Agenda item

Purpose: To present an overview on the pharmaceutical provisions in West Berkshire. Assessment of current provision and opportunities for improvement.

Bekithemba Mhlanga, Pharmacy and Optometry Senior Commissioning Manager, NHS England presented the report on Community Pharmacy in West Berkshire (Agenda Item 5).

Bekithemba Mhlanga highlighted that the Health and Wellbeing Board was responsible for developing and publishing the Pharmaceutical Needs Assessment (PNA). From 1^st July 2022 community pharmacy commissioning was delegated to the Buckinghamshire, Oxfordshire and Berkshire Integrated Care Board (BOB ICB). The BOB ICB was responsible for pharmacy regulation, new entrants, applications to consolidate, relocations and changes of ownership. He noted that pharmacies provided a suite of services. These were Essential Services, Advanced Services and Enhanced Services which were locally commissioned. Community pharmacies were checked on regularly. There was an annual cycle to the community pharmacy framework which must be adhered to. It comprised of three stages. Stage One was a ten question questionnaire. Stage Two was a long questionnaire completed by those who did not complete the short questionnaire or those the pharmacy team had identified concerns or issues with. Stage Three was a visit to some of the community pharmacies. This was approximately 1 – 3 % of the 1500 pharmacies in the NHS England South East region. This was a risk-based approach.

Bekithemba Mhlanga moved on to advise the Committee that there were three circumstances in which a pharmacy might exit the market. These included voluntary closures in which the pharmacy must give three or six months’ notice depending on their opening hours; secondly a consolidation of pharmacies; or thirdly a removal from the pharmaceutical list. This was very rare and only when there were serious or repeated breaches of the terms of service or fitness to practice matters.

Bekithemba Mhlanga advised the Committee that the PNA belonged to the Health and Wellbeing Board and that a summary of the PNA was in the report. He highlighted that there were no gaps in provision in the area and that there was a summary of the PNA on slide nine in the report. Bekithemba Mhlanga then addressed the challenges to pharmacy provision in late 2022 in Thatcham with the ad hoc closures of two Lloyds’ pharmacies in Thatcham and one pharmacy in Pangbourne due to severe staff shortages. There were also issues with queuing outside at Boots Pharmacy due to a closure of access via the GP Practice. Bekithemba Mhlanga advised that Lloyds had now recruited staff. There were weekly meetings with Lloyds and they were all operating as expected. Bekithemba Mhlanga advised the Committee that there were significant workforce challenges nationally but that unplanned closures due to staffing had decreased since 2022. He advised that some of the workforce shortages were due to pharmacists moving to GP practices and that this led to a significant number of closures. It was advised that pharmacies must inform the commissioner as soon as possible and then a suite of actions were activated to ensure continuity.

Bekithemba advised that the decision to close all Lloyds’ pharmacies in Sainsbury stores would result in two pharmacies closing in West Berkshire on 22 April 2023. Lloyds were in constant discussions with the NHS to ensure the public were communicated with regarding their nominated pharmacies. There were also discussions with the Health and Wellbeing Board regarding the PNA and whether any gaps would need action. Bekithemba Mhlanga noted that all pharmacies in West Berkshire and the services they provided were detailed in the slide deck. He stated that generally, West Berkshire was fairly well covered for all services.

Councillor Tony Linden highlighted that the Pharmacy in Calcot Sainsbury was in his Ward and asked whether the Boots on site would be prepared to bring in a pharmacy service. Bekithemba Mhlanga advised that the volume of prescriptions at Calcot Sainsbury was very small compared to other pharmacies. He quoted 895 prescriptions per week compared to other pharmacies which completed 5000 to 6000 prescriptions per week. However, Bekithemba advised that this did not mean that it was not required and that Boots might have wished entry onto the list. He said that it was down to the Health and Wellbeing Board to determine if there was a gap as a result of the closure. Councillor Graham Bridgman advised that the data indicated that in November 2022, Sainsbury in Calcot dispensed 5000 prescriptions of which around 60% were from the Theale Medical Centre. Councillor Bridgman confirmed that the Health and Wellbeing Board would discuss the PNA and whether a supplementary statement was needed regarding the removal of Lloyds Chemists from the two Sainsbury sites. He raised the query about where Calcot residents would go instead. He advised there were at least five pharmacies local to Calcot but he would not pre-empt the Health and Wellbeing Board decision. He asked what NHS England would do in response if there was under availability identified.

David Dean, Chief Executive Officer, Thames Valley Pharmacy, advised the Committee that the Local Pharmaceutical Committee was a non-profit statutory body representing 250 pharmacies in Berkshire and Oxfordshire including the 20 pharmacies in West Berkshire. He advised that Lloyds exiting the market was a last resort. There was immense financial pressure on community pharmacies. The contract was negotiated seven years ago and so there had been a 30% real terms cut in funding. There were increased workforce costs, energy costs and suppliers’ medication costs. Many medications were being prescribed at a loss. In addition, pharmacies had delivered more services for the NHS for the same amount of money. He highlighted the work of pharmacies throughout the pandemic and noted the vaccination services provided. David Dean advised that when pharmacies closed due to financial pressures there were impacts on local residents and it was therefore important to protect the 18 pharmacies remaining in West Berkshire, noting that opening a new pharmacy could cause others to close.

The Chairman highlighted that patients were directed to pharmacies for advice and minor ailments and queried why pharmacies were not given additional funding. The Chairman also noted that many pharmacies were dispensing medications at a loss and asked why this was. David Dean advised that the supply chain was broken. Some prices were rising faster than the Government could compensate pharmacies. Prices changed every day and so many hours were spent by pharmacists trying to source medications at lower prices. It was a very complicated funding model. David Dean explained that pharmacies cost the Government £2.6bn per year and that amount had stayed the same for seven years. He noted that the more pharmacies there were, the less funding others received. They were asking for increases in funding to provide more services to help GP and Accident and Emergency Departments but the Government would not pay the extra. The Chairman noted that pressure could be put on the Government to assist but that was beyond the remit of this Committee.

Councillor Linden advised that his local pharmacy was owned by a London company and staff did not want to travel from London. He asked if pharmacies worked together to ease the impacts of staff shortages. David Dean advised they were encouraging contractors and pharmacies to work together. He noted that the workforce crisis was abating slightly and the quality of pharmacists was improving immensely. They were also working with the BOB ICB. He noted that the formation of Primary Care Network’s (PCN’s) took 3000 community pharmacists out of the market and so they were working to build the gaps behind it. It was still an issue and would not improve quickly. Sarah Webster, Executive Place Director Berkshire West, BOB ICB, added there was a move to more local commissioning and to find opportunities to work differently, and commitments when recruiting not to poach from one another.

Councillor Andy Moore asked what the impact was of medications by mail order on local pharmacies. He asked if it was beneficial or detrimental. Bekithemba Mhlanga advised that it provided 15 – 20% of prescriptions with a significant amount of the public using them. He also noted that it was important to keep in context that of the 21 pharmacies, only 3 were problematic at the end of 2022 and 18 were providing a good service in supporting Primary Care.

Councillor Jeff Beck explained that there were problems at his local pharmacy with very long queues with waits of up to 1 to 1 ½ hours frequently. He noted the phone and emails were not answered and that it was now closed on a Saturday morning. He was also concerned that the delivery service was unreliable and intermittent. He advised that it was a desperate situation. David Dean advised that online pharmacies were available for patients but that he would encourage the use of local, independent pharmacies. He advised any concerns about a specific pharmacy would need to be looked into by the NHS. David Dean noted there was a customer charter and customers could speak with the Head Office or Chief Superintendent of the Pharmacy. Regarding the delivery services by local pharmacies, David Dean advised these were not commissioned by the NHS and would start to dwindle. Bekithemba Mhlanga advised that he would follow up Councillor Beck’s concern with the local pharmacy.

Standing Orders were suspended so that Fiona Worby, Healthwatch West Berkshire, could speak. Fiona Worby advised that Healthwatch could also assist with complaints and positive feedback, and they had Enter and View powers. Standing Orders were then reinstated.

The Chairman noted praise for his local pharmacy but acknowledged concerns regarding long waits and out of stock medications.

RESOLVED that: the report be noted.