The contribution of community pharmacies is critical to the success of primary care delivery throughout the UK. However, their involvement and relationship with the NHS is often poorly understood. The King's Fund has published a useful review of their role (Baird and Beech, 2020).
Community pharmacies make up one of the four pillars of the primary care system in England, along with general practice, optical services and dentistry. Most people only know pharmacies as dispensers and retailers of medicines, but their role in contemporary society is now much wider. Traditionally situated in most high streets, pharmacies are also now to be found in many large supermarkets. The role of community pharmacists has been crucial in supporting the general public and patients with long-term health conditions.
Community pharmacies and the COVID-19 pandemic
Pharmacies have played a vital role during the pandemic, not only by ensuring a stable supply of key medicines, but also in becoming an information hub regarding the virus. Many pharmacies are now the most common first point of contact for patients, giving pharmacists opportunities of early detection and appropriate referral, as they were in China at the beginning of the pandemic (Ung, 2020).
Visacri et al (2021) discussed the pivotal role of pharmacists, who have adopted innovative strategies to minimise the adverse impacts of the pandemic. They have provided drug information for health professionals in addition to patient counselling.
Pharmacies have reduced the burden on other healthcare providers by supporting non-COVID-19 patients with other ailments, acting as a triage service and by providing home deliveries of medication to housebound shielders (Bukhari et al, 2020).
As the COVID-19 vaccines have been rolled out during the second wave of the pandemic, fake news that undermines people's confidence in their effectiveness needs to be simultaneously tackled. This is not surprising as anti-vaccine propaganda is as old as vaccination itself, which began with Edward Jenner's ground-breaking work against smallpox in the 18th century (History.com, 2020).
Since then, many vaccines have been developed but, despite the obvious success of vaccines in immunising people against diseases that can kill, fears of vaccine side effects persist. Vaccination remains a stubbornly controversial topic in many societies today. Media reports frequently cover these issues (Pager, 2019).
In many societies, vaccines designed to immunise people, but especially babies and young children, against infectious disease, arouse fears, leading to the spread of misinformation (Gatenby, 2019).
In recent years, these have included the utterly false link between the measles mumps and rubella (MMR) vaccine and autism in parts of North America and Europe, and claims that the tetanus vaccine is a vehicle to covertly administer birth control agents in Kenya and Nigeria. Similarly, in Afghanistan the Taliban have strongly opposed the administration of polio vaccine because of fears that this is an attempt by the West to sterilise Muslim children (Glasper, 2019).
It is known that a higher belief in misinformation about the virus is consistently associated with a reduced willingness to get vaccinated. The spread of false information about COVID-19 poses a serious risk not only to the success of the vaccination campaigns, but to public health in general. Sadly, corrections to so-called fake news are unlikely to entirely undo the damage caused by the initial delivery of misinformation, although media and technology organisations have collaborated to try (BBC News, 2020).
‘There is no doubt that community pharmacies have stepped up to the greatest challenge in society since the Second World War, that of helping deliver the national roll out of COVID-19 vaccines.’
A particular challenge in the UK is persuading many in some faith communities, who have expressed suspicion about or opposition to the COVID-19 vaccines, about the safety of the vaccine. The proliferation of fake medicines, fake news and medication misinformation surrounding COVID-19 underscores the role of pharmacists as key health professionals who have the required skills and training to contribute to the spread of accurate information as trusted members of the community (Erku et al, 2021).
UK politicians are keen to more fully involve community pharmacies in the COVID-19 vaccine rollout, with the Labour leader stressing that the Government should capitalise on their offers to help achieve a faster 24/7 vaccination programme. Six pharmacies across England began vaccinating people against COVID-19 on 14 January 2021, including sites run by Boots, Superdrug and four independent pharmacies. More than 200 pharmacies are now expected to join the rollout initiative over the coming months. Harnessing the power of community pharmacies will enable older people and those in at-risk groups to be vaccinated much closer to home (Robinson, 2021).
The Tony Blair Institute for Global Change, of which the former prime minister is the executive chairman, has recently published a report emphasising that vaccine distribution should be commenced in all pharmacies, regardless of their size, with an aim of bringing 5500 community pharmacies online in the fight to roll out the vaccines (Miller et al, 2021).
However, the threat to the vaccine delivery schedule and especially that of the Oxford AstraZeneca vaccine caused by a delay in deliveries from India, and the need to retest a batch of 1.7 million doses, is likely to result in a slowdown of supplies to pharmacies in April 2021 (Donnelly et al, 2021).
Community pharmacy services
The community pharmacy contractual framework with the NHS outlines three types of services that pharmacies offer (Baird and Beech, 2020).
These are mandatory and part of what community pharmacies must provide to fulfill their contract with the NHS. These include the dispensing of medicines and medical appliances, the disposal of unwanted or spare medicines, advising patients on self-care, providing advice on healthy living and providing medicines support following a hospital discharge.
These are optional services that pharmacies can choose to provide. They are nationally set and specified, and the option to provide them is open to all community pharmacies, provided they meet certain minimum requirements. The advanced services currently commissioned through the contract framework include flu vaccination, the New Medicine Service (which aims to help patients understand and make best use of a newly prescribed medicine), and the recently developed Community Pharmacist Consultation Service, which allows certain other parts of the health system to refer patients to community pharmacy for some urgent care needs such as emergency medicines supply, as well as for some minor illnesses.
These are optional services such as anticoagulation services.
In addition to these nationally determined services, community pharmacies can also be contracted to provide locally commissioned services, which are assigned by public bodies, including clinical commissioning groups (CCGs) or local authorities, to meet the needs of particular local populations outside the nationally set and specified services. Examples of local commissioning from community pharmacies includes services on sexual health, needle and syringe exchange and smoking cessation.
It is clear that community pharmacies will continue to evolve and offer an increasing menu of patient services, working closely with GPs (Baird and Beech, 2020).
The vaccine challenge
Anyone watching the Prime Minister's regular televised briefings will be aware of the complexities in delivering the mammoth COVID-19 immunisation rollout in the UK. As this journal went to press, more than 30 million people had received their vaccinations, many of which were delivered through community pharmacies (Department of Health and Social Care, 2021).
There is no doubt that community pharmacies have stepped up to the greatest challenge in society since the Second World War, that of helping deliver the national roll out of COVID-19 vaccines.
Community pharmacies already have the experience of vaccinating people against flu annually, which is already one of their fundamental roles in managing the health of local populations. The national vaccination programme requires a Herculean effort and the contribution of community pharmacies must therefore not be overlooked and underappreciated.
- The contribution of community pharmacies is critical to the success of primary care delivery in the UK
- The role of community pharmacists is crucial in supporting the general public and patients with long-term conditions
- Pharmacists can provide a ready source of advice and support around patient medicines, minor acute illnesses, and long-term conditions
- The role of pharmacies has expanded during the COVID-19 pandemic
- Pharmacies have reduced the burden on other healthcare providers by supporting non-COVID-19 patients with other ailments, acting as a triage service and by providing home deliveries of medication to housebound shielders