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10-Year Health Plan consultation begins

The government’s consultation on a new ‘NHS 10-Year Health Plan’ is underway.

A nationwide public engagement exercise will help shape the plan which will be published in spring 2025 and promises three big shifts in healthcare - hospital to community, analogue to digital, and sickness to prevention.

The NPA will be submitting a formal response, in which we’ll develop the following points:

• Ministers are right to want to rebalance resources away from hospitals to primary care and community services. Investing more in local pharmacies would deliver a major return on that investment, at pace.

• Community pharmacies can be a centrepiece of the post-pandemic recovery of the health service – but only if we are first lifted off our knees after years of relentless real terms funding cuts.

• Fixing community pharmacy will allow the nation’s 10,000-plus pharmacy teams to help fi x the wider NHS too – dramatically improving access to primary care, preventing ill-health and reducing health inequalities.

• The NPA has a detailed plan to stabilise the community pharmacy network which has been hit by devastating cuts, and to expand pharmacy services, starting this winter and running through to the end of this Parliament and beyond. Meanwhile, we have warned that many community pharmacies will be forced to close without improved funding, before the long term plan has even been published, in spring 2025! The NPA will make a formal submission on behalf of independent pharmacies.

If you want to send your thoughts directly to the government team leading the consultation, you can do so via the online platform: change.nhs.uk

Pharmacy First thresholds updated

The threshold for Pharmacy First payments will be as follows, following changes announced in October:

Pharmacist takes the witness stand at Covid inquiry

On 10 October, National Pharmacy Association member, Jonathan Rees, became the fi rst pharmacist to give oral evidence at the UK Covid-19 public inquiry hearings.

During the pandemic, Jonathan worked at Penclawdd Pharmacy near Swansea and also supported the NPA’s effort to respond to the extra needs of its members across Wales during the peak of the crisis.

Jonathan gave evidence about the role and responsibilities of pharmacies during the pandemic; the impact of the pandemic on pharmacy services, working conditions and medicines supply; and the challenges of obtaining Personal Protective Equipment.

His testimony covered the whole range of challenges faced by pharmacies during the pandemic including the emotional impact of always being switched on to help. He also highlighted that a continuation of fi nancial pressures during, and since, the pandemic may have weakened community pharmacy’s ability to respond as effectively to future public health crises.

Paul Rees, chief executive of the National Pharmacy Association, said: “The NPA is proud to be telling the story of the vital role pharmacies played during the Covid pandemic, and ensuring that our members’ voices are heard in this Inquiry.

"We’re determined that lessons will be learned about the importance of properly funding this vital public health network – in readiness for future crises – and that tomorrow’s history books will record the heroics of pharmacy teams across theUK.

“Jonathan’s testimony exemplifi ed the high level of care, responsiveness and commitment to duty demonstrated by pharmacies in Wales and across the UK during the pandemic.”

The inquiry’s chair Baroness Hallett said: “I, for one, certainly appreciate the work pharmacies do…. You worked enormously hard to look after your local communities. Thank you.”

The NPA is the only community pharmacy employer body to be a core participant at the inquiry, allowing it to put on record the vital role of community pharmacies during a time of national emergency.

The NPA has provided a number of statements in different modules of the Inquiry and will continue to advance the priorities of community pharmacy within the proceedings. Other NPA witnesses may be called in due course.

Valproate use in men

A MHRA Drug Safety Update on valproate use in men advises, as a precaution, men and their partners should use effective contraception. More on the NPA’s dedicated website hub: Supplying valproate-containing medicines safely

OPD regulations updated

Pharmacy contractors in England may consider dispensing up to 10 per cent more or less than the amount prescribed, where appropriate, for NHS prescriptions from 1 January 2025. However, they must exercise their professional judgment and decide if it is suitable to use the Original Pack Dispensing enablement (exceptions apply). Go to the NPA website for more details.

‘Hub and Spoke’ update

Proposals for ‘hub and spoke’ dispensing between di erent legal entities will not be implemented from 1 January 2025, as previously intended. This is because progress to amend the Human Medicines Regulations (2012) and the Medicines Act (1968) was paused due to the general election.

We will provide NPA members with a further update once further clarity on the timescales becomes available.

Promoting pharmacy at the Labour Party conference

NPA board, staff and members met dozens of MPs and councillors at the Labour Party conference in Liverpool. Our message was “fix community pharmacy to fix the NHS” including beating the 8am scramble to get a GP appointment.

NPA at Primary Care Best Practice Show

NPA staff attended Primary Care Best Practice in Birmingham this month, advocating for pharmacy to an audience of key opinion leaders from the world of general practice.

Our integration lead, Michael Lennox reports: “There was defi nitely a keener appetite to put NHS community pharmacy on the agenda than in the past. The Practice Managers Association again acted as supportive partners, giving me a platform to speak about the community pharmacy workforce.

“One highlight was a constructive conversation with Dr Amanda Doyle (NHSE Primary and Community Care Director) who really gets how strengthening community pharmacy could help fix the wider NHS. She spoke at length on this theme in her keynote session.”

Ask for ANI closes

From 4 November 2024, the Ask for ANI emergency codeword scheme – devised in response to the social isolation brought about by Covid-19 – is no longer available.

However, pharmacy owners who wish to continue to provide the ‘SafeSpaces’ scheme can complete a short online form here: uksaysnomore.org/ask-for ani-and-uk-says-no-more-sign-up/ . This scheme will continue in pharmacies, banks and building societies across the UK.

All Party Pharmacy Group in Parliament

The All Party Parliamentary Group on Pharmacy – of which the NPA is a sponsor – reconvened in September. At its inaugural meeting in the new Parliament, Steve Race MP was elected as chair of the group, with Sadik Al-Hassan MP, Lord Scriven and Baroness Cumberlege elected as the other officers. pharmacyappg.co.uk

Monitored Dosage Systems guidance

In this article we address some of the common myths surrounding dispensing medicine into a monitored dosage system (MDS) as a reasonable adjustment under the Equality Act 2010. For more, go to the NPA’s MDS website hub: npa.co.uk/monitored-dosage-systems/

Myth: The prescriber must request a patient to be supplied with their medicines in an MDS.

Truth: It is the responsibility of the pharmacist to comply with their obligations under the Equality Act 2010 by ensuring that reasonable adjustments are made for the patient if they have a disability; an MDS may be the most appropriate reasonable adjustment – for example, considering the patient’s medicine compliance, regimen and any existing health conditions.

Myth: MDS is the best solution for all patients requiring support in taking their medicines.

Truth: The best reasonable adjustment is one that meets the individual patient’s needs, and sometimes, multiple adjustments may be required. Examples include:

• Adherence issues – a simpler regime, reminder chart, coloured stickers

• Dexterity problems – larger and easier opening or non-child resistant containers, wing lids, dropper aids

• Visual impairment – larger font/ symbol-based label, accessible PIL

• Confusion – simplifying a regime, seeking family/ carer support, providing repeat medicine and delivery services.

Myth: All medicines can be placed into an MDS.

Truth: Not all medicines are suitable to be placed into an MDS. Examples of those not suitable include: valproate-containing medicines which can only be placed into an MDS as an exceptional circumstance following a risk assessment; medicines requiring stability outside of its original manufacturer packaging, especially for dispersible, soluble, buccal, cytotoxic medicines and those requiring desiccant or temperature control, or those sensitive to air, heat or moisture; medicine dosing when to be taken as required

Myth: Patients will not get a patient information leafl et (PIL).

Truth: Legislation requires a PIL to be supplied for every licensed medicinal product (this does not apply to unlicensed medicines), including if it is supplied in an MDS. PILs should be supplied each time a medication is dispensed.

Myth: A prescriber can request a pharmacist to make changes to an existing MDS already supplied

Truth: Legislation does not oblige pharmacists to make changes to medicines or to re-package an existing MDS once it has been dispensed to the patient. Therefore, if a prescriber makes amends to medicines within an MDS, they should issue a new prescription for all items

Myth: NHS prescriptions for 28 days treatment can be dispensed in an MDS and supplied to the patient on a weekly basis.

Truth: Under NHS legislation, prescriptionsfor 28 days can only be dispensed on one occasion – it cannot be split into weekly dispensing – a exception being instalment prescriptions. If the patient requires weekly dispensing (or other shorter intervals), then the prescriptions should be issued as such, and the pharmacist will supply it accordingly. Reasons could be: medicine stability outside of its original packaging; the patient being at risk of accidental/ deliberate self-harm; the patient having their regime amended regularly. Alternatively, if the pharmacist deems it appropriate, the prescription for a single supply could be supplied weekly as a series of owings.

NEW AND POPULAR NPA WEBSITE RESOURCES

• Flu vaccination service hub: Here you’ll find the latest updates regarding implementation of the flu service in England. This includes the service’s standard operating procedures (SOPs), PGD and National Protocol, flu training pathway, vaccine decision-making flowchart and more.

• Gender dysphoria hub: The Department of Health and Social Care has announced an extension to the puberty blockers ban that was set to expire on 3 September – the temporary ban now ends on 26 November 2024. We have updated our guidance as the new legislation came into force on 3 September in England, Scotland and Wales. It has also now been extended to Northern Ireland where it came into force from 27 August 2024. (update: npa.co.uk/information-and-guidance/ emergency-restrictions-on-puberty-blockers/)

• IP hub: A new IP resource is now available on the IP hub - Independent Prescribing Record Keeping guidance and template. This contains guidance on the details Pharmacist Independent Prescribers (PIPs) should be recording during consultations for prescribing services, how long to retain these records and a template for PIPs to complete during consultations.

• New resources for Scottish members: We have updated the flu SOPs and information for Scotland, as well as a new Emergency Hormonal Contraception and Bridging SOP following amendments to the service specifications.