Royal Pharmaceutical Society stands by NHS reforms

Clearly the RPS are a load of odd balls and out of step with other healthcare professional bodies. The problem is that for those of us working in NHS is that it has been two years waiting for redundancy for the original plans to turn out as a complete fudge by the time it all settles down. Before anyone goes mad calling me a public sector skank, I work 50% of my time in community pharmacy in the private sector too.

I don't think anyone is against reform, but pushing through reforms while trying to save £20Bn quid will deliver very little in positive patient outcomes. The reforms should have been more gradual, more consultation and tapered cuts rather than wholesale ideological amputation and salami slicing of services.

Anyway, I blame the politicians on both sides for panicking people and disinformation that nobody is quite sure what is going to happen at the end of the day.

RPS! Out of touch, out of step. Out of sight, out of mind.

Looking at the article it doesn't appear that RPS is out of step with other pharmacy bodies. The real change the Bill creates is the removal of PCTs. There are a number of new structures replacing them and pharmacy needs to see if these give more opportunity that currently exists. I agree with Mike Holden that one of our opportunities must be to work with Public Health in Local Government as they are not as likely to be wedded to a medical model of delivery. Also pharmacy should use the change to drive a message about medicines optimisation, seeing medicines as an investment in care, rather than medicines management, seeing medicines as a cost in care to be reduced.
The devil will be in the detail in secondary legislation and regulation and pharmacy must aim to influence this if the Bill completes its passage and look to see how we create a more positive environment for pharmacy and pharmaceutical care and services.

Excellent points Ash - and we all have cause to be grateful for your role on the Future Forum "batting for pharmacy"

Actually if you read the headline which claims "RPS Stands by Reforms" it doesn't relate to the story at all!! First of all NONE of the pharmacy bodies (of which the RPS is only one) has come out overtly and said "Kill the Bill" Second, the RPS has very real concerns about the bill and has said so: Don't believe me? Look here

http://www.rpharms.com/what-s-happening-/news_show.asp?id=415:

Finally - please join the RPS seminar on the subject. To do so go here:

http://www.rpharms.com/what-s-happening-/news_show.asp?id=436

Regards

Graham Phillips, English Pharmacy Board, RPS

I agree pharmacy needs to pitching its stall for the new public health bodies, but there has been £2Bn alloacted for these projects and that money needs to be shared among all the local authorities, GPs, dentists and other trusts. It does not specifically ring fence money for pharmacists, but public health bodies would be short sighted to overlook community pharmacies as key stakeholders when forming partnerships on public health agendas and campaigns. However, we need to make sure that pharmacy is not trampled down in the rush for funding streams, but for goodness sake lets not fall into the trap of doing it for nothing as a lsot leader. We are better delivering focussed campaigns that are financed and part of a strategy either locally or nationally.

Ash Soni begins his comment by stating that the RPS doesn’t appear to be “out of step” with other pharmacy bodies. Graham Phillips also picks up on this point. This is, of course, true. This does not mean to say that this stance is correct. In addition, it is worth bearing in mind that the Society is the professional membership body – incorporating members from all sectors of the professions and from all grades – as opposed to a contractor body such as the NPA, PSNC and PharmacyVoice (<8% of pharmacists are contractors).

Ash Soni goes on to state that pharmacy “needs to see” if the new structures envisaged by the Bill provide pharmacy with a greater opportunity to contribute than currently exists with the status quo. This highlights one of the most frequent complaints about the Bill. It is a behemoth at over 360 pages but it is also written in incomprehensible, impenetrable (to the layman) and vague wonk-speak. It lacks specificity and clarity throughout on what are issues of fundamental importance. I do not think progressing on a ‘we need to see’ basis is how policy-making should be undertaken. Unfortunately, the Bill has created unprecedented confusion and inertia within primary care at a time when the NHS should be facing up to meeting the demands of the Nicholson Challenge.

As an advocate for greater pharmacy involvement in the public health movement I am heartened to hear that Ash Soni feels the proposed reforms will enable pharmacy to play a fuller part when that function is moved to local authorities (LAs) as they are less wedded to a medical model. Unfortunately, I do not read the post-bill landscape in the same terms. Cash-strapped LAs have little desire to take on this function; especially as their funding is being squeezed by a centrally issued missive to freeze or reduce council tax rates. LAs will also suffer from a lack of pharmacy expertise. Furthermore, the membership of health and wellbeing boards (HWBs) will include at least one representative from each CCG within the LA’s boundaries (including CCGs which nominally straddle a boundary). In some circumstances this will leave representatives from CCGs in the majority on HWBs. This hardly suggests that the commissioning of services to meet identified public health needs will be free of GP influence or less wedded to a medical model.

A more important point remains that this Government's health reforms are likely to be damaging to the wider public health function in the UK. We have seen a focus on ‘nudge theory’ as a means of behaviour change even though there is an extremely limited evidence-base to support its use in the health context. We also have Public Health Responsibility Deals which allow major corporations to contribute to the development of public health policy. Regarding the specifics of the Health and Social Care Bill; CCGs (unlike PCTs) do not have any obligation to provide comprehensive and equitable health that is available to all people within a defined geographic area. This gives them the freedom to pick and choose who receives care and also which services are available to the patients on their lists. In this context it is unsurprising that the membership of the Faculty of Public Health (FPH) overwhelmingly voted for the FPH to call for withdrawal of the Bill.

Concerning the achievements of the Future Forum in amending the legislation, I am certainly not the only individual who believes that the core, contentious issues within the Bill remain unchanged (see, for example: http://www.mirror.co.uk/news/uk-news/david-camerons-listening-exercise-on-the-nhs-675749)

One final comment about Graham Phillips’ assertion that the “RPS has very real concerns about the bill” and his provision of a link to support that claim. There is nothing in the statement linked to that even remotely suggests that the RPS has ‘very real concerns’ about the Bill.

In the next couple of days we'll publish the results of C+D's PCT Investigation 2011.

The results will be unsurprising to those of you who have followed our previous PCT Investigations. Shockingly huge variances in funding and quality and on average a pretty poor return on investment for contractors.

It's symptomatic of a general failure by the NHS, commissioners, PCTs et al to make the most of pharmacy's potential - and if you have any doubt of what the sector can do, feel free to take a look at the healthy living pharmacy initiative.

But the real issue here is - will the Health and Social Care Bill actually make any difference to community pharmacy practice?

In theory, it could open up a whole host of opportunities for multi-disciplinary working. In practice, there's a very real fear of more of the same, as GPs take an even firmer hold of power.

Quite how the RPS is "working with the government on the implementation of the reforms to make sure they benefit pharmacists and their patients as much as possible" would be useful to know. If it believes this is the right thing to do, it should state exactly what it is doing and what it's specific objectives are.

Gary Paragpuri, Editor, C+D

(For info, I am no longer an RPS member)

Hi Joseph

Good points and well made - and nice to see an academic pharmacist venturing forth into the world of community pharmacy! I hope you'll join the RPS webinar; I can assure you that this IS a genuine attempt to engage with and listen to our members. The RPS will never be able to "please all of the members all of the time" (If you'll forgive the paraphrase) but we ARE trying!
Graham

Hi Graham,

I welcome any move from the Society to engage meaningfully with its members. I just think there's more than a hint of bolting the stable door after the horse has vaulted about the current strategy. Additionally, I do not buy the line that the Society has somehow consulted with the membership thus far. One consultation on the original White Paper (NOT the Bill which is a completely different beast) which attracted a minimal response (I have seen the responses by the way) and two Future Forum 'Listening Events' (I attended one of these by the way) have probably garnered the opinions of not much more than 50 members. For the Society to extrapolate from such a sample and suggest that its stance is an accurate reflection of the views of the membership is an affront to both logic and the principles of a democratic professional membership body.

Regarding the Society not being able to please all of the members all of the time - I completely agree. I am not asking for the Society's stance to reflect my own. I expect the Society's stance to reflect the opinions of the wider membership. Asking that wider membership for that opinion might (or perhaps may have been) a good place to start.

Regards,

Joe.

Further to this I have set up a brief questionnaire to assess pharmacists' views towards the Health and Social Care Bill. I would be very grateful if any pharmacists reading this could spare a few minutes to complete the questionnaire here:

http://www.surveymonkey.com/s/SZSHWZC

Many thanks,

Joe.