RPS 2026 Election Manifesto for Wales

Context:

• Adverse reactions to prescribed medicines account for 11% of unplanned adult hospital admissions, rising to 18% in some hospitals, taking 1-2% of the NHS budget¹
• Public Health Wales indicate that, annually up to 2026 132,000 older people will fall more than once in their own home with 8,100 suffering a serious injury and ending up in hospital²
• Polypharmacy significantly increases fall risk, with older adults taking 10 or more medications having a 14.8% risk of falls, compared to just 1.5% in those not on any medication³.

How to implement

Ensure pharmacy’s medicines expertise is central to multidisciplinary frailty services across all health boards.

Benefits

• Reduces possible or probable hospital admissions
• Optimises treatment outcomes
• Promotes patient independence
• Reduces adverse drug reactions and side effects
• Improves medication safety, especially in regard to ‘falls risk increasing drugs’ (FRIDs).

How to implement

As part of their personalised care plan, patients with comorbidities and complex medication regimens who are at high risk of adverse reactions, should receive regular pharmacist-led medication reviews.

Benefits

• Reduces possible or probable hospital admissions
• Ensures the safety of prescribed medications for the patient
• Monitors patients for any potential side effects from their medicines
• Supports patients in adhering to their prescribed medication regimen
• Helps manage polypharmacy, where patients take multiple medications
• Optimises the use of medicines to improve patient outcomes
• Leads to opportunities for lifestyle advice and social prescribing
• Involves patients in decisions about their medication, ensuring their perspectives and concerns are heard and addressed.

How to implement

Establish formal referral protocols that allow pharmacists to directly refer patients to other services and enable them to request simple tests through agreed patient pathways when referral to a GP is the most appropriate route.

Benefits

• Monitors patients for any potential side effects from their medicines
• Supports patients in adhering to their prescribed medication regimen
• Enables earlier diagnosis and intervention
• Makes greater use of community pharmacy’s accessibility – particularly in more deprived areas
• Helps combat the inverse care law – ensuring individuals who are less likely to engage with the wider health system are captured and receive care at an earlier stage
• Enhances efficiency and improves access to treatment and reduces GP workload
• Makes uses pharmacists’ skills by utilising their clinical capabilities.

How to implement

Raise the profile of medication safety and adverse drug reaction reporting across the NHS; ensuring medication related incidents are reported and actioned to improve patient safety and avoid repeated incidents.

Benefits

• Reduces the risk of medication errors and adverse reactions being repeated
• Enables ‘once for Wales’ implementation of good practice/preventative measures
• Enables ‘once for Wales’ learning from medication errors
• Ultimately, reduces incidences of medicine related errors experienced by patients in Wales.

Context

• In 2023-24, the total net ingredient cost of all items prescribed through general practices in Wales and dispensed in the community was just over £704 million, equivalent to £214.10 per patient registered with a GP in Wales⁴. It should be stressed that these figures only account for medicines prescribed in primary care settings. There will be significant additional pharmaceutical expenditures within hospital settings, but detailed data are not readily available
• Across Wales, an estimated £21.6 million worth of prescribed medicines are wasted annually⁵
• While specific data for NHS Wales is limited, estimates from NHS England suggest that medicines account for approximately 25% of the NHS’s total carbon footprint⁶
• Antimicrobial resistance (AMR) is one of the top global public health threats identified by the World Health Organisation. Caused by the misuse and overuse of antimicrobials, AMR puts the gains of modern medicine at risk by making infections harder to treat and procedures like surgery, caesarean sections, and cancer chemotherapy much riskier⁷
• Pharmaceuticals, including antibiotics, antidepressants, and hormones, are increasingly found in waterways and farmland due to human excretion and inadequate wastewater treatment, poses significant risks to both human, animal and environmental health.⁸

How to implement

Enhance public awareness of the impact of medicine waste and improper disposal by investing in public-facing resources and encouraging healthcare professionals to inform and educate patients at every contact.

Benefits

• Reduces the NHS spending on medicines – which accounts for around 10% of the health budget
• Reduces NHS carbon emissions -around 25% of which is attributed to medicines
• Improves patient independence of their own medication
• Tackles antimicrobial resistance
• Encourages patients to only order what they need (prompted by NHS Wales App)
• Reduces stockpiling and potential harm from ‘out of date’ medicines being use
• Reduces inappropriate disposal (e.g. flushing or throwing down sink) that harms our environment).

How to implement

As suggested above, increase the frequency of pharmacist-led medicine reviews for patients on multiple medications.

Benefits

• Reduces the NHS spending on medicines – which currently accounts for around 10% of the health budget
• Reduces NHS carbon emissions -around 25% of which is attributed to medicines
• Promotes best value prescribing
• Identifies if the patient still needs to be on all their current medicines
• Lead to de-prescribing when appropriate.

How to implement

Drive innovation by supporting research and initiatives that:

• Integrate environmental data into prescribing process
• Explore the safe re-use of medicines
• And to prevent pharmaceutical pollution of rivers, seas, and farmland.

Benefits

Could inform future developments that:

• Enable the medicine with the lowest environmental impact to be first choice when multiple medicines have equivalent clinical efficacy
• Reduce the level of waste from the estimated 250 tonnes of unused prescription medicines returned to pharmacies in Wales each year
• Allow dispensed unused medicines but found to still be clinically effective and safe to be used
• Reduce pharmaceutical water pollution – even tiny amounts can impact on nature and marine life
• Tackles antimicrobial resistance.

Context

• The 2024 pharmacy workforce wellbeing survey revealed that 88% of the pharmacy workforce in Wales is at risk of burnout⁹
• The survey also found that 73% of respondents reported insufficient protected learning time during working hours, with 46% citing a poor work-life balance as a result
• As of March 31, 2024, there were 689 community pharmacies in Wales, a decrease of 19 (2.7%) from the previous year¹⁰
• Digital Health and Care Wales is currently rolling out its ‘Digital Medicines Programme’ and project to digitise how medicines are prescribed, dispensed, administered, and records shared across all care settings. It aims to support safer, more efficient, and joined-up care by replacing paper-based processes with digital systems¹¹.

How to implement

Ensure pharmacist job plans in Wales include dedicated time for training, teaching, and research.

Benefits

• Promotes a healthy work-life balance that both ultimately lead to improved patient care Makes a career in pharmacy in Wales more attractive – supporting retention and recruitment of the workforce
• Enables skill development (particularly in prescribing)
• Enables development of new roles and builds further capacity within multidisciplinary teams.

How to implement

Recognise the severe pressures on community pharmacy and commit to reviewing the funding formula to enable the sustainability and growth of clinical services.

Benefits

• Reverses the trend of pharmacy closures
• Ensures patients to continue to benefit from the expertise of community pharmacists
• Encourages care to be delivered closer to home
• Enables equity of access to care – particularly in rural and areas of high deprivation
• Facilitates the continued development of clinical services that are financially viable.

How to implement

Continue to advance the digital infrastructure around medicines-use by ensuring the implementation of electronic prescribing and a shared medicines record is completed.

Benefits

• Reduces waiting times for prescriptions and the potential for ‘lost’ paper prescriptions
• Improves patient safety by reducing medication errors
• Enables better decision-making by providing clinicians with comprehensive medication histories
• Streamlines workflows for healthcare professionals, reducing administrative burdens
• Facilitates more efficient communication between primary, secondary, and community care teams
• Eliminates the environmental impact of paper prescriptions.

Context

• Shortages of pharmacists saw the profession added to the Home Office’s Shortages Occupation List in 2021¹²
• While most recent data shows a small growth in the percentage increase in pharmacist head count over the last five years, Wales at 8% is lagging behind England (15%) and Scotland (13%) in this regard¹³
• Worryingly, the gap in growth of pharmacists between Wales and the rest of GB has widened in the last year from 4% to 7% compared to England and from 2% to 5% compared to Scotland¹⁴
• Data shared with RPS indicate an average vacancy rate for pharmacy of 20% across all hospital pharmacy roles¹⁵
• In 2023 Health Education and Improvement Wales launched its 10-year Strategic Pharmacy Workforce Plan that includes ‘Attraction and Recruitment’ as one of its seven key themes¹⁶
• Pharmacy: Delivering a Healthier Wales is the 2030 vision for pharmacy in Wales. Launched in 2019, the vision sets long-term ambitions for how patients will benefit from the expertise of pharmacy teams by 2030¹⁷.

How to implement

Support and fully fund the profession to implement the HEIW Strategic Pharmacy Workforce Plan and our 2030 vision; Pharmacy: Delivering a Healthier Wales.

Benefits

• Pharmacists will be guaranteed time to upskill, expanding their scope of practice and allowing them to support more complex care in all settings
• Addresses recruitment challenges in rural and remote areas by broadening the pool of pharmacists available to fill posts. 
• Delivers on our 2030 target to have a prescriber in every community pharmacy. 
• Continues the development of specialist pharmacist roles, ensuring patients in areas like mental health, oncology, and palliative care benefit from integrated pharmacy expertise within multidisciplinary teams.
• Supports the delivery of high-quality care by ensuring pharmacists have the necessary skills and competencies. 
• Promotes a more flexible and adaptable pharmacy workforce through cross and multisector career development and training opportunities.

How to implement

Maximise the benefits of new pharmacy degrees at Swansea and Bangor (supplementing the long-standing Cardiff degree) by fully resourcing the HEIW multi-sector ‘foundation’ training year for new graduates to meet increased demand.

Benefits

• Ensures Wales can support and is best placed to retain our growing number of pharmacy graduates
• Addresses recruitment challenges in rural and remote areas by expanding the pool of pharmacists available to fill posts
• Increases the number of pharmacists able to provide services and engage with patients in Welsh
• Promotes multi-sector working during the training year to build a more flexible future workforce that enables portfolio careers and improves patient flow and care transitions.