Pharmacy in the United Kingdom

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Pharmacy in the United Kingdom has been an integral part of the National Health Service since it was established in 1948. Unlike the rest of the NHS, pharmacies are largely privately provided apart from those in hospitals, and even these are now often privately run.

Contents

History

Commerce of drugs in United Kingdom was initially regulated by the Guild of Peppers since 1180, they were in charge of the assurance of the items that were. In 1345 some members of the Guilt of Peppers founded Worshipful Company of Grocers that operated until 1617, that was in charge of assurance of the quality of food and drugs, their role related drugs business was replaced by Worshipful Society of Apothecaries (one of the 110 Livery companies) that operated since 1617 and its members were in charge of train as apprentice for 7 years the future new members until they became free man and get the "freedom" of being apothecary's apprentices.

Silvanus Bevan received 7 years of training and later he cofounded Allen & Hanburys in 1715 (that developed salbutamol in 1966 and now is part of GlaxoSmithKline).

The Pharmaceutical Society of Great Britain was founded in 1841. The Pharmacy Act 1868 limited the sale of poisons and dangerous drugs to qualified pharmacists and druggists.

The advent of the NHS had an immediate beneficial effect on the pharmaceutical industry. [1] In 1960 there were proposals that the private patients of general practitioners should be enabled to receive their drugs free on the health service, but they were not implemented. [2]

The supply of drugs in the hospital service represented about one-tenth by value of the supply through the retail pharmaceutical service in 1965. [3]

The Pharmaceutical Society of Great Britain was replaced by the Royal Pharmaceutical Society and the General Pharmaceutical Council in September 2010.

There was a reduction of more than a quarter in the number of pharmacies in the community between 1963 and 1979. According to the Pharmaceutical Services Negotiating Committee at that time over 4,000 pharmacies in England and Wales dispensing less than 24,000 prescriptions per annum were losing money on NHS services. [4]

As measured in defined daily doses per 1,000 inhabitants per day the UK had a moderate rate of consumption of antibiotics in 2015 with a rate of 20.5, double that of the Netherlands, but half that of Turkey. [5]

The Health Survey for England 2016 showed that 48% of adults in the country had taken at least one prescribed medicine in the past week, and 24% had taken three or more. 10% were using antidepressants. A total of 1.1 billion prescriptions were dispensed in England in 2016 - 47% more than 2006. [6]

In 2022, the NHS reported the lowest number of pharmacies remaining open since 2015. [7]

Contract

NHS pharmacies are governed and paid for their NHS work under a standard contract, which was modified in 2019. This modification enabled pharmacy contractors to be paid for Medicines Use Reviews conducted by pharmacists for people with multiple long term prescriptions. There are also New Medicine Services, which are intended for patients who have started on long term medication, such as asthma treatment. [8]

In 2016 the government announced that the budget for pharmacy would be reduced by £170 million nationally from 2017 (£113 million in England) - its “share” of the £22 billion in savings required across the NHS. [9] Under the new contract there will be a payment of £1.33 per prescribed item dispensed, but the flat rate establishment payment (around £25,000 per pharmacy) set up in 2005 will be reduced by 40% and is to be abolished. There will be a Pharmacy Access Scheme with monthly payments for the 1427 pharmacies more than a mile away from the next pharmacy. [10] There will be additional quality incentives for:

In October 2017 the first payments to community pharmacies under the new quality payments scheme were made by NHS England. 90% of community pharmacies, 11,094 applied. 10,985 passed the qualifying criteria and received a payment. Future payments under the scheme are conditional on all pharmacy staff being able to send and receive email by the November review date. Pharmacists who have accessed Summary Care Records more than 100 times between two specific dates will also be eligible for a payment. [12]

The revised contract for 2021 in England provided payment for blood pressure checks in high street pharmacies. [13]

Wales

The NHS in Wales has a separate pharmacy contract. In April 2017 Vaughan Gething announced that there were "no proposals to reduce investment in community pharmacy here in Wales" as was happening in England. By 2020 Welsh pharmacists will have access to patients’ summary care records in order to help deliver the Welsh common ailment service. [14] By March 2018 all the Welsh pharmacies with access to the Choose Pharmacy IT system will be able to access the Welsh GP record. [15]

Scotland

The Royal Pharmaceutical Society in Scotland called for the creation of a single electronic patient health record which pharmacists could access in October 2017. They said their members needed to have the same access to records as a GP or hospital consultant in order to provide safe treatment to people in the community. [16]

Pharmacy First was launched in 2017. This scheme permits pharmacists to treat uncomplicated urinary tract infections in women and impetigo in children without a doctor's prescription. It also increases access for patients with chronic obstructive pulmonary disease to medication-related advice and patient-centred medicine review. [17]

The Scottish government's 'NHS Recovery Plan' launched in 2021 includes a hospital discharge and medicines reconciliation service run by community pharmacies. [18]

Northern Ireland

Antibiotic use is the highest in the UK, with prescribing rates in October 2017 being 30% higher than in England. [19]

Dispensing doctors

In rural areas GPs are permitted to dispense medication if there is not a pharmacy within a mile of the surgery. [20] There are 1,290 dispensing practices across the UK serving 8.8 million patients in 2015. [21] Many are members of the Dispensing Doctors' Association. [22]

England

NHS England is supporting initiatives to place pharmacists in GP practices in order to improve the management of medication for patients with long term conditions. About 420 million repeat prescriptions are generated in the UK each year — about 200 for each general practitioner each week. In the practice pharmacists can do more medicine use reviews. [23] By April 2017 there were plans for 1350 practices in England to have access to clinical pharmacists. [24] It is intended to have 1,500 pharmacists in general practice by 2020. [25] NHS England’s announced funding for 180 pharmacists and 60 technicians to work in care homes in March 2018. [26] In April 2022 Health Education England announced funding for independent prescriber training to more than 3,000 pharmacists. [27]

The cost of medicines in primary care in England in 2017/2018 was £8.87 billion, slightly less than the previous year.

The community pharmacy consultation service started from 29 October 2019. Patients can be referred to community pharmacies from NHS 111 for minor ailments, such as earache, nasal congestion and sore throat. They are reimbursed at £14 per consultation. [28] More than 10,000 pharmacies signed up in the first three weeks but by March 2020 there had only been 60,000 consultations. It was reported that each one took about 20 minutes and there were inappropriate referrals. [29]

The NHS Discharge Medicines Service started on 15 February 2021. Hospitals digitally refer patients to community pharmacies for advice on newly prescribed medicines or changed prescriptions when patients leave hospital. [30]

In June 2022 there were 3,294 full-time equivalent pharmacists recorded as working in English primary care networks, an increase of about 700 in a year. [31]

Costs

In 2018/2019 medicines prescribed in hospitals and in primary care cost £18.9 billion, 4% more than in the previous year. 54% of the cost was attributed to hospital prescribing. These sums are based on list prices, not necessarily the prices paid. [32]

Hospital dispensing

Because of greater use of specialist medicines the cost, at list price, of prescribed medication in hospitals in England increased by 10.8% to £9.2 billion in 2017/2018 compared with the previous year. In 2010/2011 the hospital pharmacy bill was £4.2 billion. The biggest single cost was adalimumab at £494.5 million, the patent on which expired in December 2018. The actual costs paid may be less than the list prices. [33]

Specialist Pharmacy Service

The Specialist Pharmacy Service provides advice primarily on high-cost, complex and innovative medicines and medicines-related services to NHS trusts and commissioners in England. It is responsible for medicines optimisation. It employs about 100 whole time equivalent senior pharmacists, pharmacy technicians and support staff. [34] It provides advice about shortages of medication. [35]

Regulation

The services provided under contract to the NHS in community pharmacies and by community pharmacists are regulated in part by the NHS, under the provisions of the Pharmacy Act 1954 and The National Health Service (Pharmaceutical Services) Regulations, which prevent new pharmacies being opened without permission. This was done by the family health services authorities and then by primary care trusts. Now regulation is by NHS England and its Pharmaceutical Services Regulations committees. [36]

Retail and retail-based hospital pharmacies in England, Scotland and Wales are theoretically regulated by the General Pharmaceutical Council (GPhC), whilst those in Northern Ireland are regulated by the Pharmaceutical Society of Northern Ireland (PSNI). [37] [38]

However, in 2018 it was revealed through a Freedom of Information request that whilst the General Pharmaceutical Council had issued 4,111 sanctions against individual registrants (pharmacists and pharmacy technicians), it had never issued any sanctions against pharmacy owners for a breach of its premises standards, since its inception in 2010. [39] Regulation may be defined as the imposition of rules, backed by the use of penalties. [40] Since penalties/sanctions/consequences are a key component of regulation, [41] and the GPhC hasn't issued any, it could therefore be argued that the GPhC does not regulate pharmacy premises.

Non-retail hospital pharmacies are regulated as part of the hospital premises regulation by the Care Quality Commission. [42]

Local pharmaceutical committees

Local pharmaceutical committees were established in every area in 1948. Each is a representative committee of persons providing pharmaceutical services as defined in Section 44 of the National Health Service Act 1977. Each committee has about 12 members. There are now about 80 in England. [43]

Retail pharmacies

89% of the UK population live within a 20-minute walk of their local pharmacy. A majority of the population visit a pharmacy at least once every 28 days. [44] In 2014 more than 1.1 billion prescription items were dispensed in England. This was 34.5 million more than in the previous 12 months and 378.4 million more than in 2004. The total net ingredient cost of prescribed items was £8.9 billion. 89.9% of all items dispensed in England were free of charge. In Scotland the total number of items dispensed in the community in 2014–2015 was 101.1 million with a net cost of £1.2bn. [45]

Since at least 1979 there have been proposals that pharmacists should develop their role of giving advice to the public. [46] NHS England announced a pilot scheme in July 2015 for GP practices in England to employ around 300 pharmacists to provide clinical care and relieve pressure on GPs. They will monitor patients with long-term conditions, create medicine plans and provide advice and expertise on day-to-day medicines issues. [47]

In London pharmacies are used to deliver the Flu vaccination. In 2013/4 108,700 vaccinations were delivered by 1,089 pharmacies in the capital. Medicines Use Reviews in patients homes are delivered by pharmacists in Croydon. [48]

In August 2015 it was announced that retail pharmacies would be given access to NHS patients Summary Care Records after a pilot of 140 pharmacies in Somerset, Northampton, North Derbyshire, Sheffield and West Yorkshire, demonstrated “significant benefits.” Pharmacists have to ask for a patient’s permission to view their record. [49]

The Association of Independent Multiple Pharmacies is a trade association, based in Doncaster. Leyla Hannbeck is the chief executive. [50]

See also

Related Research Articles

<span class="mw-page-title-main">Pharmacist</span> Healthcare professional

A pharmacist, also known as a chemist or a druggist, is a healthcare professional who prepares, controls and distributes medicines and provides advice and instructions on the correct and safe use of medicines to achieve maximum benefit, minimal side effects and to avoid drug interactions. They also serve as primary care providers in the community. Pharmacists undergo university or graduate-level education to understand the biochemical mechanisms and actions of drugs, drug uses, therapeutic roles, side effects, potential drug interactions, and monitoring parameters. This is mated to anatomy, physiology, and pathophysiology. Pharmacists interpret and communicate this specialized knowledge to patients, physicians, and other health care providers.

<span class="mw-page-title-main">Pharmacy</span> Clinical health science

Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links health sciences with pharmaceutical sciences and natural sciences. The professional practice is becoming more clinically oriented as most of the drugs are now manufactured by pharmaceutical industries. Based on the setting, pharmacy practice is either classified as community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies is considered clinical pharmacy.

<span class="mw-page-title-main">Medical prescription</span> Health-care communication from a physician to a pharmacist

A prescription, often abbreviated ℞ or Rx, is a formal communication from a physician or other registered health-care professional to a pharmacist, authorizing them to dispense a specific prescription drug for a specific patient. Historically, it was a physician's instruction to an apothecary listing the materials to be compounded into a treatment—the symbol ℞ comes from the first word of a medieval prescription, Latin: Recipere, that gave the list of the materials to be compounded.

<span class="mw-page-title-main">Prescription drug</span> Medication legally requiring a medical prescription before it can be dispensed

A prescription drug is a pharmaceutical drug that legally requires a medical prescription to be dispensed. In contrast, over-the-counter drugs can be obtained without a prescription. The reason for this difference in substance control is the potential scope of misuse, from drug abuse to practicing medicine without a license and without sufficient education. Different jurisdictions have different definitions of what constitutes a prescription drug.

General practice is the name given in various nations, such as the United Kingdom, India, Australia, New Zealand and South Africa to the services provided by general practitioners. In some nations, such as the US, similar services may be described as family medicine or primary care. The term Primary Care in the UK may also include services provided by community pharmacy, optometrist, dental surgery and community hearing care providers. The balance of care between primary care and secondary care - which usually refers to hospital based services - varies from place to place, and with time. In many countries there are initiatives to move services out of hospitals into the community, in the expectation that this will save money and be more convenient.

The Pharmaceutical Benefits Scheme (PBS) is a program of the Australian Government that subsidises prescription medication for Australian citizens and permanent residents, as well as international visitors covered by a reciprocal health care agreement. The PBS is separate to the Medicare Benefits Schedule, a list of health care services that can be claimed under Medicare, Australia's universal health care insurance scheme.

<span class="mw-page-title-main">Pharmacy technician</span> Licensed health care provider well-versed in pharmacy

A pharmacy technician performs pharmacy-related functions, working collaboratively with a licensed pharmacist. Training, certification, licensing, and actual practice of pharmacy technicians varies not only worldwide but in some countries regionally as well as by employer.

The NHS Electronic Prescription Service is part of the NHS National Programme for IT of the National Health Service in England. It enables the electronic transfer of medical prescriptions from doctors to pharmacies and other dispensers and electronic notification to the reimbursement agency, NHS Prescription Services.

<span class="mw-page-title-main">NHS Scotland</span> Publicly-funded healthcare system in Scotland

NHS Scotland, sometimes styled NHSScotland, is the publicly funded healthcare system in Scotland and one of the four systems that make up the National Health Service in the United Kingdom. It operates 14 territorial NHS boards across Scotland, 7 special non-geographic health boards, and NHS Health Scotland.

The NHS treatments blacklist is an informal name for a list of medicines and procedures which will not be funded by public money except in exceptional cases. These include but are not limited to procedures which the National Institute for Health and Care Excellence (NICE) has ruled of limited effectiveness and particular brand name medicines. In 2017 there was a proposal for 3,200 over-the-counter (OTC) drugs to be restricted and 18 procedures to be added to the list. This generated some controversy amongst doctors with some arguing that OTC should be blacklisted instead, and others believing the move did not take into account individual patient needs.

The Drug Tariff, also known as Drug Tariff price, is that amount that the NHS repays pharmacies for generic prescription medications. It differs from prescription charges which are £9.35 per item/drug as of 2021 unless exemptions apply.

Charges for prescriptions for medicines and some medical appliances are payable by adults in England under the age of 60. However, people may be exempt from charges in various exemption categories. Charges were abolished by NHS Wales in 2007, Health and Social Care in Northern Ireland in 2010 and by NHS Scotland in 2011. In 2010/11, in England, £450 million was raised through these charges, some 0.5% of the total NHS budget. In April 2021 the charge was raised to £9.35 for up to a three-month supply of each item. In 2022, for the first time since 2010, the charge was not increased.

A veterinary pharmacist is a specially trained pharmacist who dispenses veterinary drugs and supplies or products and advice to owners of companion animals and livestock. In addition, they advise the regulatory bodies and are involved in the formulation of veterinary drugs. Veterinary pharmacy is a field of pharmacy practice, in which veterinary pharmacists may compound medications, fill prescriptions, and manage drug therapies for animals. Veterinary pharmacists are licensed pharmacists who specialize in the distribution of medications for animals.

<span class="mw-page-title-main">Pharmacy (shop)</span> Shop which provides pharmaceutical drugs

A pharmacy is a retail shop which provides pharmaceutical drugs, among other products. At the pharmacy, a pharmacist oversees the fulfillment of medical prescriptions and is available to counsel patients about prescription and over-the-counter drugs or about health problems and wellness issues. A typical pharmacy would be in the commercial area of a community.

<span class="mw-page-title-main">Healthcare in Wales</span> Overview of the health care system in Wales

Healthcare in Wales is mainly provided by the Welsh public health service, NHS Wales. NHS Wales provides healthcare to all permanent residents that is free at the point of need and paid for from general taxation. Health is a matter that is devolved, and considerable differences are now developing between the public healthcare systems in the different countries of the United Kingdom, collectively the National Health Service (NHS). Though the public system dominates healthcare provision, private health care and a wide variety of alternative and complementary treatments are available for those willing to pay.

A formulary is a list of pharmaceutical drugs, often decided upon by a group of people, for various reasons such as insurance coverage or use at a medical facility. Traditionally, a formulary contained a collection of formulas for the compounding and testing of medication. Today, the main function of a prescription formulary is to specify particular medications that are approved to be prescribed at a particular hospital, in a particular health system, or under a particular health insurance policy. The development of prescription formularies is based on evaluations of efficacy, safety, and cost-effectiveness of drugs.

Electronic prescription is the computer-based electronic generation, transmission, and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, physician assistant, pharmacist, or nurse practitioner to use digital prescription software to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy. It outlines the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic medical records. By sharing medical prescription information, e-prescribing seeks to connect the patient's team of healthcare providers to facilitate knowledgeable decision making.

Medication therapy management, generally called medicine use review in the United Kingdom, is a service provided typically by pharmacists that aims to improve outcomes by helping people to better understand their health conditions and the medications used to manage them. This includes providing education on the disease state and medications used to treat the disease state, ensuring that medicines are taken correctly, reducing waste due to unused medicines, looking for any side effects, and providing education on how to manage any side effects. The process that can be broken down into five steps: medication therapy review, personal medication record, medication-related action plan, intervention and or referral, and documentation and follow-up.

A Summary Care Record (SCR) is an electronic patient record, a summary of National Health Service patient data held on a central database covering England, part of the NHS National Programme for IT. The purpose of the database is to make patient data readily available anywhere that the patient seeks treatment, for example if they are staying away from their home town or if they are unable to give information for themselves. Despite opposition from some quarters, by September 2010, 424 GP practices across at least 36 primary care trusts had uploaded 2.7 million Summary Care Records. On 10 October 2010, the Health Secretary announced that the coalition government would continue with the introduction, but that the records would 'hold only the essential medical information needed in an emergency – that is medication, allergen and [drug] reactions'. By March 2013, more than 24 million SCRs had been created across England.

Separation of prescribing and dispensing, also called dispensing separation, is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from the pharmacist who provides the prescription drug.

References

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