Community pharmacy has lost much of its ability 'to be a shock absorber' for other parts of primary care, sector leaders have warned as GP collective action begins today.

And they have called for 'a new deal' for the community pharmacy sector in addition to resolving government disputes with GPs.

Having voted overwhelmingly in favour of taking action, practices can 'pick and choose' from a range of actions proposed by the British Medical Association (BMA), beginning today.

This could include limiting daily contacts per clinician to 25 and switching off the  GP Connect Update Record functionality that allows community pharmacies to send data about Pharmacy First consultations that can be easily added to the patient's record.

But Janet Morrison, chief executive of Community Pharmacy England (CPE), warned 'GP teams are not the only people in primary care who are exhausted, overworked and struggling to make ends meet'.

And she said the negotiator would continue to push the new government and NHS England 'to address the underfunding of pharmacy services'.

She suggested that if patients were not able to access their GP practice for help, many would turn to their local pharmacies instead, as happened throughout the pandemic.

'But pharmacies are already under considerable strain as everybody in the sector is only too aware,' she said.

'Pharmacy teams will always do their best to help patients during times of crisis – but they can only do so much.

'They may have to prioritise the safe supply of NHS prescriptions and dealing with patients referred by NHS 111 over other NHS services.

'Patient safety is our utmost concern and pharmacy owners may need to activate parts of their business continuity plans, including prioritising the safe supply of NHS prescriptions,' she said.

Nick Kaye, National Pharmacy Association (NPA) chair, agreed that collective action by GPs was 'bound to have a ripple effect on community pharmacies'.

'Where GP practices limit their number of daily appointments, it’s likely that more patients will come to community pharmacies for healthcare advice, reassurance and over-the- counter medicines.

'However, community pharmacy’s ability to be an effective shock-absorber for disruption elsewhere in the healthcare system has been eroded by persistent underfunding, which has created serious capacity challenges in our own sector.

'Pharmacies in England have suffered a 40% real-terms cut over the last decade, leading to staff cuts, reduced opening hours and a wave of closures.

'As well as finding a resolution to the doctors disputes, the new government must forge a new deal with community pharmacy which funds us properly, treats us with respect and keeps our doors open to serve patients,' he said.

Malcolm Harrison, chief executive of the Company Chemists' Association (CCA) suggested that the impact of the action could be similar to that caused by the recent global IT outage, when pharmacies saw 'significantly more patients' than usual.

He also highlighted that the pressures seen within general practice 'are also prevalent within community pharmacy'.

Highlighting over 1,200 pharmacy closures since 2015, he commented: 'Pharmacies will only be able to continue to provide NHS services to patients if there is a complete overhaul of the pharmacy contract.'

'It’s clear that primary care as a whole needs additional funding, if the new Government is to deliver on its ambitions for the whole health service,' Mr Harrison said.

Dr Leyla Hannbeck, chief executive of the Independent Pharmacies Association (IPA), also commented that the action in general practice would 'only place a heavier burden on already stretched community pharmacies'.

'Our sector is severely underfunded and overworked - we kept our doors open throughout the pandemic and have worked non stop for the NHS delivering accessible care,' she said.

'We cannot continue being taken for granted.’

What actions can GP practices choose from?
  1. Limit daily patient contacts per clinician to the UEMO recommended safe maximum of 25. Divert patients to local urgent care settings once daily maximum capacity has been reached. We strongly advise consultations are offered face-to-face. This is better for patients and clinicians
  2. Stop engaging with the e-Referral Advice & Guidance pathway - unless for you it is a timely and clinically helpful process in your professional role​.
  3. Serve notice on any voluntary services currently undertaken that plug local commissioning gaps and stop supporting the system at the expense of your business and staff.
  4. Stop rationing referrals, investigations, and admissions​
    - Refer, investigate or admit your patient for specialist care when it is clinically appropriate to do so. ​
    - Refer via eRS for two-week wait (2WW) appointments, but outside of that write a professional referral letter in place of any locally imposed proformas or referral forms where this is preferable. It is not contractual to use a local referral form/proforma – quote our guidance and sample wording
  5. Switch off GPConnect Update Record functionality that permits the entry of coding into the GP clinical record by third-party providers.
  6. Withdraw permission for data sharing agreements that exclusively use data for secondary purposes (i.e. not direct care). Read our guidance on GP data sharing and GP data controllership.
  7. Freeze sign-up to any new data sharing agreements or local system data sharing platforms. Read our guidance on GP data sharing and GP data controllership.
  8. Switch off Medicines Optimisation Software embedded by the local ICB for the purposes of system financial savings and/or rationing (rather than the clinical benefit of your patients).
  9. Defer signing declarations of completion for “better digital telephony” and “simpler online requests” until further GPC England guidance is available. In the meantime:
    - Defer signing off ”Better digital telephony” until after October 2024: do not agree to share your call volume data metrics with NHS England.
    - Defer signing off “Simpler online requests” until Spring 2025: do not agree to keep your online triage tools on throughout core practice opening hours, even when you have reached your maximum safe capacity.
  10.  Defer making any decisions to accept local or national NHSE Pilot programmes whilst we explore opportunities with the new Government.

    Source: BMA