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England's pharmacies provide 58 million unpaid consultations a year

Nearly a quarter (24%) of the consultations were related to COVID-19
Nearly a quarter (24%) of the consultations were related to COVID-19

Pharmacies in England provide as many as 58 million free consultations a year, according to a sector audit from the Pharmaceutical Services Negotiating Committee (PSNC).

In its latest pharmacy audit report published today (May 28), PSNC said that 24% of the pharmacy consultations recorded earlier this year included advice and support related to COVID-19. Despite the data being collected differently to 2020, PSNC said that “we do think they indicate an increasing reliance on pharmacies through the pandemic”.

Average of 16.9 consultations per pharmacy, per day

The audit – which took place between January 25 and February 12 this year, involving 5,380 pharmacies in England (52.5% of the total number in the country) – found that during the audit period, 114,898 patient consultations were recorded.

This indicates that, on average, a pharmacy carries out 16.9 informal consultations per day.

This amounts to more than 100 per week, which PSNC extrapolated to estimate that over 1.1 million pharmacy consultations take place in England every week.

Nearly all (97%) of the consultations recorded during the audit period resulted in advice being given by a member of the pharmacy team, with 54% resulting in the sale of medicine as well.

The average consultation took just over five minutes, PSNC found, with consultations relating to COVID-19 taking on average 20% longer. This amounted to around 90 minutes of clinical consultations per pharmacy, per day, the report said.

More than three quarters (76.3%) of consultations were the result of patients self-referring, with 9% of the consultations the product of informal referrals from a GP, and 2.4% from NHS 111. During the audit, 8.6% of people seeking advice from a pharmacy said they had been unable to access another part of the healthcare system.

Nearly half (49.6%) of the patients seen during the audit said that if they had been unable to access advice from their local pharmacy, they would have visited their GP, while a further 6.2% would have visited A&E or an NHS walk-in centre. Just 12.4% of consultation patients were referred on to another healthcare professional, the report found.

PSNC said that this indicated that community pharmacy saves GP surgeries a total of 24 million appointments per year, and NHS hospitals and centres 3.3 million walk-ins a year.

However, during this audit, 61% of pharmacies reported being under “intense pressure”.

“Part of this will be related to COVID-19, however part will be related to underlying work and professional pressure,” PSNC said.

“GP burden unmanageable without pharmacy”

The audit report, authored by Richard Brown, chief officer of Avon local pharmaceutical committee (LPC), concluded that “clearly the additional burden on general practice and other healthcare settings were this pharmacy advice to be taken away would not be manageable”.

PSNC chief executive Simon Dukes added that the results “help showcase the incredible work that community pharmacies do every single day and the value that this brings to their patients”.

But the report also argued that the data shows that pharmacies “continue to handle a higher number of patients who have been informally referred by NHS 111 and general practice, rather than using the formal CPCS [Community Pharmacist Consultation Service] referral route”.

“This poses a risk of patients not being followed up, and means pharmacies miss out on funding that could be critical to the successful running of their business,” the report stressed.

Earlier this month, C+D revealed that despite over 90% of community pharmacies in England now offering the CPCS, LPC chiefs claim only a minority receive referrals from GP practices.

Meanwhile, at the end of April, Pharmacy London chair Raj Matharu said that most London pharmacies have yet to receive a GP CPCS referral, with the city “languishing” at the bottom of an NHS GP referrals table. Mr Dukes had previously suggested that introducing incentives could potentially increase GP practices’ engagement with the CPCS.

“Important data” for funding negotiations

Mr Dukes commented that the audit “will provide an important dataset for use in our negotiations with [the] government”, which PSNC announced at the end of April had begun for the 2021/22 pharmacy funding contract.

“While a level of funding is provided for pharmacies for supporting people with ‘self-care’ through the community pharmacy contractual framework (CPCF), PSNC still believes that this is insufficient to cover this increasingly important part of community pharmacies' work,” the report said.

“We will continue to press HM Government and the NHS to recognise the incredible efforts of community pharmacies throughout the COVID-19 pandemic by providing a sustainable funding package for them,” it added.

Marc Donovan, chief pharmacist for Boots UK, said the audit provided “some of the strongest evidence yet of the value of community pharmacies”, adding that he looked forward to working with the NHS “to further develop a model that provides even more opportunities for patients to easily access services via our pharmacies”.

Of those pharmacies that took part in the audit, 44% sat within the Company Chemists’ Association (CCA), while the remaining 56% were non-CCA.

What do you make of the results of the audit?

V K P, Community pharmacist

Nothing new here. PSNC make pharmacies carry out all these free audits which generate big data for them. We are hooked in by the pre-tense that the data will help negotiations which never seem to materialise. the data is definitely not flawed hence the only conclusion would be that the negotiator is incompetent. How about they telling the DHSC that there shall not be any free walking advice provided from pharmacies. Similar to the way that pharmacy are only paid a dispensing fee when a prescription is dispensed and POM cannot be given out without a prescription. Then the advice seeking has to come through the formalised route of CPCS or there is no advice. Which GP provides any advice without having an appointment booked for the  patient. They want to be paid for every interaction with the patient, so how about the same principle being applied to the pharmacy sector. We should go as far to say that the NHS and DHSC have defrauded pharmacy of 58million time £14 ( £812million) worth of fees. that is a direct gain made by the system at the detriment of the pharmacy sector. Will the PSNC wake up and talk about gain sharing? or would it be that they completely lack the ability to negotiate? Hence more advertisment of free work.

Snake Plissken, Student

It’s a fact of life that the vast majority of people don’t value the things they get for free. 

Mark Boland, Pharmaceutical Adviser

It isnt for free - employees are paying for it through extreme stress and workload. People dont value the hard work of retail workers.

Retail is an underclass of workers rarely protected by trade unions and not given the angel status of NHS workers.

People want their stuff now!!!

Gursaran Matharu, Community pharmacist

Perhaps it is time to look at the contract in a different light? Front loaded per capita payments based on EPS R2 nominations which aligns with the objectives within ICS medicines optimisation agenda. 

NHSE&I to buy set amount of community pharmacy appointments from the sector (and not the pitful £14 consultation fee which will be eaten away by IT costs) to reduce the pressure on GPs, UCCs and A&Es.

Dispensing function retained and the fee covers the all the costs of dispensing, but would contractors let go of the margin profit?

There is a debate to be had.

M. Rx(n), Student

If I read you right, wouldn't this lead to the same mad opportunistic scrambles that have beset EPS nominations, repeat sign-ups, MURs etc.?

I get you....but from another perspective, attempting to replicate the doctor-patient consultation in a community pharmacy setting (outside of specific indications) is a fool's errand.

You are certainly right though that the contract (and I'd add the whole system) needs to be looked at in a different way than it is currently.

Mark Boland, Pharmaceutical Adviser

Any new money ought to be used to pay for the work conditions that would allow employees to offer a high quality service. In reality any new money would go straight into the bottom line and employees would be bullied into fitting more tick box behaviour into their workload.

This is the fundamental conflict within community pharmacy.

M. Rx(n), Student

During the Reign of Terror of the French Revolution, one morning’s executions began with three men: a rabbi, a Catholic priest, and a freethinker. The rabbi was marched up onto the platform first. There, facing the guillotine, he was asked if he had any last words. And the rabbi cried out, “I believe in the one and only true God, and He shall save me.” The executioner then positioned the rabbi below the blade, set the block above his neck, and pulled the cord to set the terrible instrument in motion. The heavy cleaver plunged downward, searing the air. But then, abruptly with a crack, it stopped only inches above the would-be victim’s neck. To which the rabbi said, “I told you so.” “It’s a miracle!” gasped the crowd. And the executioner had to agree, letting the rabbi go.

Next in line was the priest. Asked for his final words, he declared, “I believe in Jesus Christ–the Father, Son, and Holy Ghost–who will rescue me in my hour of need.” The executioner then positioned this man’s head on the block. And he pulled the cord. Again the blade flew downward–thump! creak!–stopping just short of its mark once more. “Halelujia,” shouted the priest. “Another miracle,” sighed the disappointed crowd. And the executioner for the second time had no choice but to let the condemned go free.

Now it was the freethinker’s turn. “What final words have you to say?” he was asked. But the freethinker didn’t hear. Staring raptly at the ominous engine of death, he seemed lost. The executioner had to poke him in the ribs and ask the question again before he would reply. But at length, the freethinker cried out, “You gullible, superstitious fools. Those weren’t miracles! You’ve got a blockage in the gear assembly, right there.”

That might explain why there are so few freethinkers today.

(From the American humanist society) -- just replace dogma & superstition with vested interests.

Interleukin -2, Community pharmacist

Ha ha ha ha ha ha ha ha ha ha this has to go down as my hiogh point of this miserable covid ridden 2021

M. Rx(n), Student

This is a ludicrous statistic and claim that is completely devoid of any grasp of the essence of Community Pharmacy!

Amazing. No wonder the PSNC cannot get the DoH to take them seriously.

The serial attempts to cravenly monetize the USP of Community Pharmacy is what has in fact caused the decline of the sector - evident in the turnover of useless self-aggrandizing so-called services.

Paying a Community Pharmacist or Pharmacy on a consultation basis defeats the very intangible care-accessibility feature that defines the job.

My word!

Interleukin -2, Community pharmacist

what kind of student are you if you dont mind my asking?

M. Rx(n), Student

That said, the solution is a fixed Pharmacy operation payment that covers all direct/indirect patient contacts outside of specific enhanced offerings.

And I would go further and say any enhanced offering should then be at the discretion of a specific RP with respect to delivery and payment.

Kevin Western, Community pharmacist

not exactly shocked, but, since it isnt news, The PSNC et al refuse to use media to rattle Politicians, and I am sure the DoH are fully aware of it but happy to ignore it, It wont make any difference.

Paul Dishman, Pharmaceutical Adviser

There's pretty much zero support for community pharmacy and pharmacists in the DoH.

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