Recognising community pharmacy’s potential is pointless with no money to back it up, argues superintendent pharmacist Graham Phillips
I’ve been arguing for all my professional life for an enhanced clinical role for the community pharmacy network based on our unique trifecta of value: clinical value; public health value; and social capital value.
Community pharmacy bucks the so-called ‘inverse care law’, wherein the communities that need most support from the NHS actually get the least. Community pharmacies are well distributed in precisely those areas of highest need and highest health inequality.
But, so severe is the financial attrition caused by years of cuts that I have recently been forced to close one of my own branches in Ramsgate, Kent, which served precisely this kind of needy population, not to mention our support of a vulnerable GP practice.
My partner is a GP, and we both agree that NHS England is a ruthless, top-down regime that brutalises frontline professionals and then castigates us for not being sufficiently kind or empathetic.
Well, they can’t have it both ways.
With the announcement of changes to the community pharmacy contractual framework, it seems the NHS has, once more, woken up to our potential and is starting to commission some really meaningful activity based on the trifecta of value.
Some examples include the discharge medicine service, blood pressure testing and the travel vaccine service.
Reasons to be cheerful?
But if the current financial attrition continues apace, who will be left standing to deliver the government’s vision? And will those who are left standing have any capacity to deliver any added value beyond the safe dispensing service, which is so fundamental to our role?
This drip-drip of one-by-one policy announcements is not credible, deliverable or cohesive.
So, what could a viable future look like and what value would it deliver?
First, maximise the entire asset of community pharmacy – i.e. leverage all three aspects of the trifecta of value – in particular, a proactive preventive public health strategy. After all, prevention is better than cure.
There’s an urgent need for a cash injection to stabilise the core community pharmacy service. Thereafter the NHS should pay ONLY for quality of service and value-added outcomes. In this way any pharmacy closures affect those adding least value.
Next, align the community pharmacy and GP national contracts. This would mean no more commissioning (like the flu service), which led to competition between community pharmacy and general practice. None of us needs that – it undermines the professional relationship and leads to a tug-of-war with the patient as the rope, rather than multidisciplinary patient-centred care.
Last, introduce electronic interoperability, thereby facilitating seamless, electronic collaboration between community pharmacy, general practice and secondary care.
The NHS has just completely revised the GP contract in response to lobbying from GPs, the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA). The NHS undertook an extensive consultation followed by a total revision of the funding and the cash flows.
Compare that with recent announcements of yet more pharmacy contractual changes, which are simply imposed from above with zero consultation and no resource.
The NHS can’t have it both ways. It either values the community pharmacy network, in which case it must reverse its policy of decimation and replace it with a policy of quality and sustainability.
Or it should come clean and allow those of us who have already invested in the future to abandon the sinking ship, leaving the cynics and the multiples in a survival race to the bottom.