Agenda item

The Committee will hear from representatives from the Clinical Commissioning Group, the Local Pharmaceutical Committee and a local pharmacist.

Presenters:

Ms J Butterworth,

Mr M Patel, Chief Officer, Local Pharmaceutical Committee

Mr K Patel, Local Pharmacist

Papers:

Medicines Optimisation Governance paper (prepared by the CCG)

Report from the Local Pharmaceutical Committee

The Chairman welcomed Ms J Butterworth, Buckinghamshire CCG; Mr M Patel, Chief Officer, Local Pharmaceutical Committee (LPC) and Mr K Patel, Local Pharmacist and owner of a number of local pharmacists.

The Chairman declared an interest in having known Mr Kalpesh Patel for several years as he was the Chairman of the local Rotary group and an owner of numerous pharmacies.

Ms Butterworth, Associate Director for Medicines Optimisation, advised that the report had provided a brief overview of where the pharmacy workforce sat in the system and stressed that they were all working together more closely than ever under a single governance structure.

During the discussion, Members asked the following questions:

• The Chairman highlighted that report referred to additional roles being recruited to support the Primary Care Networks (PCNs) and asked how recruitment was going and what would happen to the funding if the posts were not filled. Ms Butterworth explained that the approval for use of the funding had been delayed due to the pandemic but the process had been accelerated and funding would be taken from this year and next year’s pot.  The number of clinical pharmacists and technicians increased each year.  Recruitment was still going ahead.  Funding was for a mid-point between a junior and senior post but if a senior pharmacist was needed the PCNs needed to provide additional funding which was an issue for some PCNs. Last year there had been anunderspend and this had been utilised creatively; it had also been used to fund a PCN lead pharmacist two days a week to provide support to pharmacies.
• A member of the committee asked what the take up was for electronic repeat prescriptions and how were the people being handled who were not computer literate.  Ms Butterworth did not know the exact figure but thought it was approximately 15%.  Ms Butterworth explained that patients could not be put on an Electronic Repeat Dispensing (ERD) service unless their medication was stable and there were a large number of patients waiting for monitoring results which had been delayed by Covid-19.  For those patients who could not be put on ERD they relied on patient access to make things easier using technology but surgeries were trying to move away from prescriptions being posted through the letter box.  However, there was a difference between electronic prescriptions, which was very high, and ERD where six to 12 months’ worth of prescriptions were loaded onto the spine at one time and then the community pharmacies could pull them down as appropriate. 
• A member of the committee stated he was conscious of the crucial role of staff in the pharmacies during the pandemic and asked if they had received all the support they needed i.e. had the insurance issue of preventing deployment staff on an emergency basis been resolved?  Pharmacists were not paid for the delivery of prescriptions – could the gap be plugged?  Pharmacists had to source their own Personal Protective Equipment (PPE) – could this be funded?  Ms Butterworth confirmed that the insurance issue had been resolved; pharmacies were being paid for the delivery of medicines for end of life drugs but in general there was no payment for delivery; this service was being stood back up for shielded patients.  It was also confirmed that pharmacists now had access to PPE.

Mr M Patel confirmed that delivery of medicines had re-started for vulnerable patients and been extended to two other vulnerable groups.  Pharmacists were signing on to the national supply of PPE.  The staff deployment insurance issue had been resolved very late and Ms Butterworth added that there had not been any requests for a community pharmacy to help out.

Mr M Patel highlighted that the report explained what the LPC was and how it worked with the local stakeholders to ensure pharmaceutical services were provided.  The report explained what had happened during the pandemic, the services offered and the challenges ahead. 

The Chairman asked for feedback from Mr K Patel on the practicalities of running a pharmacy during the pandemic.  At this point, K Patel declared a past interest as a previous chair of the LPC. 

K Patel advised it was his ‘worst nightmare’ to run a business ensuring his staff and the public were safe and provide the medicines required.  A system had been put in place whereby electronic prescriptions could be diverted to another group if the scenario arose where all the staff in one branch became ill.  There were now three dispensing robots which could be used overnight if needed.  K Patel commended all the staff who had known nothing about the virus at the beginning of the pandemic. 

Pharmacies had moved their counter to the doorway to prevent people entering the premises.  There had been issues with the lack of PPE but he had been fortunate to source PPE from India and China until it was provided by NHS England.  Volunteers were prepared to cover other branches when staff were ill or self-isolating.  There had been an increase in demand, particularly in repeat prescriptions, and staff worked over the weekend to process the orders; a recent increase had just been seen due to the latest lockdown.  Prescriptions were delivered to patients by volunteers and the scheme had recently re-started. 

Approximately 200 deliveries a day were carried out in the Chesham area alone and the majority had been continued as the pandemic continues/.  It was possible to manage demand but not stock shortages. There had been a huge extra investment in pharmacies; the government had made an advance payment but would claw it back at a later date.   The health economy needed to be better prepared going forward and the system needed a review to address the problems.

The first drug which was in short supply was paracetamol; K Patel had six months’ supply but when he managed to source new stock in small quantities they were very expensive so he had to dispense from larger packs to manage the supply problem.  Other products such as sanitising spray and thermometers were also very expensive during the start of the pandemic. 

During the discussion, Members asked the following questions:

• The Chairman asked how the Government had helped pharmacies to access supply.  K Patel stated that he had not been able to wait to ask for help; he had to take action before the systems were operational e.g. sourcing PPE.  No one had predicted the virus and the extent of the effect on the whole economy and it would have been unrealistic to expect NHS England to supply PPE when they were struggling to supply the hospitals.    M Patel added that he had worked closely with the PSNC (the negotiating committee for pharmacies) who negotiated the medicine supply, pricing etc.  The LPCs fed back what happened locally and the PSNC carried out the negotiation.  M Patel stated he would like to engage with the MPs in the area to lobby as he was concerned about the mental health and wellbeing of pharmacists.  The Chairman agreed mental health was a key issue right across healthcare. 
• In response to whether anything could be done to prepare for 1 January 2021; K Patel stated that the industry had been asked to have a six week supply, but questioned whether six weeks was enough.  He kept a three week supply of drugs in his pharmacy but keeping a six month supply would cost too much.  He had the choice of losing half his staff due to the stress after 1 January or to build up his stock so there was less stress in the system   Guidance was needed on what to do after 1 January because leaving it too late would mean pharmacies would not  be able to procure from alternative sources as drugs had to have quality assurance. Ms Butterworth added that the six weeks supply was in addition to what the wholesalers already had in stock.  Ms Butterworth also stated she understood the concerns on the ground but assured that the Department of Health was looking at the issue; the team had been increased and were working to manage drug shortages.  A shortage protocol had also been introduced to allow substitutes.  M Patel added that there was a tracker system which was communicated to the practices. 
• The Chairman asked how much involvement the pharmacists had with the Health and Wellbeing Board (HWB) which consisted of a number of health partners.  M Patel advised that they were not members of the HWB and were only involved during the Pharmaceutical Strategic Needs Assessment (PSNA) which was carried out every four years but had been postponed to April 2021 due to the pandemic.  The Chairman agreed to contact the Chairman of the Health & Wellbeing Board.

ACTION: Chairman to write to the Chairman of the Health & Wellbeing Board

• It was noted that there would be a soft launch on 1 November 2020 where GPs could refer patients to the community pharmacy as a first port of call for self-care and minor aliments; it was a six month national roll out which would be deployed by the PCNs.  M Patel stated that councillor and MP support would be required and that patient education needed to be improved.

Julia Wassell stated the pharmacists had been heroic during the pandemic; the Chairman agreed and asked for the Committee’s thanks to be put on record.

The Chairman thanked J Butterworth, M Patel and K Patel for their input.