Increasing the numbers of pharmacist independent prescribers in primary healthcare would be one way to improve access to medicines and allow doctors to spend more time with patients but other measures could also help.

Jonathan Ashworth says, “First of all, on repeat prescriptions, in this era of modern technology there should be no reason why we cannot have a greater role for community pharmacists. Community pharmacists build up a rapport and an understanding of their patients in the same way the GP does and I found this very directly here in Leicester ….. where it’s often the community pharmacist, who can speak Gujarati, Punjabi and Urdu, who’s got very close relations particularly with older patients who ……. sometimes find it easier to speak in Gujarati or Punjabi rather than English. So there’s a very strong bond and relationship between the patient and the pharmacist and I see no reason why the pharmacist cannot have a greater role in repeat prescription management”.  Furthermore, the recent Lancet report on the future of the NHS¹ also talks about using  technology to allow electronic prescriptions to be repeated, he adds.

Regarding deregulation of medicines [reclassification POM-to-P] he notes that such decisions need to be clinically driven and adds that “As a principle I can see the merit of it and I would want to look at what the possibilities are on that front”.

Investing in training

In recent years there has been a steady decline in the number of community pharmacies in the UK. In addition, there has been a decrease in the number of pharmacists – to the point where pharmacists were added to the Home Office shortage occupation list (SOL) in March 2021.

Mr Ashworth takes a keen interest in the training of health professionals at the two universities in Leicester. He says, “I know how important it is to encourage people to train to become pharmacists. We would want to look at how we can make that easier [with] proper financial support for potential students but also for universities”.

There is currently a shortfall of 210,000 health and social care staff and even more staff will be needed in future to cope with the demands of an ageing population.

Mr Ashworth says, “We are going to need as a country to put [a] big investment into workforce development. It has to become a priority and community pharmacy and pharmacists are absolutely key to that because if you need to manage – whether it’s diabetes or hypertension or kidney problems, you are going to need that army of pharmacists in every community”.  This includes both pharmacists working from community pharmacy premises and those based in primary care hubs and GP surgeries, he adds.

Pharmacy education now incorporates prescriber training and from 2026 new graduates will be independent prescribers (IPs) from the day of registration and will be capable of working in multi-professional teams across a variety of healthcare settings. Mr Ashworth foresees important developments in primary care.

He says, “There’s an interesting debate about how you encourage more [people] to think about general practice as an option ……this perhaps is more directed at potential GPs than community pharmacists, although I’d be interested to explore it further. We know, for example, that a potential GP spends a lot of their time training in the acute sector – they might spend a lot of their time doing orthopaedics – even though they want to be a GP. So, why are we training so many GPs in hospitals and not training them in general practice? Now it’s not quite the same with community pharmacy but we’ve got to think about how we make sure that they get proper training as well in the appropriate places, [that] is the broader point I’m making and I’ll be interested to explore that further with the …. pharmacy community

Raising the pharmacy profile

Asked how pharmacy might raise its profile with politicians, Mr Ashworth says that he has found it very valuable to spend time shadowing frontline NHS staff.

He says, “I would encourage every community pharmacist to write to their MP (Member of Parliament) and invite them to spend a day with them. …. You’re not going to get the full picture, obviously, but at least you get a flavour of it and I think that’s really important.  I think it’s incumbent upon those politicians to champion community pharmacy and I think as the NHS is restructured locally …… it’s vitally important that the community pharmacy is not forgotten again”.

He explains that during the NHS reorganisation led by Andrew Lansley (the then Secretary of State for Health and Social Care) about 10 years ago, the minor ailments service was abandoned because Clinical Commissioning Groups (CCGs) decided it was not in their financial interests to fund it. He attributes this to the fact that community pharmacy did not have a proper voice in the system. “If we are moving to integrated care systems I think we’ve got to make sure community pharmacy’s voice is properly heard and they are properly represented in those structures as well”, he says.

Funding high-cost drugs

Addressing the question of how we fund high-cost drugs in future Mr Ashworth says, “We need to think about what we get in return for the investment that we put in via R & D (research and development).  I’m very much in favour of investment in R & D, by the way, but we need to think about what we get in return and this is going to become ever more vital. I mean, you’ve mentioned drugs, which is quite right, but as we understand more around healthcare data and we know that therapies and drugs and other interventions can be developed on the back of that, we’ve got to make sure that we get a fair deal for the NHS and the taxpayer. …… We could have a day-long seminar on how we reform that – but that’s something we’ve obviously got to think about”.

Reference

Anderson M et al.  LSE–Lancet Commission on the future of the NHS: re-laying the foundations for an equitable and efficient health and care service after COVID-19. Lancet 2021; 397: 1915–78

Contact details for Jonathan Ashworth MP

Email: jon.ashworth.mp@parliament.uk

Read and watch the full series on our website or on YouTube

The recent statement by Sajid Javid, Secretary of State for Health and Social Care that he would give pharmacists the right to prescribe so that doctors could have more time to spend with patients made headlines briefly. Jonathan Ashworth, Shadow Secretary of State for Health and Social Care, along with many pharmacists, pointed out that pharmacists have been able to prescribe for many years. In fact, independent prescribing was introduced in 2006 and there are now nearly 12,000 independent prescribers on the General Pharmaceutical Council (GPhC) register, representing about 20% of all UK pharmacists.

Mr Ashworth says he is “a huge fan and champion of community pharmacy” and that “community pharmacy is an incredibly important part of our health ecosystem”.

He recalls, “I became particularly interested in community pharmacy about five years ago when I started in this role as the shadow Health Secretary, when the Government at the time were cutting the investment going into community pharmacy and we were very fearful that we’d lose a number of community pharmacies from our high streets”. In the event some pharmacies closed and others had to cut back some of the services that they offered, he notes.

“I remember throwing myself into the campaign and it became absolutely crystal clear to me that that community pharmacy is a vital part of healthcare; it’s a vital part of providing patients with the quality care that they deserve”. Moreover, community pharmacy should be properly integrated with community care and primary care. Failure to integrate in this way leads to burdens in other parts of the healthcare system, he says.

“It’s important that we do all we can to increase the investment available [and] the training available so that the pharmacists can take up the options to move into prescribing. If you remember, the last Labour government …. was looking at moving to a sort of ‘ailment first’ service (Pharmacy First Minor Ailments Scheme) in community pharmacy which would have given the community pharmacists more of a role in managing conditions and responding to illnesses that people have. I think it’s really important that we return to that broader vision – and I know Scotland are doing something similar now.  Community pharmacists can offer so much, not just in terms of self-care but they should be able to look at prescribing, they should be able to look at appropriate medications, you should be able to get repeat prescriptions, usually through electronic means – the technology is there these days.

Vaccinations

“There’s a massive role [for] community pharmacy [in] some of the other wellness services that can be offered, you know, blood pressure checks, lung checks, help with smoking cessation as well – there’s a whole range of things that we should be mobilizing community pharmacy to do.  And, of course, vaccinations, you know – I’ve not had my ‘flu job yet but I always make sure I get my ‘flu job at a community pharmacy just to highlight the important role of community pharmacy in delivering the flu jabs”, he says. “Of course, they need to be mobilized further to do more covid jabs as well, in my view”, he adds.

Primary care pharmacists

Asked about the growth in the numbers of primary care pharmacists and the opportunities that this might offer, Mr Ashworth says that reform is now needed of the way in which general practice [medical services] are delivered in this country.  “Community pharmacy must be a key part of that alongside a wider range of skilled health professionals providing clinical care. We’re having this discussion on the day on which the Health Secretary has announced £250 million for general practice. He’s been criticizing GPs for not doing face-to-face appointments even though Matt Hancock (the previous Secretary of State for Health and Social Care) [before] the pandemic was encouraging GPs to move to Skype and app-based appointments – well they’ve now U-turned on that! But let’s be absolutely honest, what has been announced today will not fix the long-standing pressures in general practice because we’re short of GPs, we’re short of practice nurses, we’re short of district nurses and there are not enough community pharmacists working in in tandem with GPs in general practice. I think we’ve got to be honest about this and look at how some of these models work – I want to see more community pharmacists working in general practice,

“If you can get community pharmacists, whether based on the on the street corner or in the surgery doing more high blood pressure checks, helping people manage cholesterol, helping people manage to cease smoking – lung checks as well – I think you can have a much better primary care offer in this country than what we have [at present]”, he says.

Invitation to pharmacists

Mr Ashworth says, “I am interested in quite far-reaching reform but I want to do that in partnership with community pharmacists so this is an offer to community pharmacists who are reading or watching this discussion that I want to hear from you about how we transform the way in which we provide community care in this country”.

Contact details for Jonathan Ashworth MP

Email: jon.ashworth.mp@parliament.uk

Read and watch the full series on our website or on YouTube