Source · Select Committees · Health and Social Care Committee
Third Report - Pharmacy
Health and Social Care Committee
HC 140
Published 29 May 2024
Recommendations
2
Deferred
Overhaul the Community Pharmacy Contractual Framework to address funding gaps and reduce complexity.
Recommendation
We recommend that the Community Pharmacy Contractual Framework (CPCF) is completely overhauled, in close consultation with the community pharmacy sector. Any new framework must: a) close the gap in funding that community pharmacy has experienced over the course of the …
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Government Response Summary
The government's response focused on Serious Shortage Protocols (SSPs) as a tool to manage medicine shortages, explaining their use and stating that the policy will continue to be kept under review. It did not address the recommendation to completely overhaul the Community Pharmacy Contractual Framework.
Department of Health and Social Care
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5
Deferred
Review the effectiveness of Serious Shortage Protocols, focusing on timing and administrative burden.
Recommendation
We recommend that the Government reviews the effectiveness of Serious Shortage Protocols, with a focus on their timing and their administrative burden. (Paragraph 49) 44 Pharmacy
Government Response Summary
The government discusses the role of National Patient Safety Alerts and Medicine Supply Notifications in managing shortages, but does not address the specific recommendation to review the effectiveness, timing, or administrative burden of Serious Shortage Protocols (SSPs).
Department of Health and Social Care
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6
Acknowledged
Para 50
Update regulations to allow pharmacists to make dose and formulation substitutions for out-of-stock medicines.
Recommendation
We recommend that regulations are updated within three months to allow pharmacists in community settings to make dose and formulation substitutions for out-of-stock items, subject to the safeguards set out in the Royal Pharmaceutical Society’s Medicines Shortage Policy.
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Government Response Summary
The government acknowledges the complexity of medicine supply and states it is taking actions to improve management, but does not commit to updating regulations within three months for pharmacist substitutions, instead stating it will keep the idea of an independent review under consideration.
Department of Health and Social Care
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7
Deferred
Para 51
Introduce generic substitution following consultation to ensure patient safety and supply chain stability.
Recommendation
We believe that allowing generic substitution would be an important way of reducing the need for patients to return to their GP for out-of-stock medication. We further recommend the introduction of generic substitution, which should follow a government consultation focusing …
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Government Response Summary
The government responds by outlining its commitment to expanding the role of pharmacists and introducing prescribing services, but does not address the specific recommendation to introduce generic substitution or to consult on its implementation.
Department of Health and Social Care
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8
Deferred
Para 52
Set out impact of Patient Safety Alerts on private prescribing and enforcement measures.
Recommendation
In their response to this report, the Government should set out what impact it believes National Patient Safety Alerts have on private prescribing and what scrutiny and enforcement measures are in place to ensure private prescribers adhere to these alerts.
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Government Response Summary
The government acknowledges the point but then discusses the new HIV Action Plan for 2025-30 and PrEP access, mentioning pilot studies for PrEP delivery, without addressing the impact of National Patient Safety Alerts on private prescribing or their enforcement.
Department of Health and Social Care
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10
Deferred
Commission an independent review of the medicines supply chain, including resilience and generic availability.
Recommendation
The Government should commission an independent review of the medicines supply chain. Given the impact that shortages are having, this should be commissioned as soon as possible and completed within 6 months of starting. The review should assess, and suggest …
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Government Response Summary
The government discusses past and present pharmacy funding mechanisms, including the phased-out establishment payment and the Pharmacy First monthly payment, without addressing the recommendation to commission an independent review of the medicines supply chain.
Department of Health and Social Care
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12
Acknowledged
Para 83
Publish a long-term vision for expanding clinical services and roles within community pharmacies.
Recommendation
We recommend that the Government and NHS England publish a long-term vision for the further development of clinical services in community pharmacy settings within one year. This vision should: a) include consideration of examples of success within locally commissioned services, …
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Government Response Summary
The government outlines ongoing efforts to roll out digital capabilities for Pharmacy First and commits to ongoing monitoring and evaluation of the service via an NIHR study, but does not provide a comprehensive long-term vision for expanded clinical services with specific timeframes or funding commitments.
Department of Health and Social Care
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13
Acknowledged
Para 84
Commission community pharmacies to provide HIV-prevention PrEP and all routine adult and child immunisations.
Recommendation
In the shorter term, and in light of the large body of evidence and long-running calls for these services to be offered in community pharmacy settings, we recommend that NHS England commissions community pharmacies to provide the HIV-prevention medication PrEP …
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Government Response Summary
The government will consider the recommendation to commission community pharmacies for PrEP and immunisations as part of developing a 10-Year Health Plan focused on technology and digital transformation.
Department of Health and Social Care
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15
Deferred
Para 92
Caution against mandating widespread implementation of hub and spoke systems in pharmacies.
Recommendation
While hub and spoke arrangements may be beneficial to some pharmacies, we do not believe this is a ‘silver bullet’ in terms of efficiencies. We urge the Government not to assume that hub and spoke alone will deliver the extra …
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Government Response Summary
The government deflected the recommendation about hub and spoke arrangements by discussing the eligibility of MPharm students for the Learning Support Fund and exploring consistent policy for funding their travel and accommodation costs.
Department of Health and Social Care
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17
Accepted
Para 98
Commit to ongoing promotion of Pharmacy First to enhance public confidence and education.
Recommendation
As well as addressing medicine shortages and broadening pharmacists’ ability to offer alternatives, to support public confidence and education, the Government should commit to the ongoing promotion of Pharmacy First beyond what has already been announced.
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Government Response Summary
The government will publish a refreshed Long-Term Workforce Plan and is implementing strategies to integrate the pharmacy workforce across Integrated Care Systems. This includes introducing rotations for trainee pharmacists from 2025/26 and providing additional funding for clinical training, including independent prescribing.
Department of Health and Social Care
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19
Deferred
Para 106
Create new Establishment Payment for community pharmacies to develop patient consultation spaces.
Recommendation
We recommend the creation of a new “Establishment Payment” to be paid to eligible community pharmacies to support the development of consultation spaces for patients. This funding should be targeted at pharmacies that are the most reliant on NHS work …
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Government Response Summary
The government deflected the recommendation for a new 'Establishment Payment' to support consultation spaces by discussing pharmacy workforce integration within Integrated Care Boards and the ongoing exploration of how to best utilise pharmacy skills for future services.
Department of Health and Social Care
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20
Accepted in Part
Para 108
Provide free over-the-counter medication for low-income patients through Pharmacy First scheme.
Recommendation
To avoid patients continuing to use GPs for support that could be offered in a community pharmacy setting because of concerns about the affordability of over-the- counter medication, we recommend that such medication is free for people on low incomes, …
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Government Response Summary
The government partially accepts, clarifying that prescription-only medications supplied via Pharmacy First are free for those with existing exemptions. However, they refer to a 2018 report which concluded that providing over-the-counter medication free of charge would not offer value for money.
Department of Health and Social Care
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21
Accepted in Part
Para 112
Require Government to detail progress on Pharmacy First digital product rollout and interoperability.
Recommendation
When responding to this report, we ask that the Government sets out what progress has been made on rolling out the full digital product for the documentation of Pharmacy First consultations, including the percentage of community pharmacies that have fully …
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Government Response Summary
The government accepts the recommendation to provide progress updates on Pharmacy First digital capabilities, detailing rollout percentages and timelines for electronic referrals and record updates. However, it explicitly rejects enabling full read/write access to patient records for community pharmacies due to NHS England policy.
Department of Health and Social Care
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22
Accepted
Para 113
Mandate Pharmacy First evaluation assesses digital systems' data sharing for patient safety and care.
Recommendation
We recommend that the ongoing evaluation of Pharmacy First includes an assessment of the extent to which pharmacy and general practice digital systems are enabling the necessary data sharing to protect patient safety and ensure continuity of care.
Government Response Summary
The government accepts the recommendation, stating that the National Institute for Health and Care Research study evaluating Pharmacy First includes a specific line of inquiry to review the effectiveness of GP minor illness referrals and data exchange between pharmacy and general practice to inform future service developments.
Department of Health and Social Care
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23
Accepted in Part
Para 130
Strategic oversight lacking for widespread adoption of automation in hospital medicines management.
Recommendation
There are clearly benefits to be found from using automation and technology particularly within hospital medicines management. These benefits could unlock gains in productivity, improve patient safety and free up pharmacist time to work more directly with patients. There are …
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Government Response Summary
The government will consider the recommendation for a more strategic view for how medicines are managed in hospitals as part of the development of the 10 Year Health Plan and how this can be applied to Trusts across England.
Department of Health and Social Care
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24
Accepted in Part
Commission independent review into hospital medicines management, focusing on automation and digital systems.
Recommendation
We recommend that an independent review is commissioned to explore hospital medicines management, to report within one year. The review should make recommendations, particularly around how the potential of automation and technological systems like connected medication management could be realised …
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Government Response Summary
The government partially accepts the recommendation, committing to explore opportunities for technology use and consider the recommendation as part of developing a 10-Year Health Plan objective, rather than commissioning an independent review within one year.
Department of Health and Social Care
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26
Accepted in Part
Update Learning Support Fund eligibility to include pharmacists and pharmacy technicians.
Recommendation
We recommend that the list of healthcare professionals able to access the Learning Support Fund is updated to include pharmacists and technicians. (Paragraph 140) Pharmacy 47
Government Response Summary
The government partially accepts, explaining that MPharm students are currently outside the Learning Support Fund's scope due to prior reforms. They commit to consider eligible professions for the fund as part of the refreshed Long Term Workforce Plan and are exploring a consistent policy for MPharm students' placement travel and accommodation costs.
Department of Health and Social Care
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27
Accepted in Part
Para 157
Review ARRS funding criteria within three months to retain community pharmacists.
Recommendation
The criteria connected to Additional Roles Reimbursement Scheme (ARRS) funding should be reviewed within 3 months to understand whether any additional flexibility could reduce the drain of community pharmacists into primary care networks. The Government should write to us with …
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Government Response Summary
The government partially accepts, stating that the Additional Roles Reimbursement Scheme funding is currently under review as part of the consultation on 2025/26 GP contract arrangements, with final details to be published after conclusion.
Department of Health and Social Care
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29
Accepted in Part
Para 173
Develop and publish an integrated, funded pharmacy workforce plan before Parliament within 12 months.
Recommendation
We reiterate that an integrated and funded workforce plan for pharmacy must be developed and laid before Parliament within 12 months. This should focus upon delivery of the targets set out in the NHS Long Term Workforce Plan. The pharmacy …
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Government Response Summary
The government partially accepts the recommendation, stating it will publish a refreshed Long Term Workforce Plan and is committed to growing the pharmacy workforce. NHS England is implementing strategies for independent prescribers, piloting services, and developing a 5-year pharmacy technician development programme.
Department of Health and Social Care
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30
Accepted
Ensure national and ICB workforce planning establishes appropriate skill mix in all pharmacy settings.
Recommendation
We further recommend that any workforce planning, be it at a national or ICB level, should ensure the appropriate and safe and mix of skills in all settings, including hospital wards as highlighted by Dr James Davies of the Royal …
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Government Response Summary
The government accepts the recommendation, stating that a 'one pharmacy workforce approach' will be supported by national and regional coordination, planning, data, and guidance. They are continuing to explore how to best utilise skill sets in community pharmacy for Pharmacy First and future prescribing services.
Department of Health and Social Care
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Conclusions (10)
1
Conclusion
Acknowledged
Para 19
There is clearly something wrong if the funding that pharmacies receive from the NHS does not cover medicine costs, given their core function of dispensing medicines. The Community Pharmacy Contractual Framework is evidently not fit for purpose. It is overly complex and has contributed to the financial pressures that pharmacies …
Government Response Summary
The government acknowledged the need for reform and stated it is committed to working with the sector. NHS England is currently undertaking an economic analysis of the community pharmacy sector, which will inform future proposals for funding and contractual arrangements.
3
Conclusion
Acknowledged
Para 47
Tackling medicine shortages is another vital component in securing the ability of pharmacy to meet its future potential. Medicine shortages cannot be ignored and left to become the norm. The wider implications of medicine shortages for the long- term potential of community pharmacy to take on more clinical work are …
Government Response Summary
The government acknowledges the need for flexibility in dispensing alternative medications and is currently examining options with stakeholders to assess appropriateness and risk management, but provides no specific commitment or timeline for implementing changes.
4
Conclusion
Accepted
Para 48
It is also especially worrying that shortages are resulting in patients being directed back into general practice. There is a serious risk that any capacity that general practice gains, through services like Pharmacy First, will be negated by the time spent re-issuing prescriptions as a result of shortages, thus undermining …
Government Response Summary
The government reiterates that current regulations require exact dispensing for patient safety, notes most prescriptions are generic, and explains that a previous proposal for generic substitution was not progressed due to patient safety concerns.
9
Conclusion
Deferred
Para 63
The global supply chain for medicines is complex, with a range of different actors involved in getting medicines from the raw materials to the manufacturer to the patient. The Government needs a clearer understanding and overview of the whole process, and the risks at each stage. If the Government already …
Government Response Summary
The government discusses its commitment to expanding pharmacy services and promoting the Pharmacy First service, but does not address the recommendation about gaining a clearer understanding of the entire medicines supply chain and communicating it to Parliament.
11
Conclusion
Deferred
Para 82
We have been encouraged to hear the enthusiasm within the pharmacy profession to deliver more patient facing care. However, the undoubted potential for pharmacy to improve access to health care, crucially including immunisations, and reduce pressure on general practice and other areas of the health system can only be realised …
Government Response Summary
The government details the charging structure for Pharmacy First consultations and prescription medications, and references a 2018 report on over-the-counter medication, instead of addressing the need for increased public funding and support for expanded pharmacy services.
14
Conclusion
Accepted
Para 91
It is clear that pharmacists are already struggling to find the time they need for consultations with patients in often busy community pharmacy environments with competing priorities, despite their ambition to do more. Future service expansion must be conscious of the capacity of pharmacists to deliver both existing services, and …
Government Response Summary
The government will publish a refreshed Long Term Workforce Plan this summer. It is also reforming pharmacist education and training, providing national funding to expand Designated Prescribing Practitioner capacity, funding training for Pharmacy Technician supervisors, and exploring MPharm student placement funding.
16
Conclusion
Deferred
Para 97
Public concerns about being referred back to the GP if they use community pharmacy to access healthcare should ring alarm bells for the Government. It is encouraging that this does not seem to be the experience within Pharmacy First, but we know that medicine shortages are driving people back to …
Government Response Summary
The government stated that funding for the Additional Role Reimbursement Scheme (ARRS) is under review as part of the 2025/26 GP contract arrangements, with final details to be published after the consultation concludes, rather than directly addressing public concerns about GP referrals or medicine shortages.
18
Conclusion
Deferred
Community pharmacies offering clinical services must have private, comfortable spaces in which to see patients. We acknowledge the minister’s comments around pharmacies being private businesses, but they are ultimately expected to provide NHS services. As the expanding availability of clinical services in pharmacy settings is encouraged, we believe a more …
Government Response Summary
The government deflected the recommendation regarding private consultation spaces by focusing on the refreshed Long Term Workforce Plan and workforce development, including supporting pharmacists to become independent prescribers and piloting an Independent Prescriber Pathfinder Programme.
25
Conclusion
Accepted in Part
Para 139
The lack of access to placements, supervisors and adequate financial support is a serious challenge, which could undermine efforts to meet the pharmacy targets set out in the NHS Long Term Workforce Plan. If those ambitions are to be met, there needs to be a greater focus on the availability …
Government Response Summary
The government partially accepts, committing to publish a refreshed Long Term Workforce Plan this summer and detailing ongoing funding from NHS England to expand supervisor capacity. They also note MPharm students' eligibility for clinical tariff since 2021 and are exploring a consistent policy for placement travel and accommodation costs.
28
Conclusion
Accepted
Para 172
Greater planning and forward thinking continues to be needed around the full pharmacy workforce, accounting for changing roles in the community, increasing demand in hospitals and supporting ICBs to build “one pharmacy workforce” that can be deployed across the full range of pharmacy services within health and social care. As …
Government Response Summary
The government accepts the need for greater pharmacy workforce planning, stating that the refreshed Long-Term Workforce Plan, due in summer, will provide a longer-term view. They highlight upcoming rotations for trainee pharmacists from 2025/2026 and ongoing funding for clinical training to support an integrated workforce.