Progress on Government commitments to support both hospital and community pharmacy services in England ‘require improvement’, an expert panel commissioned by the parliamentary Health and Social Care Committee has found.
The panel concluded that the Government had not met several of the policy commitments it made for pharmacy services, and the report aims to hold the Government to account and support the focus of such commitments going forwards.
Hospital pharmacy was one of five policy areas examined by the panel along with integrated care, community pharmacy, workforce education and training and extended services. Across these, nine commitments were separately evaluated and two were rated as ‘good’, five as ‘requires improvement’ and two were ‘inadequate’.
Paper prescribing commitment missed
Once such ‘inadequate’ commitment by Government was to eliminate paper prescribing in hospitals and introduce digital or e-prescribing across the entire NHS by 2024. Experts found that poor ‘digital maturity’ was partly responsible, and they reported that even prioritised funding for IT systems was insufficient.
The report stated: ‘This commitment will not be achieved by 2024, with only 3% of Trusts having achieved the commitment so far. Although the deadline for achieving the commitment has been postponed by the Government until 2026, the evidence available to us indicate that it is not likely to be met by this deadline either.‘
Commenting on this finding, Professor Dame Jane Dacre, chair of the expert panel, said: ‘A Government pledge to move entirely to digital or e-prescribing across the NHS by the end of 2024 was overly ambitious. We found inadequate progress in the delivery of this commitment due to the lack of joined-up digital infrastructure in the NHS and Social Care.‘
The second hospital pharmacy commitment outlined was to optimise NHS aseptic services to deliver better clinical outcomes for improved patient experience and to achieve productivity gains. This included various targets around standardisation and automation via hubs to increase capacity to 40 million units of aseptic preparation.
While the appropriateness of this commitment was deemed ‘Good‘, all other aspects such as funding and resource, impact on patients and overall success were found to require improvement.
DMS requires improvement
The introduction of a medicines reconciliation service to ensure that changes in medicines made in secondary care are implemented appropriately when the patient is discharged back in the community also required improvement.
While the Discharge Medicines Service is working in some areas and seeing a positive impact on patients, the report highlighted the considerable variation in the number of referrals from hospital trusts to community pharmacies – even within the same integrated care system.
Several reasons for this were highlighted, including staff shortages, insufficient incentives for hospitals and incompatible IT systems between hospitals and community pharmacies.
Steve Brine, who chairs the Health and Social Care Committee that commissioned the report into pharmacy, said it made for ‘sobering reading’.
He added: ‘Success will rest on resolving challenges around funding, the digital infrastructure and, crucially, workforce skills and training. The level of detail about progress by the Government so far will feed into our work and, ultimately, help shape the recommendations we make to ministers.‘
Commenting on the report, James Davies, director for England at the Royal Pharmaceutical Society, said: ‘The Inquiry report makes compelling reading and is a wake-up call for the Government, highlighting that improvement is required to meet many of its commitments to patients through pharmacy. In particular, the report highlights the recurrent theme of inadequate funding to support the government’s ambitions.‘
He added: ‘Outdated paper prescribing is still the norm in too many settings. The lack of integration and ability for IT systems used in community pharmacy and hospital pharmacy to exchange and use information holds back further progress in removing prescribing errors and improving patient care.‘
The commitments to maintain a Pharmacy Access Scheme within community pharmacy and deliver a new Community Pharmacy Consultation Service with referrals from NHS 111, GPs and A&E were both found to have been met, but with a few issues to address.