The Pharmacist’s editor Beth Kennedy talks to PSNC’s new chief executive Simon Dukes about how his past role with fraud prevention service Cifas will shape his negotiation tactics for pharmacy
How do you think you’ll be able to use your experience with Cifas in your role at the Pharmaceutical Services Negotiating Committee (PSNC)?
I think that there are some transferable aspects of the job because Cifas was a member organisation and it represented really large organisations like retail banks but also very small ones as well. It worked across industry and it worked with the Government.
The similarities occur firstly when you’ve got a negotiation with the Government about the importance of community pharmacy. Secondly, dealing with and working with quite a variety of organisations from the big multiples to the independents. Thirdly, that financial crime and fraud had a fragmented landscape of representative groups and trade bodies and we’ve got the same thing here in pharmacy. I have a naturally collaborative approach to the way I work, both with the Government and everyone else.
In three months, I have travelled 3,000 miles going around England talking to pharmacy owners – big multiples as well as the independents, getting a sense of how some of the challenges they are collectively facing can be best represented by PSNC.
You’re not a pharmacist. Do you feel at this point that you know enough about the sector to confidently go into negotiations with the Department of Health and Social Care (DHSC)?
Well, I’ve got a committee of 31 people, all of whom are pharmacists. I’ve got a fantastic team of people behind me here at PSNC, who are incredibly knowledgeable. I go to local pharmaceutical committees (LPC) meetings on a regular basis, I go to visit community pharmacists. From the point of view of obtaining and ingesting knowledge about the sector, I’m really well served.
I wasn’t employed in this job to be a pharmacist. I was employed for my judgement, not for my pharmacy knowledge. I believe I’ve got absolutely enough pharmacy experts here to give me and us the best possible way to the best possible deal.
Pharmacy leadership can be quite fragmented. How well do you think pharmacy is serviced by its representation?
I think we have some great representative groups. We have a number of them. That doesn’t mean to say that we can’t work together. I’m pleased to say that the outreach that I’ve made to other groups and other representative bodies has been really, really positive. I regularly meet them all individually and we’re all getting together as well to discuss some common themes.
Do you have an idea of when negotiations for the next pharmacy contract with the DHSC will start?
None at all. We’re hopeful for something in the autumn but we’ve got no indications yet.
What are your negotiation tactics going to be like?
I’ve got a different negotiation style to my predecessor, as she did to hers. As I said, collaboration clearly is at the heart of it. 85-90% of community pharmacy’s income comes from the Government. Therefore, we need to work out how we can deliver on government priorities and help them with their strategic objectives but equally we need to make sure that we get the best possible outcome for community pharmacy as well. I don’t think those things are mutually exclusive.
Do you think PSNC’s been strong enough in negotiations in the past?
It is genuinely difficult to answer that question without being in the room at the time. How can I possibly answer it? I think over the years that PSNC has served community pharmacy extremely well and I hope to continue that tradition.
What will you be pushing for in negotiations?
The things that we’ve already been very vocal about in terms of a service-based contract, in terms of especially supporting patients with long term conditions are really important and fundamental in terms of what we want.
What does a service based contract look like in terms of remuneration?
We’ve seen examples of it already with the pilots of minor ailments services and that gives that a sense of community pharmacy’s worth and value in this area. The challenge will be how we can get proper remuneration for those services. There’s no doubt on either side that they can be delivered by community pharmacy, but it’s about making sure that we’ve got a way of remunerating appropriately and that’s where the negotiations start
Do you think new health secretary Matt Hancock will be a good advocate for the sector from what you’ve seen so far?
We can go on his comments, which sound very positive. When I last dealt with Matt Hancock, he was at the Department for Culture, Media and Sport (DCMS) and unsurprisingly given that role, his technology focus was very strong. Clearly from some of the things that he’s said already, that’s the case here too, talking about Babylon and talking about technology for healthcare for the benefit of patients. So I think we can expect that as well.
He was secretary of state for DCMS and I was chief executive of CIFAS so we met infrequently. I’ve met him before and I’ve seen how he operates close up before and he’s very dynamic, lots of energy and with that technology focus I think we should expect him to bring that to community pharmacy and to healthcare more generally.
Were you surprised coming into the position that shortages have affected contractors so badly?
I suppose I was. What impressed me was that when I go out to pharmacies and I speak to them about things like that is the efforts and the lengths that they go to to ensure that patients get their medicines and that is amazing. We are very aware at PSNC, given the margins work that we do, of the issue and we’ll continue to work with the DHSC to try and alleviate it for the future.
How well do you think the concessionary prices system is working?
It certainly increases the workload at PSNC quite substantially and therefore increases the amount of time needed in order to do it properly. We are under increasing pressure to deliver in a relatively short space of time on this. I think it [the process] needs refining.
How would you do that?
Well it has to be in consolation and discussion with the Government. But we can’t have a system where the potential exists for community pharmacists to effectively supplement the Government through selling drugs at a cost. So we’ve got to find a way to be able to deal with that and – especially with the technology available to us – make a system that is perhaps more real time or at least doesn’t have quite such a delay built into it.
Do you anticipate that shortages could get worse over the coming months? We’ve got Brexit and the falsified medicines directive (FMD) coming up – how do you think those could affect the supply chain?
Clearly, these are going to be big challenges. We’re working with the DHSC and the Government more generally on some of the Brexit challenges in particular and clearly we’ve formed our own Brexit panel here where not only the other representative groups but also distributors are members so we’re doing all we can to try and address that.
What do you think some of the particular Brexit challenges will be?
If we are looking at – as seems increasingly likely – a so-called hard Brexit then we’re going to potentially end up with difficulties that the main ports of entry and distribution and therefore the logistical concerns on both sides of the channel on how we can get a free flow of goods. Medicines are no different from other commodities in that respect.
What are some key challenges for independent pharmacies right now?
The cash flow issues that were and are being caused at the moment because of the funding cuts and the increases in drug prices are eating away at savings – if, indeed, small pharmacies have got any savings left. And actually, it applies to multiples too.
And it is that sum of money that will eventually be needed to deliver some of the changes that we want for service-based contracts. So my concern is that, already facing quite severe in some cases financial challenges themselves, they’re not going to have the money to make some of those quite substantial changes to deliver on service-based outcomes.
PSNC recently secured a £15m increase in Category M payments. Did that feel like a big achievement?
It was a good sign of the future of collaborative working between PSNC and the Government. The more important thing was that it relieved the cash flow pressure temporarily on contractors and what we need to do now we’ve got this breathing space is to start discussing a more long-term solution
Do you think it goes far enough to alleviate those pressures?
Well, it’s a start, isn’t it?
Is there anything else you’d like to say to The Pharmacist’s readers?
It’s a great honour to be in this role. The reason I was interested in the job in the first place was because community pharmacy has got a really important part in important part in our healthcare process. I don’t think they are seen as being part of the NHS, yet 90% of their income comes from the NHS and we need to do something collectively – again, this is not just a PSNC thing, this is across community pharmacy – to ensure that the pharmacist, a very well qualified healthcare professional, is seen in the same light as others equally qualified in the NHS and wider. We need to ensure that we claim that back.
How do we do that?
We’re talking about a culture change so that doesn’t happen overnight. It is having discussions within the sector and I think that moving slowly towards a service-based contract will help.
The fact that you go to your pharmacist because you are feeling unwell and that they may be able to treat you there and then or refer you onto general practice. All of a sudden, it’ll take a generation, but you’ll start to see pharmacists viewed as they should be viewed rather than someone you go in and just get handed your paper bag. We’ve got to move on from that.