Pharmacy is still reeling from the shock of the pre-Christmas letter from the government. One month on, it is still difficult to know how to respond – or where to start. The only thing that seems clear is that community pharmacy will be hit with a minimum 6% cut in funding.  The rest of the letter is a jumble of seemingly half-baked proposals. The lack of any detail makes substantive comment or negotiation impossible. 

We know times are hard for the NHS. And it doesn’t look like they’re going to get much better, as demand for treatment continues to outstrip supply. We also understand the need for change. Pharmacy has been moving down a process of transformation since the "new" contract was introduced in 2005 and, through this, the Department of Health (DH)/NHS has much to be thankful for.

To start with, some one billion prescriptions are dispensed annually in England in an efficient and safe manner. In doing so, pharmacy plays a key role in managing both prices of medicines and helping patients get the best from the medicines they take. 

But dispensing is only part of the story. Alongside this, pharmacists deal with the management of minor ailments and long-term conditions, the provision of services around sexual health and drug misuse along with a plethora of other much-needed services. We provide flu vaccinations on the high street. At the same time, we do much to improve public health, while signposting people to other healthcare services where appropriate.

So pharmacy is not only a service, but a linchpin to local communities. It takes a considerable burden off other health services, in particular general practice – a service that is extremely difficult to access.

Over a number of years, there have been countless reports, proposals and considerable evidence in support of the many ways in which community pharmacy can enhance its contribution to improving the health and wellbeing of local communities. Indeed, the government regularly talks about the important and significant contribution pharmacy makes. But beyond this token lip service to pharmacy's contribution, we haven’t received much support – and this letter gives little clarity on what exactly it wants from pharmacy.

It tells us that in some areas there are too many pharmacies. It does not, however, give any indication as to the basis for this assertion, let alone give even the faintest idea of how it intends to deal with any surfeit other than through the blunt and unreliable instrument of attrition.

It also tells us that the future lies in hub-and-spoke.  There is no doubt that there will be a place for hub-and-spoke and other technological solutions as a means of handling volume and logistics in pharmacy supply, but to suggest an overall solution lies in the universal use of a so far untested and uncosted solution is, at best, premature – and, at worst, reckless.

Pharmacy practice does need to change and to keep pace with modern methods and processes. But change is difficult. A key factor in the success of any change management process is to get buy-in from stakeholders and to have connectivity from top to bottom. This begins with a clear understanding of the current state of play.

The letter suggests the government has either little or no idea of the significant contribution community pharmacy already makes to improving healthcare, or simply doesn’t care. This must cast serious doubt on the robustness of their sweeping generalisations for a future model.  It is, in short, an insult to hard-working community pharmacists and will do nothing to motivate pharmacist engagement.

John D’Arcy is managing director of Numark

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