The National Pharmacy Association – Who we are, what we do, what we believe

What we Believe - NPA

Contents:

Who we are – the representative voice of the independent community

The National Pharmacy Association (NPA) is the representative voice of independent community pharmacies across the UK and a key provider of services to the pharmacy sector. More than half of pharmacies are family owned and run, small to medium-sized businesses (approx 6000 independent pharmacies UK-wide).  The vast majority of independents are NPA members.

Who we represent – community pharmacies across the UK

Pharmacies are a local lifeline and vital to the health of the nation.  Often the first port of call for advice and treatment, pharmacies are a key part of neighbourhood health services.  Pharmacies provide a range of NHS services, ensure people can get face-to-face care without an appointment, and take pressure off GPs and hospitals. There is potential for so much more.

What we stand for – thriving pharmacies, healthy patients

The NPA has a vision for the future of community pharmacy, in which pharmacies are thriving and patients are enjoying the benefits in all parts of the country.  We want tech-enabled community pharmacies, better integrated with other health services, operating efficiently as neighbourhood health and wellbeing centres, providing excellent patient care and recognised as the front door to the NHS.  This is a vision grounded in reality, respectful of the past and excited about the future.

These are the NPA’s Core Beliefs:

Community pharmacy works. We have unique strengths and deliver immensely valuable benefits to patients, communities and the NHS.

Community pharmacy can do so much more (given sustained support and investment). Pharmacy premises are conveniently located health & social care assets in communities across the country. Our skilled people have the capability to do so much more if supported to do so. Because of their positive experience of our support during the coronavirus pandemic, people now want and expect more from their local pharmacy.

A pharmacy is more than ‘a shop’. A pharmacy is a valued community asset and a convenient health care practice. It is both part of the fabric of our society and the frontline of our health service.

Face to face care is vitally important. Community pharmacy provides care to millions of people, in person, daily. Even in this age of increasing automation and digitalisation, the face-to-face relationship between health professionals and patients matters.

A pharmacy without a pharmacist is not really a pharmacy at all. The delivery of excellent care is a team effort and convenient access to a team dedicated to pharmaceutical care is a key strength of community pharmacy. Yet the pharmacist is central to the operations of a pharmacy, indeed to its very identity.

Pharmacists are clinicians and our future is clinical. Fully realising the clinical potential of all pharmacists, including community pharmacists, would improve access to primary care, strengthen public health and make life more convenient for millions of people with long term conditions.

We are in the NHS family.  Community pharmacy is at its best when working as part of a team with the NHS and integrated with others in health and social care.

Community pharmacy is about people, not just pills. Our dedicated, professional workforce provides a patient-focused and caring service. Everyone who works in a pharmacy and all those who rely on pharmacy services deserves to be treated with compassion and respect.

Community pharmacy is the best first port of call for health care in the vast majority of circumstances. We are the most visited of all health care settings. As the ‘front door to health,’ we can do even more to help keep people well and help take pressure off the NHS.

Medicines supply and service belong together. The link between supply and service is our history and our future. This link is a crucial element of the established, trusted service model of community pharmacy – namely convenient, face-to-face care from health care professionals, locally responsive and community-based.

Change is inevitable and necessary – we are on a journey. Pharmacies must be progressive and modern, whilst staying true to the historic values of pharmacy as a personal, caring profession. In particular, the sector must optimise the use of technology, recognising that the expectations of patients and consumers are constantly evolving.

Our key policy positions

Community pharmacy needs a true partnership with the government and the NHS

We want to engage with Ministers, officials and NHS staff on the implementation of a programme for change and improvement, which builds on the strengths of our sector.  By working together, we can make the pharmacy sector and the health system overall more efficient, whilst ensuring that no patient is left behind.  We need Government to see local pharmacies as a solution to many longstanding problems in the NHS, and act to unlock the sector’s huge potential.  With consistent support from Government and NHS, pharmacies can step up and change the NHS for the better – massively improving patient access, medicines safety and preventative care, and achieving better value for money from the drugs budget.

Investment in community pharmacies can take pressure off GPs and hospitals

General Practice has a long-standing access problem and the entire NHS is dealing with a backlog of care resulting from the pandemic.

Millions of GP consultations and many A&E appointments relate to common ailments which could instead be dealt with by support from local pharmacies. A community pharmacy is a convenient setting to get help for coughs and sneezes and all manner of other health concerns which don’t necessarily require a GP or hospital appointment. Investment in pharmacy-based services (such as a digital minor ailments service) would help manage demand on GPs.

Investment in community pharmacies can make access to NHS care more convenient

Your local pharmacy is one of the few places in the health service where you can simply walk in off the street and get treatment and healthcare professional advice without an appointment.  Pharmacists – the medicines experts – should be permitted to supply a wider range of medicines without the need for a GP appointment.  More treatment options in pharmacies mean more convenience for patients and reduce costs for the health system.

With consistent support from Government, pharmacies can help ensure people get the primary healthcare they need, when and where they need it, at less cost to the NHS.

Investment in community pharmacies can improve care for people with long-term conditions

Community pharmacists and their teams see people with long-term conditions more regularly and frequently than other health care professionals. Many medicines prescribed for long-term conditions are not taken correctly.  Pharmacists, with their unique education and training in medicines, should be supported to provide services that help people get better use of their medicines for long-term conditions.   In particular, pharmacy-based NHS medicines optimisation services for people with long-term conditions should be extended.  Some patients with long-term conditions, including many older people, would benefit considerably from such developments.

Investment in community pharmacies can reduce health inequalities

There is currently a ‘positive pharmacy care law’ – the more economically deprived an area, the better the access to primary healthcare through pharmacy. Because of the concentration of community pharmacies in deprived areas, investment in pharmacy-based services can have the effect of reducing health inequalities (which is a legal obligation for the Health Secretary).

Investment in community pharmacies can tackle medicines waste and save the NHS money

Avoidable medicines waste in primary care is running at about £150 million a year.  Research looking at the cost-effectiveness of the new medicine service (NMS) has found that the service increased patient medicine adherence by 10 per cent compared with normal practice, which translates into increased health gain at the reduced overall cost. The authors, from University College London and the Universities of Manchester and Nottingham, estimated that the NMS offers the NHS short-term savings of £75.4 million and long-term savings of more than half a billion pounds.

NHS medicines advice services should be extended into other therapeutic areas where there is significantly poor adherence.

The medicines supply chain is not working well for independents

Independent contractors have had a torrid time in recent years due to generic medicine shortages and turbulent prices. Pharmacists have spent a considerable amount of extra time and effort sourcing stock.  They have displayed professionalism and put patients first by continuing to supply medicines to patients promptly in good faith, despite knowing that they may be doing so at a loss.  With prices of generic medicines often varying widely, the shortfalls can be significant. Many independent pharmacies cannot buy bulk stock in advance, therefore they are particularly vulnerable to price instabilities, as well as branded generic prescribing.

We need a fair, competitive and sustainable generic medicines market, with a resilient and robust medicines supply chain, that provides pharmacies with a rational and fair financial return.  We must have a more effective concessionary pricing system that allows contractors to have a reasonable certainty of what they will be reimbursed much earlier in a given month.

Medicines shortages are frustrating and time-consuming for pharmacists and can be distressing for patients.  Pharmacists work hard to get patients the medicines they need, when and where they need them, but this time could be better spent on giving healthcare advice and support. Pharmacists frequently pay inflated prices to get patients what they need and even dispense medicines at a financial loss to the pharmacy, which shows how dedicated they are to patient care.

Pharmacists in GP surgeries are no substitute for community pharmacy 

We are fully behind the principle that multi-disciplinary working, designed locally, based around the patient and delivered in the community, is the best way to deliver transformative improvements in health care. However, by themselves, GP-based pharmacist schemes do not address the serious underlying capacity problems in General Practice. The NHS must not overlook the transformational opportunities in community pharmacy – maximising the clinical potential of thousands of pharmacists available without an appointment, in community pharmacies right across the country.

We have called for mandatory local impact assessments before any further recruitment of pharmacists into GP/PCN pharmacist roles.  These assessments should consider the impact on the ability of all healthcare providers in the area – including community pharmacies – to deliver their objectives on behalf of the NHS.

Pharmacies represent excellent value for money.

Aside from the benefits for patients and communities, pharmacies have also been very successful in driving down the cost of medicines for the NHS, saving at least £11bn since 2005/06 by effective procurement of medicines.  Furthermore, a study by

PricewaterhouseCoopers (PwC) showed that just 12 community pharmacy services (not including the core dispensing service) contributed £3 billion to the NHS, the wider public sector and directly to patients in 2015. These savings stemmed from the preventative activity which avoided NHS treatments having to be made, reduced social care pressures and money saved by patients through reduced travel time compared to that which would be needed to access other NHS services.

Most independent community pharmacies are heavily geared to NHS services and are therefore severely impacted by the NHS cuts introduced in 2016/18.  There is a better way to achieve efficiencies than by applying funding cuts – one which builds on the strengths of the community pharmacy network rather than risks dismantling it.

We see no case for ‘managed decline of the pharmacy network

We haven’t seen a compelling case for reducing the pharmacy network, planned or otherwise. Every pharmacy is precious to the patients it serves. The current network gives people a good level of access and choice and provides a platform for health improvement interventions at scale, including in deprived areas. Pharmaceutical provision ought to be based on identified local needs, rather than closures being forced randomly by financial attrition.

Online pharmacies offer a welcome choice but are not a substitute for local pharmacies

Online pharmacies are convenient for some, and it’s inevitable that digital technology will be an increasing feature of healthcare, as it is in every other part of society.  Modern consumers, including NHS patients, expect that online is going to be part of their experience.

However, an online pharmacy is not equivalent to local pharmacies, which provide a range of NHS and non-NHS services close to where people live, work and shop. Local pharmacies are often the first port of call for advice and treatment.  They provide a range of NHS services, ensure people can get face-to-face care without an appointment, and take pressure off GPs and hospitals.

Change always presents opportunities as well as threats – and since we are in a period of rapid change in the digital sphere, it follows that there are opportunities here.  ‘Clicks and bricks’ is an increasingly prominent business model in many sectors of the economy, and could be very suited to many pharmacy businesses.  This model combines the benefits of fast online transactions and the face-to-face service at which community pharmacy has always excelled.

Pharmacists and Pharmacy Technicians have different roles, but the same aim – to help patients stay well

The safe supply of medicines is at the core of what pharmacies do and the minimum expected of us by the public. Responsibility and accountability for safe advice and supply should therefore remain with a pharmacist and not be delegated to pharmacy technicians, who are not qualified for this role. Patient safety, public confidence and ready and easy access to a pharmacist are the uppermost concern.  Effective use of skill mix is important in pharmacy, and technicians make a very important contribution. However, in many situations, there is no substitute for the professional judgement of the pharmacist.

There should be a pharmacist present in every community pharmacy throughout the opening hours

Regulations relating to supervision and the role of the responsible pharmacist together must permit the profession to move on and deliver services efficiently. Yet patient safety, public confidence and ready access to a pharmacist must be regarded as the uppermost priority.  Responsibility and accountability for the safe supply of medicines should remain with the responsible pharmacist. Standard operating procedures and systems only go so far. In many situations, there is no substitute for the professional and clinical judgment of the pharmacist on the spot. Therefore, there should be a pharmacist present in every community pharmacy throughout the opening hours. We support the further development of the skills and role of the whole pharmacy team. At the same time, the accessibility of the pharmacist must be maintained and indeed enhanced. The effect of any changes should be to enable the pharmacist’s presence in the pharmacy to become more, not less, visible to patients.

Community pharmacy contractual framework

Independents must fully embrace the clinical service agenda, which is our best hope for a change in fortunes from our current precarious situation and the right thing to do for our patients.  Yet many pharmacies, worn down by funding cuts and escalating costs, are not in a position to invest in new services that would greatly benefit patients and the NHS.  The core funding for England’s pharmacies is not enough to achieve the transformational improvements the NHS and pharmacists would like to see.  For some pharmacies, it won’t even be enough to keep the doors open, unless other substantial sources of income can be found. With half of all pharmacies in deficit, the government must be prepared to invest in the future of community pharmacy and back us to deliver clinical services to a high standard.

Prescription charges

Prescription charges deter many people from getting the medicines they are prescribed. That is troubling to pharmacists, who understand the benefits medicines can bring and the human cost of not taking medicines as prescribed. Patients on low fixed incomes who do not qualify for exemption suffer the most. Meanwhile, prescription charges involve an administrative burden on pharmacists which is counterproductive to the government’s aim in getting pharmacists to spend more time on clinical services.  Pharmacists, like other health care professionals, experienced great pressures on their time and any release of time could be used to enhance patient care.  The NPA is a member of the patient-led Prescription Charges Coalition, which seeks reform of the current illogical and unfair situation.