After 18 months of running on fumes, community pharmacy is once again battling for what it deserves. But, as Ashley Cohen writes, it seems that after a glimmer of hope from the former health secretary, the Government isn't prepared to do 'whatever it takes' to help pharmacy fight back from Covid
I can still hear the words being recited over again by politicians, civil servants and key NHS executives and even the Prime Minister.
‘Whatever it takes.’
‘Covering all Covid costs.’
These were the reassuring sentiments from our paymasters in March 2020, as the pandemic was rife. The country was in complete lockdown. High streets we all but closed, with the exception of a few essential units. All routine secondary care services were postponed, to meet the tsunami of Covid admissions in all major hospitals.
The majority of primary care professionals changed the way they worked overnight – reducing, or in some instances, closing access to patients with immediate effect.
One profession not only remained open, but picked up the slack from elsewhere – helping vulnerable individuals navigate around a complex healthcare system to ensure they were looked after and supported, had access to lifesaving medication, and were signposted to other professionals.
We didn’t hide behind desks. We didn’t work behind closed doors. We didn’t filter our consultations via a telephone or Zoom. We were not furloughed like other industries and paid to stay at home.
We remained open.
Open seven days a week. Open in the evening. Open on bank holidays. Open, without need for an appointment, to those who needed healthcare.
We supported people who were having a mental health crisis, people with minor ailments, and people with more serious conditions who were unable to access care from their GP.
We provided reassurance to the worried, maintained pharmaceutical supply when stock was scarce, dispensed at a loss with the high costs of wholesaler bills, ensured each branch was open safely and covered the many staff who were ill with Covid, or were self-isolating, or needed be at home for childcare, or were shielding.
Cash-poor from the beginning
It’s important to remind ourselves that our sector was hardly awash with cash prior to the outbreak, as our funding was significantly cut in 2015/6, with a further cut the following year. We are currently mid-way through a five-year settlement, which has 0% increase through the whole period, and we’re being asked to do more work for less.
At the end of our five-year settlement our ‘pay’ will be circa 20% below what we received back in 2014/15.
In March 2020, the Government quickly mobilised cash to our rescue, because – quite simply –without the injection of £370m our sector would have collapsed in days. Our staffing costs rocketed to meet the demand, and to ensure we could operate safely under Covid guidelines, our wholesaler bills in March and April 2000 were greater than our FP34 income.
So, this immediate cash injection was not only welcome – it was essential.
Fast forward 18 months, and this week the community pharmacy sector finally found out that the advance payments, which provided us a lifeline at the height of the first Covid wave in March 2020, will need to be repaid.
This is hardly a ringing endorsement for ‘Whatever it takes’.
I have spoken to many other pharmacy contractors, and the general consensus is that we don’t have the ‘loan’ sat idle in high interest savings accounts ready to be repaid. It’s gone!
It’s been spent. Not on fancy cars and luxury holidays – but gone. Spent on high-value wholesaler invoices, on ensuring our pharmacy practices are Covid-secure, on additional staff to cover those who are ill. Spent on staff to support the 100% increase in phone calls we have been receiving since the start of the pandemic, on staff having to deal with the deluge of people accessing our services because they cannot get appointments elsewhere.
Claiming for Covid costs
Alongside the announcement that the advance payments will need to be repaid, pharmacy contractors were informed that the Government would cover Covid costs for a period of 13 months from March 2020.
However, we are now having to spend many hours over the coming weeks gathering evidence of what are ‘acceptable’ Covid costs. We must prove with invoices what is a Covid-related cost. This, at a time when we are already stretched and still trying to catch up from the past 18 months.
How can you put a cost on a pharmacy owner having to work from 6.30am most days to simply clear the backlog from the day before, and staying till 10pm at night to prepare for the next day?
At times during the pandemic, we did not have the luxury of accessing extra staff due to such a high volume being off ill, self-isolating or shielding. The extra work was done by existing staff who were well, and business owners. Many are still doing this now as people are still needing to self-isolate.
How can you put a cost on diverting activities from our workforce having to deal with the high volumes of patients using our pharmacy because they cannot speak someone at their GP practice?
How can you put a cost on the loss of potential sales because footfall was reduced significantly in some pharmacy sites due to their location?
How can you put a cost on the increased demand from young people experiencing a mental health crisis who were unable to access specialist services, and therefore were assessed and triaged by our pharmacy teams?
Will contractors be able to claim the thousands of pounds from dispensing certain medicines at a loss due to exceptionally high wholesaler prices versus low drug tariff prices?
Of course, Government needs to ensure that spend has been appropriate. I’m certainly not suggesting they should throw excessive resources at us or other industries.
However, we’ve had reports and audits submitted to the Treasury and Department of Health and Social Care – from the likes of the PSNC, the All-Party Pharmacy Group (APPG), National Pharmacy Association, and Ernst & Young – informing them of the additional costs and the impact Covid has had on the sector. The costs are known and have been worked out in detail.
We just want parity with other healthcare sectors
Trust deficits were very quickly wiped out. Primary care networks received uplifts to help work through the pandemic, and GP practices received new funds to help with their additional workload.
So why does pharmacy have to be looking for invoices and populating spreadsheets to account for our costs? Contractors should work together over the coming weeks, to brainstorm, to talk with neighbouring pharmacies, to liaise with their LPCs. Listen to PSNC to make sure you claim back everything you can.
Just seven days ago, I attended an excellent webinar held by Sigma Pharmaceuticals. The company hosted then Secretary of State for Health and Social Care, Matt Hancock, to share his vision for pharmacy services.
He described his plan for vaccination to be driven through community pharmacy sites, sharing his belief that the community pharmacy consultation service (CPCS) should be used to take pressure off our GP colleagues, applauding our work ethic, and how as a profession, pharmacy had a bright future. There was hope: a health secretary who truly understood our role and, more importantly, our potential. Perhaps the future was not all that bleak.
Then everything changed and, in the blink of an eye, a new minister took charge of the DHSC.
Oh, how a week is a long time in community pharmacy!