With time dwindling before the proposed 6% government cuts come into effect, can community pharmacy absorb the £170m losses and is there scope to negotiate a better future?
The Pharmacist caught up with Pharmacy Voice chief executive, Rob Darracott, who offered a refreshing outlook on the future of the sector.
While acknowledging the business challenges pharmacists face, Darracott suggests there is now “everything to play for” as discussions with the Department of Health (DH) and NHS England march on.
Pharmacists, not the government, are the experts and are perhaps in a stronger position to negotiate for positive change for the profession and patients than ever.
Darracott: It depends what you think the objective is around publishing the letter.
We are taking it at face value that we are going to have a conversation with them not just about the cuts but also about the other elements of the package and what they might mean.
Whether the government is prepared to listen to a discussion about money in its first year I don’t know but I have had it impressed on me that the cuts are the cuts and the number is the number.
So is there wiggle room in that? I don’t know but I’m sure we will ask the question.
Why do you think the Department of Health approached the announcement of the cuts on December 17 2015 in the manner it did?
I think people have been very quick to make comments without actually asking how and why these things happen.
It was unfortunate in one way because people say ‘that’s a really nice Christmas present isn’t it?’ but I read somewhere that there were over 300 announcements from the government on 17 December of which this was one.
Even at the last hour it looks to me like the DH’s capital budget was raided in order for NHS England to have more money.
Basically we are bailing out hospitals because that is where all the money goes at the moment. So the timing is probably more linked to the Spending Review than people wanting to be difficult over Christmas.
Can you expand on your point about hospitals a little?
The prediction is that by the end of this financial year, collectively if they weren’t being bailed, our foundation trusts would be £2.5bn in the red.
All the extra money that has gone in this year is going to go into bailing out foundation trusts and we stand absolutely four-square with general practice in saying the future is in primary care.
We have got to keep people out of hospitals because when people go into hospital expensive things happen to them and yet the amount of funding going into primary care is being reduced and reduced and reduced.
But I think there are lots of parts of the system that are coming under pressure right now and I don’t think you can divorce the challenging times for community pharmacy right now from an appreciation of the wider picture.
Do you think it is possible for community pharmacy to absorb the cuts by making efficiencies if they are in the right places?
Well I don’t think we have had a conversation about that particularly have we, so far? We have been arguing about the cuts and they are going to be really difficult to manage, but what would be our solution for that? Can we be more efficient?
I think we have tried in the second part of our response, to say actually it is incumbent on all of us to do this hard thinking not just about what we could do to do things better but also about how we can meet those challenges to be more efficient and I think that is all to play for.
But we need to start having those conversations and we need to be honest about some of the challenges posed in the letter of December 17.
Some people say it is weird that a letter that talks about £170m cuts also talks about creating a clinically-focussed community pharmacy service and that does not add up.
Well maybe it does add up and maybe we just have to think about how we might use some of the opportunities that clearly are in the letter around the integration fund to ask how would we use that to do something a little bit different – to actually prove, conclusively to government that investing in pharmacy services will deliver benefits at patient scale across healthcare.
You mention proving patient benefits to the government, do you think there has been a failure in community pharmacy to record its achievements?
Day-in day-out community pharmacists do amazing things, they make interventions that are life-changing and in some cases life-saving and I have got no hesitation saying that I absolutely know that is what community pharmacists do.
Some of the really, really amazing stuff that the Community Pharmacy Future team has done is shown that you can take the very basic building blocks that are currently in the system and link them together.
Have we been able to translate that into something that seeps into how the NHS as a whole has redesigned services to improve care? Maybe we haven’t because otherwise things would be being commissioned all over the place.
I think there have been many times over the last three or four years where we have had to argue with whoever, often at a local level, that the sort of tick-box exercises they make pharmacists do don’t add one jot to improving patient care – they are exercises in measuring activity. It’s not even trying to get closer to outcomes.
The motto of my hometown is ‘out of darkness cometh light’ – people change when they have to change. Out of adversity comes change and maybe we have moaned about some of these things for a heck of a long time, we have talked about shifts from products to services for most of my professional career.
Maybe now the chips are down we have to think about some of those things.
Do I think the government has got the answers? No of course it hasn’t. Are there answers in that 17 December document? No, there aren’t.
We are the experts in our sector so it is incumbent upon us to say we have got some ideas about how to be more efficient and, I’ll tell you what, there are a few things that you could fix for us that will make it more efficient.
Let’s be clear about what we want to have fixed and let’s be honest and say do you know what we might have some better ideas than some of those people because we know our business better than them.
And by the way let’s not stop talking about how pharmacists can really improve things for people as part of the redesign of primary care, how do we make that happen?
I find your attitude towards the cuts really refreshing.
Do you? I’m so glad. Claire [Ward, chair Pharmacy Voice] and I have been sitting thinking about how we can challenge our own thinking about this in a way that says: ‘Look, maybe we can get it delayed but it isn’t going to go away’.
It’s not going to go away so maybe now is the time to say what about healthy living pharmacy, what about all the great patient safety work we are doing?
What about the brilliant work this little group is doing over here, what about that fantastic pharmacy over there that just has such an amazing community focus?
What about those pharmacies that have got people turning up on a Wednesday morning to go off and have a little walk because walking is healthy?
What about some of the great ideas that the devo team, Community Pharmacy Greater Manchester have got for their transformation?
Maybe that is what we should be doing right now while we stress about the challenge that businesses are absolutely going to face to make ends meet.
So what’s next?
We have been gathering some responses to what we have said, we have actually prompted some people who sit slightly outside the sector to give us their honest opinions about what we have said.
There are lots of bits to the jigsaw that are changing at the moment and we need to have some fundamental conversations about it.