Funding, commissioning and regulation must change to enable a digital-first future for community pharmacy, sector bodies have said.

The National Pharmacy Association (NPA), the Independent Pharmacies Association (IPA) and the Company Chemists' Association (CCA) set out a vision for an artificial intelligence (AI) and automation-enabled future for community pharmacy in their responses to the government's 10-Year Health Plan consultation.

But sector bodies including the regulator and negotiator have stressed that funding, commissioning and regulatory arrangements must change to make this possible.

A digital-first future for pharmacy

The NPA said it was 'excited about the potential application of artificial intelligence [AI] in the years ahead, from diagnostic tools to safer dispensing'.

'The key will be to deploy AI in such a way as to increase, not diminish, the face-to-face access to care that people so value,' the organisation added in its response to the consultation.

And the IPA suggested that automation tools 'such as dispensing robots and advanced inventory management systems' could help reduce repetitive tasks, 'allowing pharmacists to focus more on providing direct patient care and fostering stronger community health outcomes'.

Meanwhile, the CCA said that to make use of greater automation and AI-enabled dispensing, the current Electronic Prescription Service (EPS), which it described as effectively 'a paper-based system which has been digitised', must be reviewed.

'This includes single item prescribing by default, greater patient and pharmacy control of prescription periods of treatment, a move away from the concept of a prescription "form" and remove the need to print hard copies of any electronic prescription tokens to send to the NHS BSA [Business Services Authority]', the CCA said.

And more widely, 'there needs to be a review of regulation and operations, to design digital-first', the CCA said.

This could include real-time claiming and payment for activity, better public reporting of activity, and digitisation of prescription tokens, the CCA said.

Digital integration and interoperability 'not where it needs to be'

The lack of integration and interoperability across existing healthcare systems was a common theme among community pharmacy responses to the 10-year plan.

The General Pharmaceutical Council (GPhC) said 'digital integration and interoperability across healthcare is not currently where it needs to be, and can be an obstacle to safe, effective and person-centred care'.

'Allowing pharmacy services full read and write access to a patient’s clinical records in all care settings will bring transformative benefits,' the regulator added.

'This should be prioritised and delivered so that patient care and safety is not put at risk and pharmacy services can maximise the benefits of data-led healthcare.’

It called for a national framework for data interoperability to be developed over the next two to five years.

The IPA also noted that 'limited access to shared care records hampers community pharmacies ability to coordinate effectively with GPs and other providers, often leaving them disconnected from crucial patient information'.

And it said that integrating pharmacies into shared digital care systems would 'significantly enhance patient safety', as well as enabling community pharmacy to deliver 'more thorough medication reviews' and better manage long-term conditions.

The CCA also highlighted 'disjointed' access to patient records in pharmacy.

Update Record was rolled out to 'most pharmacies' by the end of June - five months after Pharmacy First launched in England.

But a snapshot survey found that 61% of GPs said their practice had turned off the Update Record functionality that allows community pharmacies to send Pharmacy First consultation information in a format that can easily be added to patient records.

Practices were instructed to do so by the British Medical Association (BMA) over concerns about data sharing.

The CCA stressed that pharmacists must be able to access records, update notes, notify the GP, and in the future, view and request testing, including phlebotomy. And two-way referrals between pharmacies and other healthcare settings must be enabled.

It also raised concerns around pharmacies using different systems across integrated care boards (ICBs).

'It is extremely difficult for community pharmacies, who provide care across boundaries, to engage with 42 different systems' services which may or may not talk to each other and which may take 42 different approaches to data protection or clinical governance,' the CCA said.

Community Pharmacy England (CPE) also alluded to issues with Update Record in its 10-year plan response, saying that 'in future, all newly commissioned services should be launched with interoperability built into the associated IT infrastructure prior to launch'.

CPE also suggested that in the future, GPs should be able to book an appointment for a patient referred to community pharmacy, and pharmacies should be able to do the same for patients referred to the GP.

And the NHS App could be expanded to allow patients to book vaccinations or other appointments with a pharmacist, CPE added.

Building on the IT integration introduced to support the Pharmacy First service in England, similar programmes are needed 'to support the flow of information between hospitals and community pharmacies, for example in relation to the Discharge Medicines Service and hospital referrals to the Smoking Cessation Service,' CPE also said.

Enablers: funding, commissioning and regulation

Community pharmacy's funding crisis is 'at the heart of the issue' preventing investment in technology, the IPA said.

'Pharmacies cannot innovate their way out of a crisis, and investments in new technologies are difficult for many pharmacies to justify due to cost pressures, cash flow issues, and many medicines being prescribed at a loss by pharmacies,' it said.

In the long term, the IPA said it would like to see government and NHS investment in technological advances that would 'equip pharmacies with advanced tools to enhance efficiency, improve patient outcomes, and enable early diagnosis of illnesses'.

Meanwhile, the CCA said that while 'many pharmacy businesses' have already invested in tools such as automation, they are 'hampered by barriers which inhibit further spending'.

And it said that while automated facilities could save workload and cost, 'there are insufficient opportunities for businesses to earn new money using the workforce capacity released'.

'As a result, business are unable to justify further investment in technology,' the CCA said.

In particular, the CCA called for regulatory changes within the next year or so, including:

The GPhC also noted regulatory changes required to make better use of technology.

It said it welcomed the new Regulatory Innovation Office’s 'early focus on digital and AI in healthcare' and was looking forward 'to discussing with them both the benefits of technology, and how to ensure the regulatory regime is responding positively and proportionately to technological advances'.

And it noted that while AI was 'revolutionising many aspects of modern healthcare', it was still susceptible to bias and cyber-attacks.

Digital literacy for patients and pharmacy teams

The GPhC also said that it would be looking at ensuring pharmacists had the necessary digital skills to make use of technology.

'Developing the skills of the pharmacy workforce now and in the future to be competent with new technology is a key long-term challenge,’ it said.

‘We will ensure this is given consideration in the standards we set for the initial education and training of pharmacists and pharmacy technicians.’

Both the GPhC and NPA also noted variability in digital literacy and access among patients.

The NPA noted how it saw community pharmacies 'taking on a key role in patient digital activation', supporting patients to navigate increasingly digital healthcare services.

The NPA also said that IT infrastructure in community pharmacy should be funded in the same way as general practice.

'The provider pays model adopted in NHS pharmacy is in contrast to the fully funded investment settlement for such platforms in general practice. We need an equitable investment model,' it said.

And it called for 'national contract mechanics to be reformed equitably' to allow medicines optimisation technology to be used by community pharmacy prescribers and case-finding services.

Meanwhile, CPE said that current 'funding squeezes across primary care' prevent investment in technology, while 'contractual incentives do not encourage collaborative working and system-wide recovery'.

'The 10-Year Health Plan must address this and lead to better alignment across the commissioning of services and contractual frameworks.'

The negotiator added: 'There is a clear need for the NHS to continue to invest in the NHS IT infrastructure which supports community pharmacy IT systems.

'That includes continuing to invest in the development of core, national IT systems such as the NHS Electronic Prescription Service.

'Appropriate NHS funding for community pharmacy IT solutions is needed to cover the costs of software, web-based platforms and hardware within community pharmacies. Such funding would allow pharmacy owners to invest in their IT systems to enhance patient care and safety.’

It added that a ‘roadmap for development of NHS and community pharmacy IT systems should be agreed by NHS England to help IT suppliers plan future development of and investment in their systems’.