It would not be an overstatement to say that community pharmacy is going through some difficult times. In December 2015, out of the blue, the government announced its intention to cut £170m from the pharmacy budget, with little evidence or explanation to support its proposals. Now in May 2016, it has shaved a hefty £48m in the latest category M clawback.
In the immediate aftermath of the government’s first announcement, various organisations representing and supporting community pharmacy appeared to come together and present a united front against the proposed cuts. This was a welcome move since pharmacy has always been a somewhat fragmented sector when it comes to representing itself to government.
There is Pharmacy Voice, an England-based trade organisation that advocates for three member associations (the Company Chemists Association, the National Pharmacy Association and the Association of Independent Multiple Pharmacies), which represents nearly all the community pharmacy businesses in the UK; the Royal Pharmaceutical Society (RPS), which is the professional body for pharmacists; and the Pharmaceutical Services Negotiating Committee (PSNC), which represents NHS pharmacy contractors and is arguably the most influential when it comes to contractual matters and the commissioning of NHS services.
In April 2016, the PSNC issued what it called its “counter proposals”, claiming they could lead to savings worth at least as much as the government’s proposed cuts to pharmacy funding.
The PSNC makes some solid recommendations to boost efficiencies and reduce waste, including a “not dispensed” scheme, where pharmacists are paid for checking whether patients need all items on a prescription; generic substitution; and therapeutic substitution, whereby pharmacists would recommend alternative products to prescribers. There is also a recommendation for pharmacists to identify excess prescribing in care homes through regular reviews, and another where community pharmacy could offer an emergency supply service to take pressure off out-of-hours services.
These are all worthy ideas, but the PSNC did not share them with the RPS or Pharmacy Voice before publishing them in April 2016.
Sandra Gidley, chair of the RPS English Pharmacy Board, told The Pharmaceutical Journal that the RPS had not been informed about the PSNC’s proposals and that the first they had heard of them was when they appeared on the PSNC’s website. “This is surprising because the pharmacy organisations had been working more closely and have been in regular contact,” she says.
Rob Darracott, chief executive of Pharmacy Voice, also only learnt about the proposals the day they were published on the PSNC’s website.
In response, a PSNC spokesperson said the counterproposals were put to the NHS as part of its confidential negotiations. He insisted the PSNC had been in contact with all pharmacy organisations to share “whatever information we have been able to” via the steering and communications groups.
The PSNC should have shared and sought feedback on its counterproposals with other pharmacy bodies before going public with them. This episode highlights the lack of unity in the pharmacy sector and it is clear that the cuts are not just a contractual issue.
The main pharmacy bodies should have responded jointly at this critical juncture. A single announcement signed by all pharmacy bodies spelling out what the sector can offer and how the savings could be made would have had greater impact. And there is a danger that the government will take advantage of a fragmented response to its proposals.
The contract negotiation process run by the PSNC, with its lack of transparency, is ripe for open discussion.
“I have long had reservations about the negotiation process,” says Gidley. “These are epitomised by the problem with the 2015 announcement of the national influenza vaccination service and the ensuing mad dash to ensure that proper standards and advice were in place.”
Darracott would not speculate on whether the PSNC mechanism is fit for purpose. “What I have said would be helpful, in our view, is an agreed future for the sector, which the negotiations can be set against.”
Considering the sector is reeling from the proposed cuts, now is a good time to ask whether the PSNC fully and optimally represents community pharmacy to the government. A sizeable proportion of the profession are not pharmacy contractors; and to a large degree it will be pharmacist employees providing these important clinical services to patients in the NHS in years to come.