By Outsider

Before I start, I must confess that I am starting to feel a little bit sorry for Matt Hancock. The portrayal of the secretary of state for health in Spitting Image is so on the nose and character-defining it reminds me of John Major eating peas in the 1990s series. For years afterwards, whenever Major stood up to speak in parliament, the opposition benches would ring out with cries of, “peas are good tonight, dear.” Hancock too seems destined to be defined by his caricature. 

As lockdowns upend our daily lives and affect the way we work and socialise, the day job doesn’t go away for pharmacies. The dispensing workload is unchanged. The seemingly inexorable march to a no-deal Brexit continues and with it, the time pharmacy teams expend fighting to source stock in an ever-worsening medicines supply situation can only increase. The complexity of the regulatory environment doesn’t ease, either, as new regulations laid last month look like increasing the burden.

On a positive note, as predicted last month, community pharmacy hit the first phase of the seasonal flu vaccination service clean out of the park. Whoever said anything about lack of ambition! The concern now must be how the extended cohort can be delivered and, specifically, how the government-procured vaccines that will arrive in a month’s time can be distributed to the providers with the capacity and capability to deliver.

The simplest thing would be to widen the access of the ImmForm vaccine supply service. Pharmacies could order the vaccines they think they can administer, up to a threshold (say a fraction of the number they administered in September and October), with local Public Health England teams intervening where supplies need to be evened out.

Unfortunately, with our obsessive protectionism of retained margin, that will not happen. Instead, some overly complex mechanism using wholesalers will doubtless be implemented. What could possibly go wrong?

as predicted last month, community pharmacy hit the first phase of the seasonal flu vaccination service clean out of the park

As for the new regulations, they continue to support implementation of the five-year contractual framework, providing legal cover for the discharge medicines service and the mandating of healthy living pharmacy standards. This latter requirement will finally force the closure of the remaining few pharmacies that are not able or are unwilling to invest in appropriate consultation areas.

There can’t be many, but there are some. Looking around my patch, I reckon it could be 1 per cent nationally. There is no guidance as to how market exit will happen or when, but with the resumption of estate rationalisation by the multiples, the number of pharmacies could drop below 11,000 for the first time since 2010.

Other pandemic-related changes to regulations may prove more useful. The pandemic treatment protocol will, hopefully, not need to be used, but seems a sensible provision. Of course, it wouldn’t be necessary if the regulatory framework recognised pharmacists’ inherent capabilities. It’s odd that when the NHS wants ‘prescribing-ready’ pharmacists for its GP practice workforce, changes can be facilitated in a year. MURs were introduced in 2005 and for their 15-year life, pharmacists still required “extra training” to be deemed competent to talk to patients about medicines.

The discharge medicines service will offer an opportunity to improve outcomes for patients on newly prescribed medicines, but without a prescribing option, the practical interventions community pharmacists will be able to make will remain limited. We all want pharmacists to be able to prescribe by right, but if there is no budget from which they can offer a prescribing service then community pharmacy will be limited to playing around the edges, offering niche private services in a postcode lottery of local commissioning.

Alongside all this are further changes to the Human Medicines Regulations that drive a coach and horses through the basic rules on who can supply and administer medicines, albeit only in a pandemic. Be very careful what you wish for. 

Of course, my doom and gloom may be misplaced. We may not go backwards at all. The pandemic wave may be averted. There may be a trade deal with the EU that eases the supply situation. The chief pharmaceutical officer may fall in love with community pharmacy. Only time will tell.

Outsider is a community pharmacist