NHS England and NHS Improvement are awaiting the completion of the annual audit of its accounts, therefore no final figure is currently available for the balance of the Pharmacy Integration Fund (PhIF). The PhIF has supported a range of initiatives, including:

- Recruitment and training of pharmacists to support integrated urgent care services, offering patients and care staff direct access to clinical advice and care from pharmacists;

- Putting pharmacists and pharmacy technicians into the multi-disciplinary teams delivering enhanced health in care homes, to support medicines optimisation for people who live in care homes;

- The development of an urgent medicines supply service. This connects people who contact NHS 111 for urgent access to medicines with local community pharmacies who are able to dispense, and redirects demand out of general practitioner out of hours services, and/or accident and emergency departments;

- The piloting of a minor illness service, which enables people who contact NHS 111 to get urgent care and advice from a local community pharmacy for a range of common illness complaints; and

- Providing leadership training for the profession to support them to work effectively with their partners in the emerging integrated care systems, with a focus on delivering the range of benefits of medicines optimisation.

Further information can be found on NHS England’s website and accessed via the following link:

https://www.england.nhs.uk/primary-care/pharmacy/pharmacy-integration-fund/

In December 2016, a new referral scheme to community pharmacy was initiated from NHS 111 to community pharmacy in response to urgent requests for medication. This has been running as a pilot with national coverage achieved by June 2017 with over 4,000 pharmacies now registered to deliver the service. This pilot is named as the NHS Urgent Medicines Supply Advanced Service (NUMSAS) within the community pharmacy contractual framework running until October 2019.

From December 2017, a further scheme started in the North East enabling the referral of patients from NHS 111 to community pharmacy for a community pharmacist consultation about minor illness symptoms. This pilot known as the Digital Minor Illness Referral Service (DMIRS) was extended to Devon, London and the East Midlands from December 2018 and is continuing until October 2019. Over 2,000 pharmacies are registered to deliver the minor illness service.

Both schemes are funded by the Pharmacy Integration Fund with the audited spend provided by NHS England as follows:

The audited spend for 2018/19 is not yet available.

The Department has made no assessment of the implementation costs of providing write access to patient records. However, in future, our ambition is for pharmacists to play an even greater role within the National Health Service and we understand that write access to NHS patient records will support this.

Providing read and write access to general practitioner (GP) records for pharmacists is complex. In some areas medical records are already shared between professionals to support locally commissioned services. To develop a national solution Departmental officials, NHS England and NHS Digital have considered important issues such as technical requirements, data standards, patient consent and data security to provide write access. Work is progressing and during 2019 pilots will commence to test that digital transfer can successfully take place between community pharmacy and GP IT systems.

The most recent NHS England ‘Pharmacy Advice’ campaign - previously called the Stay Well Pharmacy campaign - ran between 4 February and 17 March 2019. We are informed by NHS England that the overall cost of running the advertising campaign was £2 million.

The data requested is not collected or held centrally.

We are informed by NHS England that in the period up to and including October 2018, spend on the 18 low priority medicines has fallen by £31.1 million from £133.6 million, compared to 2016/17. This represents a reduction of 23%.

The volume of medicines prescribed reduced by 27% and the number of patients prescribed these medicines reduced by 32%.

In addition, NHS England has worked with PrescQIPP and the NHS Business Services Authority to refine its assessment of the amount of money spent on over the counter medicines.

In the 12 months to January 2019, the total National Health Service spend in England on over the counter medicines was £449.4 million. This was a saving on total spend of £25.9 million from the 12 months to January 2018, which was £475.3 million. This saving does not account for the potential impact to the NHS from a reduced number of general practitioner appointments, for which no assessment has been made.

These savings will be reinvested into the NHS, ensuring patients can access high quality care now and in the future.

The Department has made no assessment of the number of patients refused prescriptions for over the counter medicines.

The Department has made no such assessment. From December 2017 to March 2018, NHS England carried out a public consultation on reducing prescribing of over-the-counter medicines for minor, short-term health concerns, ‘Conditions for which over the counter items should not routinely be prescribed in primary care: A consultation on guidance for CCGs’ which can be found at the following link:

https://www.engage.england.nhs.uk/consultation/over-the-counter-items-not-routinely-prescribed/

At the end of March 2018, NHS England published guidance to enable savings of up to £100 million for frontline care each year by curbing prescriptions for ‘over the counter’ medicines. The guidance does not affect prescribing of over the counter items for longer term or more complex conditions, or where minor illnesses are symptomatic or a side effect of something more serious.

We are informed by NHS England that in the 12 months to January 2019, the total National Health Service spend in England on over the counter items was £449.4 million. This was a saving on total spend of £25.9 million from the corresponding figure for the 12 months to January 2018, which was £475.3 million. This saving does not account for the potential impact to the NHS from a reduced number of general practitioner appointments, for which no assessment has been made.

NHS England established the United Kingdom Antimicrobial Resistance (AMR) Diagnostics Collaborative in 2018 to deliver the UK’s diagnostic ambitions for AMR. The Collaborative has played a valuable role in developing the diagnostic elements of the new five-year UK AMR national action plan, published in January this year.

The work of the Collaborative contributes directly to the Government’s commitments on AMR, and the Collaborative’s secretariat communicates with the Department on a regular basis and it has been represented by its secretariat and former chair in the UK AMR Programme’s governance groups.

The Collaborative’s chair remains vacant while NHS England develops detailed plans to support the implementation of the new national plan on AMR. As part of this work, the membership of the Collaborative is under review.

Current membership is drawn from a range of stakeholders across Government and its agencies, the devolved administrations, the health system, veterinary medicine, professional bodies, academia, the research community and industry. Members at or above ‘very senior manager’ (VSM) level and partner agencies involved in the Collaborative are listed in the following table.

The National Health Service (Clinical Negligence Scheme for General Practice) Regulations 2019 were laid in parliament on 25 February 2019 and come into force on 1 April 2019. The Regulations establish a scheme which provides indemnity cover for future clinical negligence liabilities of general practitioners, and others working in general practice in respect of services provided as part of the National Health Service in England.

The Department also intends to establish the arrangements for an existing liabilities scheme in April 2019, subject to satisfactory discussions with the Medical Defence Organisations.

In 2017/18 the National Health Service carried out 21.9 million diagnostic tests, nearly 1.7 million more than in 2015/16.

NHS England publishes monthly data on diagnostic waiting times which includes the volume of patients waiting for a diagnostic test. The data is available at the following link:

https://www.england.nhs.uk/statistics/statistical-work-areas/diagnostics-waiting-times-and-activity/monthly-diagnostics-waiting-times-and-activity/

The 2015 Comprehensive Spending Review made a commitment to invest up to £300 million per year by 2020/21. The published financial profile agreed for the NHS England Cancer Programme over the four years to 2020/21 was:

This is being invested in earlier diagnosis and personalised care, including additional staff capacity and equipment. In addition, £130 million has been invested to modernise radiotherapy equipment. Funding has been allocated for over 80 new or upgraded linear accelerators across the country since October 2016.

The Government has been clear that it wants to change the focus of the health and care system onto prevention and Ministers have also set out an ambition for local pharmacies to play a stronger role in helping people stay well in the community. The Department has committed to publishing a Green Paper on prevention that will set out how these plans will be achieved in more detail. An assessment specifically focusing on the potential merits of nationally commissioning more public health services through community pharmacy has not been undertaken.

An updated list of the 1,413 pharmacies found to be eligible for the pharmacy access scheme was published in January 2018, this is publicly available and can be found at the following link:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/670305/PhAS_List_20122017_updated.pdf

A small proportion of the pharmacies eligible for the scheme will not receive a payment because they do not meet the payment criteria as set out in the Drug Tariff. This means their income in 2016/17 is greater than their 2015/16 income less a 1% efficiency saving, and/or their estimated income in 2017/18 and 2018/19 is greater than their 2015/16 income less a 3% efficiency saving. The number and proportion of pharmacies on the scheme in receipt of a payment, for each year that the scheme has been running, is set out in the following table.

^[1]Two additional pharmacies have been accepted on to the scheme since the publication of the updated list. This explains the difference in the figures of 1,413 and 1,415 for 2017/18.

The fees and allowances paid under the Community Pharmacy Contractual Framework (CPCF) for the provision of essential services, including dispensing, provided by community pharmacies each year from April 2015 to March 2018 are detailed in the following table, based on data provided by NHS England. The structure of fees and allowances does not allow payments just for dispensing to be isolated. These payments do not include the medicine margin that community pharmacies earn as part of the payment for essential services, which is paid through reimbursement within the drugs’ bill.

Enhanced services are locally commissioned. As such they are funded outside of the national CPCF and the Department does not hold the information sought.

²This comprises the fees and allowances paid under Part IIIA: Professional Fees (Pharmacy Contractors) and Part VIA: Payment for Essential Services (Pharmacy Contractors) of the Drug Tariff, and through the Quality Payment Scheme and Pharmacy Access Scheme. This does not include medicines margin.

Within the NHS Long Term Plan, Government has committed to expanding the number of pharmacists in Primary Care Networks. These pharmacists are well placed to work alongside the wider medical team to optimise the use of medicines, promote medicines adherence and improve the clinical and cost effectiveness of prescribed medications. Identifying and supporting patients on complex polypharmacy and those with long term conditions necessitating repeat prescriptions will form an important part of their role. Alongside this, in August 2018, NHS England, announced plans for a new pilot scheme, with investment of £1 million from the Pharmacy Integration Fund to develop system leadership within pharmacy across all settings. These pharmacy leaders will set the vision to systematically tackle medicines optimisation priorities for the local population within GP Network and Integrated Care System foot prints, further supporting medicines adherence, and in turn reducing medicines wastage.

The Government has been clear that it wants to change the focus of the health and care system onto prevention and Ministers have also set out an ambition for local pharmacies to play a stronger role in helping people stay well in the community. The Department has committed to publishing a Green Paper on prevention that will set out how these plans will be achieved in more detail. An assessment specifically focusing on the potential merits of nationally commissioning more public health services through community pharmacy has not been undertaken.

An updated list of the 1,413 pharmacies found to be eligible for the pharmacy access scheme was published in January 2018, this is publicly available and can be found at the following link:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/670305/PhAS_List_20122017_updated.pdf

A small proportion of the pharmacies eligible for the scheme will not receive a payment because they do not meet the payment criteria as set out in the Drug Tariff. This means their income in 2016/17 is greater than their 2015/16 income less a 1% efficiency saving, and/or their estimated income in 2017/18 and 2018/19 is greater than their 2015/16 income less a 3% efficiency saving. The number and proportion of pharmacies on the scheme in receipt of a payment, for each year that the scheme has been running, is set out in the following table.

^[1]Two additional pharmacies have been accepted on to the scheme since the publication of the updated list. This explains the difference in the figures of 1,413 and 1,415 for 2017/18.

The fees and allowances paid under the Community Pharmacy Contractual Framework (CPCF) for the provision of essential services, including dispensing, provided by community pharmacies each year from April 2015 to March 2018 are detailed in the following table, based on data provided by NHS England. The structure of fees and allowances does not allow payments just for dispensing to be isolated. These payments do not include the medicine margin that community pharmacies earn as part of the payment for essential services, which is paid through reimbursement within the drugs’ bill.

Enhanced services are locally commissioned. As such they are funded outside of the national CPCF and the Department does not hold the information sought.

²This comprises the fees and allowances paid under Part IIIA: Professional Fees (Pharmacy Contractors) and Part VIA: Payment for Essential Services (Pharmacy Contractors) of the Drug Tariff, and through the Quality Payment Scheme and Pharmacy Access Scheme. This does not include medicines margin.

Within the NHS Long Term Plan, Government has committed to expanding the number of pharmacists in Primary Care Networks. These pharmacists are well placed to work alongside the wider medical team to optimise the use of medicines, promote medicines adherence and improve the clinical and cost effectiveness of prescribed medications. Identifying and supporting patients on complex polypharmacy and those with long term conditions necessitating repeat prescriptions will form an important part of their role. Alongside this, in August 2018, NHS England, announced plans for a new pilot scheme, with investment of £1 million from the Pharmacy Integration Fund to develop system leadership within pharmacy across all settings. These pharmacy leaders will set the vision to systematically tackle medicines optimisation priorities for the local population within GP Network and Integrated Care System foot prints, further supporting medicines adherence, and in turn reducing medicines wastage.

The Government has been clear that it wants to change the focus of the health and care system onto prevention and Ministers have also set out an ambition for local pharmacies to play a stronger role in helping people stay well in the community. The Department has committed to publishing a Green Paper on prevention that will set out how these plans will be achieved in more detail. An assessment specifically focusing on the potential merits of nationally commissioning more public health services through community pharmacy has not been undertaken.

An updated list of the 1,413 pharmacies found to be eligible for the pharmacy access scheme was published in January 2018, this is publicly available and can be found at the following link:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/670305/PhAS_List_20122017_updated.pdf

A small proportion of the pharmacies eligible for the scheme will not receive a payment because they do not meet the payment criteria as set out in the Drug Tariff. This means their income in 2016/17 is greater than their 2015/16 income less a 1% efficiency saving, and/or their estimated income in 2017/18 and 2018/19 is greater than their 2015/16 income less a 3% efficiency saving. The number and proportion of pharmacies on the scheme in receipt of a payment, for each year that the scheme has been running, is set out in the following table.

^[1]Two additional pharmacies have been accepted on to the scheme since the publication of the updated list. This explains the difference in the figures of 1,413 and 1,415 for 2017/18.

The fees and allowances paid under the Community Pharmacy Contractual Framework (CPCF) for the provision of essential services, including dispensing, provided by community pharmacies each year from April 2015 to March 2018 are detailed in the following table, based on data provided by NHS England. The structure of fees and allowances does not allow payments just for dispensing to be isolated. These payments do not include the medicine margin that community pharmacies earn as part of the payment for essential services, which is paid through reimbursement within the drugs’ bill.

Enhanced services are locally commissioned. As such they are funded outside of the national CPCF and the Department does not hold the information sought.

²This comprises the fees and allowances paid under Part IIIA: Professional Fees (Pharmacy Contractors) and Part VIA: Payment for Essential Services (Pharmacy Contractors) of the Drug Tariff, and through the Quality Payment Scheme and Pharmacy Access Scheme. This does not include medicines margin.

Within the NHS Long Term Plan, Government has committed to expanding the number of pharmacists in Primary Care Networks. These pharmacists are well placed to work alongside the wider medical team to optimise the use of medicines, promote medicines adherence and improve the clinical and cost effectiveness of prescribed medications. Identifying and supporting patients on complex polypharmacy and those with long term conditions necessitating repeat prescriptions will form an important part of their role. Alongside this, in August 2018, NHS England, announced plans for a new pilot scheme, with investment of £1 million from the Pharmacy Integration Fund to develop system leadership within pharmacy across all settings. These pharmacy leaders will set the vision to systematically tackle medicines optimisation priorities for the local population within GP Network and Integrated Care System foot prints, further supporting medicines adherence, and in turn reducing medicines wastage.

The Government has been clear that it wants to change the focus of the health and care system onto prevention and Ministers have also set out an ambition for local pharmacies to play a stronger role in helping people stay well in the community. The Department has committed to publishing a Green Paper on prevention that will set out how these plans will be achieved in more detail. An assessment specifically focusing on the potential merits of nationally commissioning more public health services through community pharmacy has not been undertaken.

An updated list of the 1,413 pharmacies found to be eligible for the pharmacy access scheme was published in January 2018, this is publicly available and can be found at the following link:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/670305/PhAS_List_20122017_updated.pdf

A small proportion of the pharmacies eligible for the scheme will not receive a payment because they do not meet the payment criteria as set out in the Drug Tariff. This means their income in 2016/17 is greater than their 2015/16 income less a 1% efficiency saving, and/or their estimated income in 2017/18 and 2018/19 is greater than their 2015/16 income less a 3% efficiency saving. The number and proportion of pharmacies on the scheme in receipt of a payment, for each year that the scheme has been running, is set out in the following table.

^[1]Two additional pharmacies have been accepted on to the scheme since the publication of the updated list. This explains the difference in the figures of 1,413 and 1,415 for 2017/18.

The fees and allowances paid under the Community Pharmacy Contractual Framework (CPCF) for the provision of essential services, including dispensing, provided by community pharmacies each year from April 2015 to March 2018 are detailed in the following table, based on data provided by NHS England. The structure of fees and allowances does not allow payments just for dispensing to be isolated. These payments do not include the medicine margin that community pharmacies earn as part of the payment for essential services, which is paid through reimbursement within the drugs’ bill.

Enhanced services are locally commissioned. As such they are funded outside of the national CPCF and the Department does not hold the information sought.

²This comprises the fees and allowances paid under Part IIIA: Professional Fees (Pharmacy Contractors) and Part VIA: Payment for Essential Services (Pharmacy Contractors) of the Drug Tariff, and through the Quality Payment Scheme and Pharmacy Access Scheme. This does not include medicines margin.

Within the NHS Long Term Plan, Government has committed to expanding the number of pharmacists in Primary Care Networks. These pharmacists are well placed to work alongside the wider medical team to optimise the use of medicines, promote medicines adherence and improve the clinical and cost effectiveness of prescribed medications. Identifying and supporting patients on complex polypharmacy and those with long term conditions necessitating repeat prescriptions will form an important part of their role. Alongside this, in August 2018, NHS England, announced plans for a new pilot scheme, with investment of £1 million from the Pharmacy Integration Fund to develop system leadership within pharmacy across all settings. These pharmacy leaders will set the vision to systematically tackle medicines optimisation priorities for the local population within GP Network and Integrated Care System foot prints, further supporting medicines adherence, and in turn reducing medicines wastage.

The Cancer Workforce Plan for England, published in December 2017 by Health Education England (HEE), set out the actions needed to target additional training support for several priority professions, including diagnostic and therapeutic radiography.

There are several initiatives to prepare the healthcare workforce, through education and training, to deliver the digital future. For example, the Topol Review, led by cardiologist, geneticist, and digital medicine researcher Dr Eric Topol and facilitated by HEE, is exploring how best to enable National Health Service staff to make the most of technologies such as genetic diagnostics.

Public Health England (PHE) operates a number of microbiology laboratories across England which provides national coverage, regardless of geographic location, and works closely with Scotland, Wales and Northern Ireland’s devolved administrations. These laboratories complement and expand on the testing that is undertaken in a larger laboratory network operating throughout the National Health Service to provide frontline diagnostics.

PHE’s laboratories use many different diagnostic technologies, including traditional and molecular microbiological, serological and innovative genomic approaches to recognise pathogens and diagnose infections promptly. These cover infections caused by bacteria, viruses, fungi and protozoal parasites. The results of PHE laboratory testing are provided directly to the NHS to support patient management, to reduce risks of onwards transmission and to minimise threats to public health throughout England.

Pulmonary rehabilitation is one of the most effective treatments for chronic lung disease. Respiratory care is one of the areas being considered as part of the National Health Service long-term plan currently in development and new guidelines from the National Institute for Health and Care Excellence are due to be published in December.

The Department supports the NHS to increase access to pulmonary rehabilitation and improve the quality of care for people with long-term respiratory conditions through the following actions:

- a national roll out of the RightCare programme by NHS England which directs clinical commissioning groups to offer pulmonary rehabilitation as part of an optimal pathway for COPD patients;

- the COPD best practice tariff encourages NHS providers to refer patients for pulmonary rehabilitation as a financial incentive;

- a pulmonary rehabilitation service accreditation programme run by the Royal College of Physicians.