Dear Secretary of State,
Congratulations on the new job. Over the coming months you will no doubt be bombarded with ‘advice’ from your civil servants, but what I offer you now is a view straight from the front line of the health service: community pharmacy.
An old friend of mine used to say, in times of crisis you need to secure food, water, medicines and shelter. As the country approaches an uncertain future post-Brexit, it is already clear that medicines remain an area of the utmost concern to the public. But even today Secretary of State, we cannot obtain the medicines we need for our patients, despite the best efforts of pharmacy teams and our panoply of suppliers. To hear that you are also concerned enough to consider stockpiling medicines is both encouraging and terrifying in equal measure. As the experts in medicines procurement (we’ve saved you more than £13bn on the national medicines bill since 2005), I hope you are consulting with the whole of the community pharmacy sector, and not just the vertically integrated wholesalers. I call on your officials to set up a single, industry wide Brexit medicines task force to ensure that patients are protected.
As we approach this unique moment in our national life, I hope you recognise that community pharmacy is a pivotal partner at the intersection between global trade and patient care. It might surprise you to learn that we often have to purchase medicines on behalf of the NHS without knowing whether the NHS will cover the full cost of those medicines; we have seen an increase in the number of medicines being subsidised directly from the pockets of pharmacy owners. The emergency ‘price concession’ mechanism is too slow, and often bears little resemblance to the reality that pharmacies face.
Given that there are significant concerns around supply chain disruption after March 2019, it is only natural that contractors will begin to increase their stockholding to protect their patients, exacerbating already precarious cashflow positions that have taken a beating from NHS funding cuts and Category M clawbacks. I call on you to make available a Medicines Contingency Fund to ensure that pharmacies are not left out of pocket as a result of trying to obtain medicines for patients in the run up to and after Brexit. Trust me, this is the only way to ensure pharmacies can supply the medicines patients need.
Speaking of Brexit, I am deeply troubled that your officials have yet to agree to fund the implementation of the Falsified Medicines Directive (FMD), which has been designed to reduce counterfeit medicines within the legitimate supply chain. The UK FMD Group has previously estimated the implementation of this EU directive will cost a minimum of £125m; the sector simply cannot sustain this hit. You may ask: “Why we are going ahead with something which needs to be implemented by February 2019, just weeks before leaving the EU?” Well, quite simply, if we don’t, our ability to trade in medicines with Europe will not exist, as we would single-handedly undermine the integrity of the European medicines supply chain. The UK could become a dumping ground for the world’s knock-off drugs, endangering patient safety at home. Minister, there are no easy answers here, we need an urgent resolution to this most pressing of matters, and soon.
With all the talk about our future relationship with the EU, I’m just as interested in our future relationship with you. Community pharmacy, as you rightly highlighted in your inaugural speech as health secretary, needs investment. To some in our profession your warm words will have felt like dawn breaking after a long night, but we’ve seen false dawns before — what counts is action.
Community pharmacy has become a Cinderella service since 2015, starved of investment and left without a coherent vision for its future. The public want more services from pharmacies, and we have so much more to offer. There are more pharmacies in areas of deprivation, unlike other providers, which offers you a unique opportunity to reduce health inequalities and to ensure the service contacts people that do not engage with any other part of the NHS.
Finally, pharmacy is the most under-represented of the major professions within NHS leadership. Very few pharmacists are represented on clinical commissioning group boards, or within NHS England itself, and this leads to a disconnect between us and the rest of the system. This doesn’t have to be the case as pharmacy is desperate for representation. What it takes to put this right is political will, which you can provide. Now more than ever we need fresh system leadership and new perspectives to showcase the positive impact that community pharmacies can and do have our communities. It is only by resetting this relationship that we can begin to work together to meet the challenges of tomorrow.
Keeping people well, and therefore out of GP practices, A&E or GP out-of-hours services, has got to be a priority for the future or else it won’t matter how much money you invest in the health service, demand will always outstrip supply. It is not easy to ask politicians to invest in preventative services for your successors to reap the benefit, but it is nonetheless essential.
The Chinese proverb, “may you live in interesting times” can feel like a curse, but it also bristles with opportunity, just like the community pharmacy sector. If you want to quickly make a real difference for patients, then this is the sector to concentrate on first. Best of luck.
Mike Hewitson MPharm MRPharmS
About the author:
Mike Hewitson is a community pharmacist and independent pharmacy contractor.
Have something to say to the new health secretary? Please get in touch with Abigail James, our opinion editor