The Daffodil Standards provide a framework for community pharmacies to build on the high standard of care they already provide to palliative care patients and their families.

They are a joint initiative between the Royal Pharmaceutical Society and Marie Curie, supported by Department of Health, Pharmacy Forum NI, and Community Pharmacy NI.

Their implementation in Northern Ireland is led by the regional lead pharmacist for palliative and end-of-life care.

Chief Pharmaceutical Officer, Professor Cathy Harrison said: “The dedication of community pharmacy makes an enormous difference to those facing the most difficult moments in their lives. With the launch of the Daffodil Standards in Northern Ireland, we take another step toward ensuring that everyone receives the care, comfort, and dignity they deserve at the end of life. I encourage all community pharmacies to embrace these standards and make them part of everyday practice.”

‘ACCESSIBLE HEALTHCARE PROVIDERS’

Over 70 community pharmacies in Northern Ireland have signed up to the Daffodil Standards and it is hoped this number will grow. Community pharmacists can sign up through the Royal Pharmaceutical Society website to receive a welcome pack.

Chris Black, Specialist Palliative Care Pharmacist Marie Curie and Belfast Trust added: “Community pharmacies are the most accessible healthcare providers and are ideally placed to support patients and the families of those diagnosed with a terminal illness.

“The Daffodil Standards build on the amazing work that community pharmacies already provide, creating a clear, structured approach to palliative and end-of-life care for the whole pharmacy team. The expertise of the community pharmacy team is then on hand to advise and reassure families when they really need support.”

Peter Armstrong, Regional Lead Pharmacist for palliative care said: “We know the huge contribution community pharmacists make towards good end-of-life care in their local communities, frequently going the extra mile to ensure the very best care for their patients.

“Implementation of the Daffodil Standards for Palliative Care provides a framework to enable the whole pharmacy team to build on their skills, develop their confidence, elevate their commitment to palliative care and reinforce their key role in supporting patients with a terminal illness and their families.”

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The historic vote comes following the shock and dismay felt in the sector at the recent Budget, which – after a decade of real terms cuts and mass pharmacy closures – has compounded a desperate situation, with a hike to National Insurance employers’ contributions and an unfunded uplift in the National Living Wage.

The ballot, run by the National Pharmacy Association (NPA), saw more than 99% of pharmacy owners say they were willing to limit their services in the interests of patient safety if improved funding is not forthcoming.

Some 71% of members in Northern Ireland took part in the poll, with 99.5% voting to serve notice on opening hours above the minimum required by their contract – meaning fewer pharmacies will be open in the evenings and at weekends.

95.4% voted to no longer collect prescriptions from GP surgeries on patients’ behalf and deliver them for free, 100% voted to refuse to co-operate with certain data requests above those required for patient safety and contractual minimums.

Other terms they voted in support of include withdrawing from supplying free monitored dose systems (medicine packs) that they are not paid to provide, other than those covered by the Disability Discrimination Act. 100% of pharmacies also voted in favour of a motion saying pharmacy owners “cannot guarantee community pharmacy services will remain safe into the future” without immediate increases in funding and the implementation of a guaranteed funding roadmap for the Community Pharmacy Strategy 2030.

The trade association is urging the government to meet and discuss an urgent uplift for pharmacy funding to guarantee patient safety and services for vulnerable people – alongside a modernisation of pharmacy with a funded expansion of clinical services.

It is also asking members to prepare to consider withdrawing services in January, if new support is not forthcoming.

Record numbers of pharmacies have shut in Northern Ireland, a record number, severely impacting access to medicines and care for the local communities they served.

Pharmacies in Northern Ireland have seen real terms cuts to their funding in the last decade even though they are dispensing record levels of prescriptions and are supporting the NHS by providing more clinical services.

National Pharmacy Association Chair, Nick Kaye said: “Pharmacies in Northern Ireland desperately want to support their local communities with access to medicines and advice but have been forced into an untenable position by a decade of underfunding.

“The sense of anger among pharmacy owners has been intensified exponentially by the Budget – with its hike in National Insurance employers’ contributions and the unfunded National Living Wage increase – which has tipped even more pharmacies to the brink.

“The ballot result overwhelmingly shows the sheer anger and frustration of pharmacy owners at a decade of cuts that is forcing dedicated health professionals to shut their doors for good,” he added.

“We strongly agree with the government’s ambition to boost community health care and hope to meet with them to discuss a new funding deal for pharmacies and modernisation of pharmacies to increase the number of clinical services they deliver, as long as they are properly funded.

“Pharmacies don’t want to reduce services but will we be left with no option but to suggest that pharmacy owners should consider acting on the clear ballot results in January if government does not act to protect this vital and much-loved part of our health service.”

He added: “As a third-generation pharmacist, I deeply care about my patients, as do pharmacy teams across the country, but I have never experienced a situation as desperate as this.

“Pharmacy owners are not a radical bunch, we have never proposed action like this before, but after a decade of underfunding and record closures, something simply has got to give.”

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Pharmacists across Northern Ireland are being stretched beyond their financial limits as pressures of the last few years come to a head and are dispensing medicines at a loss, according to one Belfast pharmacist.

The revelation comes after a Stormont Health Committee was told there was an urgent funding crisis in the sector, which is impacting the financial viability of community pharmacy here and could place the supply of medicines in pharmacies at risk.

Paul Savage, who owns Woodbourne Pharmacy on the Stewartstown Road, told NR that a 10% ‘clawback’ applied by the Department of Health is compounding the situation.

“This clawback removes tens of millions of pounds from the community pharmacy budget each year. The Department is set to implement the changes to the English clawback, which will see an increase of 20% on generics. As a comparison, in Scotland there is a clawback of 1%,” said Mr Savage.

“Pharmacies can no longer hold stocks of medicines where the basic cost of those medicines is not met by the NHS.

“Never mind the overheads associated with sourcing, procuring, ordering, documenting, recording, storing those medicines and the financial overheads of paying for medicines to remain on shelves and of course, the risk that the patient is changed and medicines are not dispensed. With the severe underfunding this service can no longer be taken as given.”

FUNDING CRISIS

Chief Executive of Community Pharmacy NI, Gerard Greene gave MLAs on the Health Committee a stark warning earlier this month, stating that a combination of chronic underfunding, outdated and unsuitable funding arrangements means that community pharmacists are struggling to pay medicine wholesaler bills.

Mr Greene outlined how this position is now placing the supply of medicines at risk. He stated that many pharmacies have reached their credit limit with suppliers and some are defaulting on payments and direct debit arrangements, and that many are juggling payments to suppliers just to keep supplies open.

The financial attrition of community pharmacy has been ongoing for over 15 years according to Paul Savage, something he describes as “preposterous”.

“That is the reality. Just prior to covid, community pharmacy were preparing to withdraw services due to the dire financial situation. With the onset of covid, community pharmacies were the only part of the health service that stayed accessible to the public,” he said.

“Community pharmacy was given a loan from the DoH to allow us to maintain services, manage wholesale bills and pay for additional staff to cope with the huge workload in challenging circumstances. We have been repaying those loans to DoH over the last two years.”

For many years, CPNI has been urging the Department to put in place a Northern Ireland drug tariff that reflects Northern Ireland’s unique circumstances as opposed to those in England.

CPNI has called for the Health Committee’s support for the urgent stabilisation of community pharmacy funding in the short term and a re-set of the community pharmacy funding.

“It is crucial that a funding model similar to Scotland is implemented, which does not take money out of the community pharmacy budget,” said Mr Savage.

“Any savings are split 50-50 and 50% is reinvested back into the sector. We would not be in this crisis if the Department of Health was not taking money out of the pharmacy budget via clawback on a monthly basis.

“I am concerned that community pharmacies will begin to close in an uncontrolled manner through the financial impact and through the relentless pressures on the physical and mental health of the pharmacist and their staff,” he added.

In response to an Assembly Question, tabled by DUP MLA Michelle McIlveen, Health Minister Robin Swann said he sought to assure the sector that he was committed to working with CPNI to “deliver fair, sustainable and affordable funding for community pharmacy”.

“Following an urgent meeting I held with representatives of CPNI on 21^st February, I have committed to an inflationary uplift of £6.1m for pharmacy services in 2023-2024,” said Mr Swann.

“Furthermore, an additional £4m was provided in recognition of service pressures for the 2023-2024 year. The Business Services Organisation arranged for payment of 10/12 of this (£8.4m) with the February payment.

“Further work will be taken forward to review community pharmacy contractual arrangements in the coming months with CPNI.”

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It is estimated that a total of 5.7 million tests, which come in kits of seven, have been distributed via the sector.

Community Pharmacy NI has welcomed the figures, highlighting that having the kits available from an accessible location has been essential to breaking the chain of transmission within our communities.

Lateral flow tests can be collected from 580 locations across Northern Ireland, including 500 community pharmacies.

Peter Rice, Chair of Community Pharmacy NI said: “Reaching this significant milestone is a testament to the entire community pharmacy network who have worked tirelessly to distribute lateral flow tests to patients.

“Facing increased demands from patients as well as workforce pressures associated with the transmission of the Omicron variant, our community pharmacy teams have remained steadfast in their efforts to distribute Lateral Flow Tests among communities. It has been a huge logistical undertaking to get to this point and community pharmacy has played an integral part.

“Over the festive period, as transmission of the Omicron variant rose sharply and demand for Lateral Flow Tests increased as a consequence, in many instances community pharmacy was the only collection point available to members of the public.

“The COVID-19 pandemic has shown community pharmacy’s value as a key component in our health system, ensuring accessible healthcare and solidifying the link between pharmacies and their communities. I would encourage the Department of Health to consider this milestone when planning for healthcare transformation. Access to local, community-facing primary care is vital and I hope we can consolidate on this.”

Lesa McLoughlin, community pharmacist at Dundela Pharmacy, Belfast said: “Working in a community pharmacy throughout the pandemic, I have seen first-hand the role my colleagues have been playing each day to support patients. We have continually stepped beyond our everyday role to take on additional services to support those living in the community. The rollout of Lateral Flow testing kits is an essential part of this as patients have come to rely on community pharmacy as part of their test, trace, and isolate routine.”

You can collect a free lateral flow testing kit from community pharmacies: https://maps.test-and-trace.nhs.uk/

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