The subheading “putting pharmacy at the heart of the NHS” from the letter from the Department of Health (DoH) and NHS England on community pharmacy contractual funding sounded great. However, the messages in it were not the Christmas present or the vision and leadership that the dedicated owners and employees of community pharmacies across England would have hoped for.
We all understand that the NHS has financial and quality challenges, and that the recent spending review would have some impact. However, a 6% hit on 2016–2017 funding — a £170m cut in the global sum in the six months from October 2016, averaging around £14,500 per pharmacy and a potentially bigger full year hit in 2017–18 — was below the already tightened belt.
It is interesting to read that the “government believes that these efficiencies can be made without compromising quality or access”. This has to be challenged. When was the last time anyone in DoH or NHS England actually worked in a pharmacy?
The letter also highlights several other planned impacts on the sector, including a pharmacy access scheme (AKA, a reduced number of contracts) which is floated in the same paragraph as the statement that “in some parts of the country there are more pharmacies than are necessary”. Who created that situation other than the DoH with the previous exemptions to control of entry?
The letter also refers to ‘hub-and-spoke’ arrangements and large-scale automated dispensing. I have yet to see any substantive evidence of cost efficiencies from such initiatives. Optimising prescription duration and online ordering of prescriptions with click-and-collect or home delivery are also mentioned. I fully accept that embracing technology and releasing time and talent from within pharmacy teams are desirable so that they can deliver yet higher levels of pharmaceutical care, clinical services and public health interventions. However, these require new funding to incentivise and reward the value of such services, not less.
Finally, it will be interesting to see the outcome objectives of a pharmacy integration fund. I have always promoted greater intra- and inter-professional collaboration and the recent investment (£40m) for pharmacists within GP practices could be an opportunity for both the profession and patients’ health if allowed to operate within an enabled and collaborative framework and culture.
The Pharmaceutical Services Negotiating Committee, Pharmacy Voice and the Royal Pharmaceutical Society have a big and important job on their hands to ensure that the burning desire within pharmacy teams to improve the health and well-being of their communities does not become a burning platform for the sector.
Michael Holden
Director and principal consultant
MH Associates, Hampshire
