11. Submissions on Behalf of the National Pharmacy Association by Mr Stanton

Mr Stanton: Thank you, my Lady.

My Lady, in this submission, I provide a brief summary of the role and mandate of the National Pharmacy Association, the NPA, and highlight the role played by NPA members in the delivery of vaccines and overcoming vaccine hesitancy, before making some observations about potential areas of focus in this module.

The NPA represents the vast majority of independent community pharmacies across the UK. The type of pharmacies represented are family-owned community-focused businesses, ranging from single outlets to regional chains, as distinct from national chains.

Over 50,000 people, including around 15,000 pharmacists, work in the NPA’s approximately 5,500 member pharmacies.

Community pharmacy is part of primary care and plays a vital role in maintaining and improving the health of communities it serves. It is most well known as a dispenser of medicines, but its role is in fact much broader and includes other NHS and publicly funded services, for example the provision of health advice, the administration of millions of flu vaccines every winter, and the provision of lateral flow tests.

Community pharmacies played a core role in maintaining access to healthcare services during the pandemic, despite immense pressures, and they were instrumental in the successful delivery of the Covid-19 vaccination programme.

This programme was the biggest success of the pandemic. It operated at unprecedented pace, scale and complexity, and it is estimated that the programme has prevented hundreds of thousands of hospitalisations.

There have already been some helpful and informative assessments made of vaccine delivery during the pandemic, and you and your team will no doubt be aware of the National Audit Office’s report of 25 February 2022 titled The rollout of the Covid-19 vaccination programme in England.

At paragraph 3.10 of this report, the National Audit Office identifies that community pharmacies and GPs went beyond expectations in delivering the Covid-19 vaccine. 71% of vaccinations were administered by GPs and community pharmacies against a planning assumption of 56%, an increase of about a third. This compares to 21% of vaccines delivered at vaccination centres, against a planning assumption of 41%, which is about half of what was expected.

The additional contribution by community pharmacies and GPs to the vaccine roll-out was a significant factor in the programme exceeding its objectives and expectations, and, as set out at paragraph 3.11 of the National Audit Office report, this delivery, at a cost of £24 per dose, was also more cost-effective than at vaccination centres, which operated at £34 per dose.

Throughout the pandemic, community pharmacy continued to scale up service delivery to meet demand. For example, the number of community pharmacies able to deliver the vaccine increased by 50% between October and December 2021, and when the government expanded the booster programme in December 2021, community pharmacies immediately increased their appointment availability.

According to figures from NHS England and NHS Improvement, by 14 January 2022 community pharmacy had delivered well over 22 million vaccinations, which is an increase of approximately 10 million in approximately three months from October 2021.

Another important feature of the delivery of vaccines by community pharmacy is that it has relieved substantial pressure on other parts of the NHS. For example, in Northern Ireland, community pharmacy played a significant role in the care home vaccination programme, and is now responsible for all care home Covid-19 and flu vaccinations.

Regarding vaccine uptake, the NPA issued guidance for members about how to tackle vaccine hesitancy in patients and on the factors influencing vaccination uptake amongst some groups.

The NPA met with government ministers in January 2021 to consider how community pharmacy could help promote uptake of the Covid-19 vaccine, including how the high levels of trust in local pharmacists could be an important factor in overcoming doubts and misapprehensions.

Following this meeting, and at the request of ministers, the NPA ran an education programme for pharmacists to support them in dealing with vaccine hesitancy.

The NPA also collaborated with NHS England to produce a toolkit to allow people from marginalised groups, such as people without secure NHS status, or those without a fixed address, to access Covid vaccinations through community pharmacy. This type of initiative and service not only improved the health of the individual patient but also provided public health support to the wider community.

Community pharmacists have strong trusting relationships with their local communities and they were able to engage with patients to discuss their concerns. This included in languages other than English where English was not the main language spoken. Pharmacists also reached out to people within their communities, including by attending places of worship, to encourage vaccine uptake, and because community pharmacists are more heavily concentrated in deprived areas, this type of engagement helped to tackle vaccine equalities.

The NPA regularly surveys its members and can share their insights on vaccine hesitancy with the Inquiry. Some examples include a pharmacist from Sutton who told the NPA that even people who don’t trust the vaccine do trust their local pharmacist and will have a dialogue with them:

“From my experience, it’s really important to give my patients the time and opportunity to talk openly about their health beliefs. I’ve had many patients ask my opinion on the Covid-19 vaccine and in particular the safety and efficacy of it.”

A pharmacist from Macclesfield said:

“I have been a pharmacist for 38 years and I can say the day when my pharmacy became one of the very first in the country to administer the Covid-19 vaccine was the biggest day of my career. It’s been quite emotional at times for our patients. Some people have not been out of their homes since last March. They are hesitant to be outside and are not used to seeing people. They see being vaccinated as the start of the end of this grim existence. I opened this pharmacy in 1990 and feel close to many of our patients. I know four generations of some families who use the pharmacy. We are hardwired into this community.”

The NPA and the community pharmacy sector is keen to ensure that lessons are learned from the vaccination roll-out programme and the NPA is pleased to note from the Inquiry’s provisional outline of scope document that this will be a focus of Module 4.

While ultimately successful, there are still aspects of the vaccination delivery programme which gave rise to concern for the NPA and its members. As early as the summer of 2020 the NPA highlighted to government ministers, policymakers and Public Health England the key potential role of community pharmacy in the administration of the vaccination service, having already had success and experience in the delivery of the flu vaccination for over 20 years.

However, despite this potential and existing expertise and experience, government engagement with community pharmacy in the initial planning of the programme in autumn 2020 was limited, and it was only later in the programme, from spring 2021, that the NPA and the wider community pharmacy network was able to participate more fully.

The Inquiry has heard in Module 1 about failures during the pandemic to adequately engage with existing knowledge and experience within health and public health services. This appears to be a recurring theme and it is identified in respect of vaccination delivery at paragraph 3.30 of the National Audit Office report where it is recorded that:

“… the [UK Health Security Agency], primary care representatives and some local government stakeholders did not feel their existing experience and knowledge had been taken fully into account at an early enough stage.”

Given their experience and track record of delivery, and their reach into local communities, the NPA suggests that the community pharmacy sector should be included from the outset in all local planning meetings around implementation of vaccination services, including supply and resourcing discussions.

From an operational perspective, a huge amount of planning is involved in the delivery of a vaccination programme and the NPA suggests that the following areas of the Covid-19 vaccination programme require improvement.

There was an initial lack of clarity about how NPA members were able to participate in the vaccination programme and a lack of consistency of approach in different parts of the country. As already mentioned, community pharmacy continued to scale up its service throughout the vaccination programme, but with clearer guidance and earlier engagement they could undoubtedly have done more, sooner.

Delivery of the vaccination service produced significant paperwork and administration that increased workload and pressure on community pharmacy at a time when services were already stretched to breaking point. At a time of national emergency, the emphasis should have been on reducing administration.

There was sporadic supply of vaccines, with many community pharmacies struggling to actions sufficient supply to meet demand. In this regard, an NPA member provided the following feedback:

“With increased quantity of vaccine being allocated to our offsite vaccination centre, we could have done so much more. Instead, patients were made to travel 40 or 50 miles to access a mass vaccination site for their first dose. By opening appointments, patients managed to book their second doses with us where they live or work. This was the only way we could force NHS England to allocate vaccines for us, having bookings to justify allocations. The NHS booking system also created issues and did not allow for a two-way dialogue between pharmacies and their patients. There were instances when patients failed to turn up for appointments but, due to the required thawing process of the vaccine, the vaccinations had already been prepared for use within a specified time. This meant that vaccinations would need to be destroyed unless pharmacies could find a way, often through their local relationships, to utilise already prepared vaccinations.”

The NPA has provisionally identified the following three areas for improvement. First, properly utilise existing expertise, capability and capacity within primary care. Innovation is, of course, important but there is evidence that new, untested initiatives were prioritised at the expense of existing expertise, experience and capacity.

Second, better planning, engagement and communication. It is essential that community pharmacy has full clarity about expected volumes so that they can plan and allocate resources, invest appropriately, and procure the right level of vaccines.

Third, improved access to information. Community pharmacy requires access to the NHS vaccine booking system and appropriate read/write access to full patient records to operate to their full potential, which is important given how stretched health services are.

Finally, in respect of the Inquiry’s key lines of enquiry and target populations for qualitative research, the NPA has provided written comments, which it does not propose to repeat here, save to highlight that there is evidence that existing trusting relationships between patients and healthcare providers within primary care, including community pharmacy, was a factor in vaccine uptake, and the NPA suggests that this issue should be specifically addressed within the research.

Thank you, my Lady.

Lady Hallett: Thank you very much indeed, Mr Stanton.

Mr Wald.

Mr Wald: My Lady, very briefly, you’ve heard helpful submissions covering a wide range of topics in the course of the day, and I know that the Inquiry team, and I’m sure you, will want to consider these with great care.

I don’t propose to address you, my Lady, on the detail of those submissions, much of which is covered in any event in the CTI note and this morning’s oral submissions, but I do wish to make one small but important revision to those oral submissions.

My list of CPs attending remotely was incomplete and I apologise to Public Health Scotland and its counsel Simon Bowie KC for my failure to include them both within that list. I hope that by their appearing in today’s transcript that will provide the necessary correction.

Lady Hallett: Thank you very much indeed, Mr Wald.

My apologies to Public Health Scotland and to Mr Bowie. They will most definitely be included. Thank you.

That completes all the submissions that I shall hear today, and with the assistance of Counsel to the Inquiry I shall consider them all carefully, as I’ve indicated, and then make any determinations where they are necessary.

I’m very grateful to everyone who’s either attended here in person or has followed us online, and again, as

I’ve already indicated, I’m extremely grateful to all those who have provided both written and oral submissions, and none of them will be wasted, I can assure you. Even if they raise issues that I have already determined, I will revisit them and, I promise you, review them.

Thank you all very much indeed.

(3.10 pm)

(The hearing concluded)