Agenda item

Ms Lisa Taylor, Managing Director at Healthwatch Hillingdon, advised that community pharmacy services were highly valued by residents and often meant that they did not have to wait for a GP appointment.  The outreach services were also really well received.  Although Healthwatch tended not to receive complaints about (or be told about) issues with community pharmacy, Ms Taylor was aware that there had been issues with the communication between GP surgeries and pharmacies, particularly in relation to repeat prescriptions, which could be frustrating for the resident. 

There had also been some issues with services being commissioned from some community pharmacies, but not all.  For example, some community pharmacies had been commissioned to provide free blood pressure checks but residents would be charged for the service in others.  There was a need for transparency in the communications about the services that were provided by community pharmacies.  It was noted that there had also been a shortage of some medicines in some areas which had led to the situation being referred to as “pharmacy bingo”. 

Ms Taylor noted that the cost of running a pharmacy had increased and had contributed to 50% more community pharmacies closing in 2024 than had closed in 2023.  This had had an impact and resulted in increased pressure on the remaining pharmacies and, because the cost of delivering some services was prohibitive, these services were being avoided or stopped (such as dosage boxes with prefilled medications) to prevent complete closure of the pharmacy. 

Hillingdon residents had raised concerns about the disparity in the services delivered by each pharmacy.  To get a better understanding of what the issues were, Healthwatch Hillingdon had launched a survey of the Pharmacy First scheme and would be undertaking some targeted engagement. 

Mr Mike Levitan, Chief Executive Officer at the Middlesex Pharmaceutical Group of Local Pharmaceutical Committees (MPG of LPCs), advised that MPG of LPCs provided support, guidance and advice to community pharmacies in nine Middlesex borough areas via the statutory LPCs in Barnet, Enfield & Haringey; Brent & Harrow; Ealing, Hammersmith & Hounslow and Hillingdon.  He noted that the themes raised by Ms Taylor were common across community pharmacy nationally but were magnified in London. 

A number of initiatives had been discussed to help improve the uptake of community pharmacy services.  As a result of the pressures faced by GP surgeries, repeat prescriptions were taking 48-96 hours to process which meant that emergency prescriptions were increasingly being used because the regular pathway was not working quickly enough.  In addition, there had been a shortage of some medicines over the last few years which had been getting worse.  It was noted that the NHS drug tariff exceeded what patients were actually paying for prescriptions.  Pharmacists were therefore spending a lot of time trying to find the medicines needed by patients at a reasonable cost so that they were not left out of pocket. 

Mr Levitan advised that community pharmacies were independent contractors, similar to optometrists, dentists and GPs.  Community pharmacies were commissioned by NHS England through a five-year Community Pharmacy Contractual Framework, which covered advanced services such as the flu and vaccination service.  However, this five-year contract was now in its sixth year and negotiations for new terms had not yet started which meant that community pharmacies were now working under an outdated contract.  Concern was expressed that an increase in National Insurance contributions for staff working in pharmacies would put further pressure on resources. 

Local authorities commissioned services from community pharmacies such as emergency contraception, smoking cessation, needle exchange and supervised consumption (class A drugs).  Ms Kelly O’Neill, the Council’s Director of Public Health advised that it had been difficult for Public Health to commission some services as community pharmacies did not want to provide them, for example, sexual health services.  However, there was a good geographical spread of other Public Health services provided across the Borough. 

Integrated Care Boards also commissioned services such as out of hours palliative care support to enable access to medication at home to prevent hospital admission.  There was also a service to make “hard to obtain” medication easier to get hold of at specific pharmacies during normal opening hours. 

Members queried which national organisation would be responsible for commissioning community pharmacy services in areas where there was no community pharmacy available.  Mr Levitan advised that the legislation had changed.  Local authorities were responsible for producing the Pharmaceutical Needs Assessment (PNA) which set out the pharmaceutical needs of the Borough, as well as things like the adequacy of the current provision (number of community pharmacies per 1,000 population), dispensing rates and access to a pharmacy within a 20 minute walk.  The relevant LPCs had been consulted during the creation of the document. 

Ms O’Neill advised that the three-year PNA was produced on behalf of the NHS and had been published in September 2022.  The next iteration would be due for publication in September 2025.  The Hillingdon Health and Wellbeing Board would need to ensure that there was adequate community pharmacy provision within the Borough as part of the PNA process – currently, there was a slight over provision in the north of the Borough and a slight under provision in the south of the Borough.  Mr Keith Spencer, Managing Director at Hillingdon Health and Care Partners, advised that it was ultimately NHS England’s responsibility to ensure that any service provision gaps were filled.  Members asked that those present identify who would need to be contacted at NHS England to make representations about service gaps. 

In Hillingdon, it was not thought that there were any large gaps in the provision of community pharmacy services.  There had been some discussion some time ago about the provision in the Heathrow Villages but it had been determined that there had not been enough population / demand for a community pharmacy at that time.  Small pharmacies would often close if there was not a big enough population / demand in the geographical area.  Mr Levitan advised that Heathrow Villages faced specific challenges.  Seven community pharmacies had closed in the last 2½ years so the PNA position might have changed.  Small pharmacy business grants were available from NHS England but the eligibility criteria for these grants had been getting higher and harder to achieve.  Consideration would also be given to the fact that pharmacy services were now being provided from a variety of outlets including supermarkets.  Concern was expressed that most of the residents in the Heathrow Villages did not currently have access to community pharmacy services and it was queried whether anything could be done about this. 

Mr Levitan advised that the support service for over the counter and repeat medication initiated by the North West London Clinical Commissioning Group in 2017 had been withdrawn but had resurfaced during the pandemic for a while and then stopped again.  Although it had previously been a free service, it was unclear whether the associated costs could be absorbed. 

Members queried whether the number of referrals through to community pharmacies for the nationally commissioned Pharmacy First services was lower than for neighbouring boroughs.  Mr Levitan advised that most of North West London (NWL) had low referral rates when compared to North East London and other parts of the country.  Investigations were underway to try to establish why but, anecdotally, it was thought that this might be because GPs were busier.  This seemed ironic as the purpose of Pharmacy First was to alleviate the pressure on GPs. 

Challenges were also experienced with regard to community pharmacies not always being able to update patient records.  GP Connect was a new platform that had been introduced which allowed pharmacists to update GP records themselves.  However, some GPs had switched the facility off, thus withdrawing community pharmacy access to their patients’ records (this access was not a statutory requirement).  It was hoped that this could be resolved and community pharmacy access reinstated. 

Mr Levitan advised that community pharmacy had been facing its own workforce crisis.  A large number of professionals had left community pharmacy to join GP practices as well as other organisations.  Although it was hoped that the planned pharmacy schools would alleviate pressure in the long term, the short-term pressure was likely to increase especially as there was an expectation that NHS England would be looking to commission more services from community pharmacy. 

Members queried how the quality of community pharmacy service provision was monitored and how complaints were dealt with.  Mr Levitan advised that complaints were investigated at a local level in the first instance but that this could be escalated to NHS England / the service commissioner.  Although the majority of complaints that were submitted were not upheld, there were occasions where there were grounds for the complaint.  Pharmacies and pharmacists were required to register with the General Pharmaceutical Council which undertook announced and unannounced inspections.  NHS England also included regulations within its rigid contractual framework and monitored adherence to the contract (which could result in follow up inspections). 

In terms of improvements to service provision, Mr Levitan suggested that it would be good for those residents in receipt of Universal Credit to obtain medication free of charge.  A similar initiative had been working well in another borough where it had been commissioned by the relevant Integrated Care Board.  Furthermore, the provision of translation services would be useful for community pharmacies to communicate with everyone who needed help.  Ms Taylor was aware of an organisation that had trained people to provide translation services and would put Mr Levitan in touch with them. 

Although this item had been included on the agenda as a single meeting review, Members agreed that the discussion had prompted a lot of additional questions.  As such, Members would reflect on the information that they had received, review the notes taken at the meeting and seek out additional information before bringing this subject back to a future meeting. 

RESOLVED:  That:

1.    those present provide the Democratic, Civic and Ceremonial Manager with the contact details of an officer at the organisation that would need to be contacted to make representations about gaps in community pharmacy provision in Hillingdon; 

2.    Ms Taylor put Mr Levitan in touch with an organisation that could provide translation services;

3.    the issue of community pharmacies be brought back to a future meeting; and

4.    the discussion be noted.