Pharmacies do not want praise, they simply demand fair funding and reimbursement to represent the Herculean effort every team has put in over the last year, writes pharmacist Ashley Cohen
Community pharmacy was hardly best prepared for this pandemic with significant cuts in our funding in 2016 and 2017. This, alongside a five-year flat funding framework, means that by 2024 our real-terms drop in funding will be more than 20%, as contractors covered increases in minimum wage, extra pension contributions, investment in our business, and general inflationary pressures.
This at a time when we hear about record investment in the NHS. It was hardly a ringing endorsement of our place in the pecking order from our paymasters. Where was all this new NHS money going, it was hardly finding its way to the pharmacy sector – supposedly the NHS gatekeepers?
However, the pandemic showed that as a sector we were flexible, responsive, adaptable, passionate, hardworking, caring and put our patients first. Our doors remained open throughout the pandemic, often seeing worried and vulnerable patients who could not access other primary care services.
Pharmacy teams during the first wave worked round the clock to service the increased demand in medicines, sourcing stock, deliveries (at its peak demand hit circa 2,000 deliveries per week across our three branches), advice, telephone calls (we observed a 300% daily increase in telephone calls during the first two weeks of lockdown).
However, contractors and the sector were comforted by the words of Simon Stevens who reassured that ‘all Covid-related costs would be covered’, and again the Chancellor of the Exchequer committed in Parliament in his March Budget that ‘whatever extra resources our NHS needs to cope with coronavirus – it will get’.
Practically, however, we were isolated during the first few months of the pandemic, left to fend for ourselves to source bread and butter stock like paracetamol and ibuprofen that was ‘short in the market’ and being sold to us at inflated prices, along with dozens of other fast moving dispensary lines. Pharmacy owners were trying to obtain PPE to protect their teams at extortionate prices from wherever we could, because the NHSE&I did not feel pharmacy required PPE.
We dispensed many items at a significant loss because the drug tariff did not reflect the true prices we were paying for medicines from suppliers. During the first five months, I had approximately 30% of my employed workforce off at any one time either ill, shielding or self-isolating, yet the work still needed to be done, so we increased overtime, took on locum staff, worked 15-hour days and weekends to keep our vulnerable safe, and ensured pharmaceutical supply.
We were even asked by local surgeries to do extra deliveries, blood pressure checks, take back responsibility for ordering repeat prescriptions, and triage minor ailments – all services we are not funded for!
Money was found to write off NHS Trust debts so that they could concentrate on combating Covid, general practice was given new money to change the way they worked, dental practices had their contracts paid in full even though workload was cut by two-thirds, and pharmacy received additional income of… £300 to contribute towards Perspex screens.
To date this is the only new money we have received. We are only this month receiving reimbursement for PPE we purchased nearly a year ago. Hardly an endorsement for being part of the NHS family?
Yes, we received advanced payments (totalling £370m), but these have now been spent, purchasing stock at inflated prices, making our premises Covid safe, extra staff to cover those ill or not able to work and to meet local demands. One year down the line contractors are no clearer as to how these ‘loans’ will be treated. If these advanced payments need paying back, many more than the 200 pharmacies in the last year will close.
Both Boris Johnson and Matt Hancock have both publicly expressed the desire to have no pharmacies close, yet four each week are closing their doors. Perhaps this is the pandemic the NHSE&I have been waiting for to finally reduce the community pharmacy sector to the levels they wanted back in 2016!
Personally, I have borrowed in excess of £100k on top of the advanced payments and invested it all into my pharmacy business to keep operating through the pandemic.
I have written to my local MPs on numerous occasions, kept in touch with other contractors through my work on my local LPC and PCN, and shared my thoughts with PSNC. I know I am not alone in this situation.
Many of our pharmacy teams are physically and mentally exhausted. Many have been seriously ill (including myself) with Covid – no doubt contracted while working. As we move towards the first-year anniversary, we are not only fighting on the frontline from a work perspective, but we are parents who are home schooling our children and are managing the pressures and anxieties that this has on our own work/life balance.
£22bn was made available for a dysfunctional track and trace system – this could have funded our sector for approximately nine years. Over £500m was spent purchasing PPE that was not even fit for purpose and has never been used; several hundred million pounds to ‘brokers’ to source PPE when this could have been part of NHS procurement, and a total of £46.4bn has been spent propping up the economy in the job retention scheme between April and December 2020.
We do not want praise; we do not want claps on a Thursday evening; we do not want promises that cannot be kept, we simply demand fair funding and reimbursement to represent the Herculean effort every pharmacy team up and down the country has put in over the last 12 months in playing the leading role at the heart of this pandemic.
Reports, analysis, audits, studies, by PSNC, ErnestYoung, NPA, RPS, the All Party Pharmacy Group all say the same thing around a massive gap in funding for our sector – and this even concurs with what our own health minister and Prime Minister say, that pharmacy should be re-imbursed in full for all work which has been delivered, and a fair contract uplift ongoing.
So, I ask the question: why, after 365 days, has this not happened?
Ashley Cohen is managing director for Pharm-Assist (Healthcare) Ltd and a committee member for Community Pharmacy North Yorkshire and Community Pharmacy West Yorkshire.