Figure 1. GP Consultations trend March 2019 to Sept 2020
Source: NHS Digital Appointment in General Practice Data (September 2020) NHS Digital Copyright 2020. Licensed under Open Government License

Electronic Prescription Service (EPS) at the forefront of the change driving the switch to online provision

This change in process led to a surge in EPS nominations which has not slowed as restrictions have been relaxed. Further enabled by the EPS system Phase 4 rollout, nominations at the end of September were close to 40 million and EPS items reached 86.5% in England.

Figure 2. EPS nominations trend Feb 2020 to Sept 2020.
Source: NHS Digital EPS data (October 2020) NHS Digital Copyright 2020. Licensed under Open Government License

The net result of this change in working has led to a shift in the way that prescriptions are handled within the UK market. Where the total market is in slight decline, the DSP market has grown by 48.6% for the period March to August 2020 compared to the same period in 2019 (Figure 3). Lloyds ECHO shows a growth of 910% and Pharmacy2U are now regularly dispensing 1 million items per month. Patients seek convenience, reliability and affordability in every transaction they complete online as they lean towards home delivery for groceries, shopping and now also prescription medications. This has undoubtedly impacted the traditional bricks and mortar community pharmacy sector – the question is, how does independent pharmacy mitigate for this change in habit, the DSP model fits the economies of scale dispensing model that is driven by the community pharmacy contract, what can be the point of difference for the independent pharmacy sector?

Figure 3. Growth of the DSP in 2020
Source: NHS Business Services Authority Dispensing Data (September 2020) NHS Digital Copyright 2020. Licensed under Open Government License

Independent pharmacy needs to capitalise on strengths and continue to develop patient relationships

Pharmacy purchasing data since March 2020 (Figure 4) show that independent and regional multiple pharmacies have seen an increase in purchasing share to the detriment of the larger corporations, potentially as customers stay local and avoid town centres due to the various lockdown restrictions. Patients have narrowed their range of locations and retailers as they seek out the best option to fit their needs. Originally driven by a need to reduce contact for safety reasons, many patients prefer the “stay local” approach, especially whilst they work from home, which could become the “new normal.”

Figure 4. Changes in pharmacy purchasing
Source: IQVIA Wholesale Sales Data (Sell-In) September 2020

So where could these behavioural shifts lead to opportunities for the independent pharmacy to engage with new patients? IQVIA have been monitoring the impact of the pandemic on the marketplace and has noted changes in demand within certain categories of drugs during 2020 – notably psychoanaleptics including anti-depressants (Figure 5). There was a spike in the use of antidepressant drugs in March, just as the first national lockdown started. As the healthcare system and associated services increasingly operated “behind closed doors” this patient demographic was growing but didn’t necessarily have the same level of access to their GP and may have questions about their new drug therapy. Online providers were not present or available for advice and support, whereas the independent pharmacies remained open and available. Antidepressant drugs are not currently included in the New Medicines Service, but potentially this presents an opportunity where a few minutes spent with a patient who needs support could make a real difference to them, while also building relationships and long-term loyalty.

Figure 5: Sales of psychoanaleptic and anti-depressant drugs in 2020
Source: IQVIA Supply Chain Manager

How has pharmacy service income been impacted during the pandemic?

This was a concern even before COVID-19, due to the community pharmacy contract funding changes announced in 2019. Medicine Use Review payments have been capped at 100 per pharmacy for this year and the funding was due to be replaced by the Community Pharmacy Consultation service and the Hepatitis C service. These services have been delayed in 2020 and have not been able to address the shortfall in funding. The Hepatitis C service was planned to deliver £2m of funding, the CPCS £9m of funding in 2020/21 and MURs were expected to deliver £24m in the same period. As the stark figures (Figure 6) below show, even with the ”extra” delivery service funding there is a massive shortfall in the services. Has this only been due to the pandemic? The statistics that are available for the CPCS service would indicate, as predicted, that the gap would be there regardless of COVID-19 – a freedom of information request by C+D showed that pharmacies that were registered to provide the service between 29th October 2019 to 31st May 2020 were paid an average of £47.73 per month.

Figure 6: Key service payments growth 2020 v 2019 (April-August)
Source: NHS Digital EPS Data (August 2020) NHS Digital Copyright 2020. Licensed under Open Government License

COVID-19, a force for change to the benefit of community pharmacy?

The pandemic has been a catalyst for change within the NHS. Whilst community pharmacy has had high and low points through the past few months, pharmacies remained open throughout, where many other healthcare professionals were less accessible - this approachability needs to be the sector’s USP and a key differentiator compared to Distance Selling Pharmacies. There is now an opportunity for commissioners to evaluate community pharmacy and its position within the healthcare system, with the perspective to integrate the sector into patient care pathways making local CCGs more agile and cost effective, whilst utilising the skills of the independent community pharmacists. Funding challenges remain, and the November 2020 All-Party Pharmacy Group enquiry will shed light onto the impact of COVID-19 on the sector and the support that it needs going forwards. Whilst the pandemic has, in the medium-term, helped the sector’s cause and raised its profile, a fairer funding settlement for the future remains to be seen.

If you’d like to discuss analysis and insights in more details, please contact Jo through email.