new contract enables greater use of skills mix and reduces administrative demands, while hub and spoke legislation is expected to change this year and new pharmacists will become prescribers at the point of registration from 2026.

Amid this changing landscape, The Pharmacist asked leaders what they thought community pharmacy reform might mean for contractors.

Related Article: Beyond ARRS: The impact and future for community pharmacy

Janet Morrison: Contract brings 'small but important changes'

Janet Morrison, chief executive of Community Pharmacy England, said the contract included 'crucial commitments' from the government, including expanded contraception clinical services, a pledge to review margin distribution, and 'a much larger commitment to work with us towards a sustainable funding and operational model for community pharmacy'.

And she said the negotiator would be working with the Department of Health and Social Care and NHS England to 'follow through' on 'their plans for community pharmacy, its inclusion in the NHS 10-Year Plan and their Spending Review submissions'.

'All of these – plus the agreements we secured for wider actions that would help the sector such as on opening hours, distance-selling pharmacies and NMS subcontracting – make small but important changes to begin shaping community pharmacy into a model that’s fit for the future,' she added.

Tase Oputu: Pharmacist prescribing will need planning and budget

Tase Oputu, Royal Pharmaceutical Society England pharmacy board chair, commented on wider reforms across pharmacist education and training that, from 2026, will see all newly qualified pharmacists become independent prescribers.

'With the right support, this could see a step change in the clinical role of pharmacists within the NHS,' she said.

'Enhanced pharmacist prescribing services could build on Pharmacy First, better manage demand across the NHS, and help the government meet its ambition to deliver more care closer to home.'

But Ms Oputu noted that 'making the most of this opportunity to transform patient care will need workforce planning and best use of skill mix, as well as investment in IT systems and a prescribing budget'.

Harry McQuillan: Reforms could free up pharmacists for patient care

Numark chair Harry McQuillan said he had been encouraged by the minister's acknowledgement of a funding gap and a 'commitment to continue to engage'.

And he suggested that the costs set out by the economic review could change as the sector develops.

In particular, he suggested that pharmacists could expect to spend less time on bureaucracy, accuracy checking and dispensing and more time on patient care.

The former chief executive of Community Pharmacy Scotland suggested this could help 'shift' patient mindset from GPs to pharmacies being their first port of call.

'Small wins', like no longer having to sign the back of prescriptions, would take pressure off busy pharmacies, he added.

And having lower interim thresholds for Pharmacy First could help keep the network engaged in the service –  laying the foundations for future pharmacist prescribing, he suggested.

Related Article: Pharmacy First: A year of the service in England

Meanwhile, with technology, legislation and training advancing, Mr McQuillan cast a vision for the future where pharmacist prescribers could manage repeat prescriptions.

And hubs – whether through wholesalers or local cooperatives – or simple scanning technology within each individual pharmacy, could make dispensing more efficient, accurate and safer, he suggested.

Daniel Lee: 'Pharmacists want to get away from the daily grind, but don't know how'

Daniel Lee, chief executive of hub and spoke provider HubRx, said independent contractors were 'really missing out' on the technology available to large automated chains which he said could lead to improved accuracy and increased capacity.

'My message to pharmacists who are running their own businesses is that their uniqueness is their clinical skill... if we can take some of that [dispensing] volume off of you to allow you to concentrate on developing your clinical skills, that builds up your USP within your community, why wouldn't you do that?

'I speak to pharmacists day in day out, who want to get away from the daily grind, but don't know how to how to do that,' he added.

Mr Lee told The Pharmacist: 'Hub and spoke is just one solution that pharmacists should look at.'

He suggested that when legislation changes to allow hub and spoke dispensing across different legal entities, using a centralised facility like HubRx or a wholesaler or supplier hub could be cost-effective for independent contractors with higher than average dispensing volumes.

But 'there are different levels of automation, and there are different levels of hub and spoke', he noted.

Other options could include manual hub and spoke solutions, creating a local cooperative hub with other pharmacies, or investing in automation within pharmacies.

Related Article: Roundtable: Six months of Pharmacy First

Ashley Kilgas: Hub and spoke legislation 'can't come soon enough'

One company supplying both manual and automated hub and spoke solutions, Centred Solutions, said incoming reforms to pharmacy hub and spoke legislation 'can’t come soon enough for many working in community pharmacy who are looking for ways to transform their businesses'.

The government has said that legislation to enable 'model one' (patient – spoke – hub – spoke – patient) hub and spoke dispensing across different legal entities will be laid 'in the coming weeks' and come into force 'later this year'.

Centred Solutions chief commercial officer Ashley Kilgas said enabling hub and spoke across different legal entities was 'more important than ever' following the contract funding announcement 'which, on its own, may not be enough to sustain community pharmacy'.

'What is needed is a combination of funding and reform. These reforms include ways of streamlining the dispensing service while maintaining, and even increasing, item volumes. This includes making hub and spoke an option for all pharmacies so they have more capacity to deliver services,' he added.