Jeremy Hunt's five biggest impacts on community pharmacy's future
From funding cuts to dispensing defences, Mr Hunt's influence on pharmacy should not be understimated
Prime Minister Theresa May’s cabinet reshuffle yesterday (July 9) means that Jeremy Hunt has left the Department of Health and Social Care (DH) after nearly six years in the role.
Number 10 Downing Street announced Mr Hunt will replace Boris Johnson as foreign secretary, and in turn will be replaced as health secretary by West Suffolk MP Matt Hancock, the former secretary of state for digital, culture, media and sport.
The appointment of a new health secretary could be an opportunity for community pharmacy to re-establish what has become a fraught relationship with the DH. Sandra Gidley, chair of the Royal Pharmaceutical Society’s English Pharmacy Board, has promised to write to Mr Hancock “offering him help in getting up to speed with what the third largest health profession can deliver for patients”.
But how will community pharmacists reflect on Mr Hunt’s time in the role, and what influence did he have on the sector? Here’s a look back at five of the former health secretary’s major policy decisions, and the impact they had.
He was the architect of the funding cuts
As the sector awaits the outcome of a High Court appeal against a 12% cut to the pharmacy funding budget in England, the role that Mr Hunt played in imposing the cuts that have put the sector under unprecedented financial pressure is beginning to emerge.
The High Court judges are currently deciding whether Mr Hunt had enough information to “rationally” implement a cut to funding for England's pharmacies. During the appeal – brought by the Pharmaceutical Services Negotiating Committee (PSNC) and the National Pharmacy Association (NPA) in May – Alison Foster QC, the lawyer representing PSNC, argued that Mr Hunt’s “failure to obtain reliable information” about the sector meant that he could “not rationally understand the impact of the funding cuts for the sector”.
But documents that came to light during the original High Court case in March 2017 suggest Mr Hunt was very familiar with the consequences of the cuts to the sector.
In a letter to the Prime Minister, dated August 2, 2016, Mr Hunt said community pharmacies had not made “any significant efficiencies to date, and as a result the number has increased by 20% in the last decade, despite retrenchment in nearly every other high street retail sector”.
Having been asked to “relook at our proposals for reforming community pharmacy”, Mr Hunt boasted that “we know privately that the sector [was] expecting a bigger package of cuts than [the £170 million] we actually announced”.
He assured the Prime Minister that he was “convinced that this level of efficiency can be made without compromising public access to pharmacies” – as his “indicative calculations…put closure figures somewhere between 500-900 pharmacies”.
Mr Hunt even set out alternatives to the swingeing cuts – including the option to “cancel the package altogether” – but encouraged Ms May to press ahead.
He introduced a dispensing error defence…
On a more positive note, Mr Hunt was the health secretary who finally introduced a long-awaited defence against criminal prosecution for pharmacy professionals who make inadvertent dispensing errors, which became law in April.
Speaking in February, the same month the defence was signed by the Queen, Mr Hunt emphasised it would “ensure the NHS learns from mistakes and builds a culture of openness and transparency”.
RPS president Ash Soni said the defence was important in “reinforcing the message that there has been a shift in culture relating to dispensing errors”. But pharmacy lawyers warn that it will not provide a water-tight legal argument in all scenarios.
The defence was part of what Mr Hunt described as a “ground-breaking” package of measures to tackle the 237 million medication errors that occur across the NHS each year, and reduce the “appalling levels of harm and death that are totally preventable”.
...but not with help from the sector
This medicines safety initiative chimed with an issue – patient safety – that Mr Hunt referred to as his “greatest passion” as health secretary. However, C+D revealed in May that he did not have a single community pharmacy representative on the advisory group that had input into the strategy. This omission was one of several occasions when ministers and decision-makers in Mr Hunt’s team ignored community pharmacy views.
He was implicated in the “secret” supervision proposals
In September 2017, C+D exclusively revealed that detailed proposals for pharmacy technicians to be handed legal responsibility for supervising the supply of prescription-only medicines (POMs) had been submitted to a DH programme board.
The revelations came just a month after Mr Hunt attempted to reassure a locum pharmacist that rumours about exactly this eventuality were pure fiction. In a letter sent to the locum's local MP – Labour MP for Leeds Central Hilary Benn – Mr Hunt insisted “the government [had] not brought forward any proposals to allow pharmacy technicians to supervise pharmacies”.
When C+D confronted the DH with leaked government documents and specifically asked whether Mr Hunt was aware of the confidential proposals, the DH did not give a direct response. A spokesperson said: “We want to make the best use of every member of staff's skills in pharmacies. Any changes made to who can dispense medicines would always be properly consulted on and would never compromise the safety of patients.”
The jury is still out on whether Mr Hunt was fully aware that the proposals were being drafted, but policy makers have since admitted the response from the sector has forced them to “go back to square one”.
He prioritised GP pharmacists over their community colleagues
On many occasions Mr Hunt made encouraging noises about making the most of community pharmacists’ clinical skills – but ultimately he did not keep his promises during his time as health secretary, as shown by his consistent failure to introduce a national minor ailments scheme.
During a speech at the NHS Confederation’s annual conference in June 2017, Mr Hunt told delegates that the government had not “exploited the tremendous skills pharmacists have” nearly as “effectively as it might”.
Mr Hunt said he wanted community pharmacy to have “a different and bigger role” in keeping people out of hospital. “I think we want a closer relationship with pharmacists, but a different relationship,” he added.
He cited pharmacists’ access to electronic health records as a means of avoiding unnecessary hospitalisations, as well as advice by a “clinically trained pharmacist” – a divisive term for pharmacists working in general practice.
And that's the issue: while money promised to community pharmacy has either been cut or siphoned elsewhere in the NHS, Mr Hunt's DH has been more than happy to spend £112m recruiting pharmacists into GP practices. With a similar financial commitment, who knows where the sector would be today?