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PSNC chief: Workforce pressures hinder pharmacy’s move to service-led model

C+D spoke with PSNC’s new chief executive Janet Morrison about her experience in the role so far, the “pressing issues” community pharmacy faces and what needs to happen for the sector to become more service-based

The conversation takes place over Zoom due to Ms Morrison’s busy schedule: her first few weeks as chief executive of the Pharmaceutical Services Negotiating Committee (PSNC) have been a whirlwind of pharmacy visits, conversations with contractors and getting to the bottom of how pharmacy businesses operate.

“It's been a fantastically big learning curve,” she says.

The biggest thing she has learnt so far? She pauses before answering and looks up into the space above her, a habit that continues throughout the interview.

“I’ve learnt a huge amount about [pharmacy’s] capacity and willingness to respond” to circumstances such as the pandemic, she states.  

“The scale of agility and responsiveness to the COVID-19 crisis [within pharmacies] has been immense,” she says, from providing “backup to the NHS” through delivery of vaccinations and care to the vulnerable, to the continued supply of new services under the Community Pharmacy Contractual Framework (CPCF).

In doing so, pharmacies demonstrated “the great potential of the sector” in areas such as preventative care, support with long-term conditions and medicine optimisation.

“I had an awareness of that [agility],” Ms Morrison explains, “but it's way more than I could have imagined”.

Community pharmacies showed “a commitment to patients and to public health”, as well as a “sense of responsibility” and duty, she adds. “They’re so agile and enterprising.”

 

Read more: Here’s what the public thinks of pharmacy’s role during the COVID-19 pandemic

Previous experience in negotiations

 

Ms Morrison calls from her London-based home – handy for trips to the PSNC offices in Farringdon, when she’s not travelling across the country for meetings and pharmacy visits.

“To add to the delights” of her first few weeks on the job, she says, laughing, PSNC “went straight into year-four negotiations within days me arriving”.

However, she seems well suited to this new, “complex environment”, which “can be political and tricky in terms of negotiating different interests”.

In her previous roles – including a stint as deputy chief executive at the National Endowment for Science, Technology and the Arts (NESTA) and 12 years as chief executive of the older people’s charity, Independent Age – she has had ample experience “influencing and negotiating with government in a variety of settings and different issues”.

Potted CV:

2019-21: Ms Morrison was chair of The Black Stork Charity, developing its strategic options, professional networks and pilot programmes

2010-19: Ms Morrison founded and acted as chair Campaign to End Loneliness, promoting awareness of its impact and prevalence of loneliness in old age for policy and to the public.

2007-19: In her 11 years at older people’s charity Independent Age, she served as chief executive and led a cross-party coalition on the future of social care and a new funding settlement working across government, the public, health and care sectors and with other not-for-profits

1999-2006: Ms Morrsion was a deputy chief executive at NESTA and lead a successful bid for £75m addition to its endowment as well as establishing new investment and funding programmes.

1997-99: As a senior policy advisor at the BBC, she secured government approval for BBC online and other commercial partnerships.

1995-97: Ms Morrison held multiple roles within NCVO, serving as director of policy and research for two years and leading its campaigning work on the National Lottery and funding for good causes.

She was involved in “building the relationships and the influence” on top of a “well-evidenced case”, she explains, sure to come in handy in PSNC’s current negotiations, as well as those to come.

As a senior policy adviser at the BBC, she sought “ministerial approval for new commercial ventures” and to make BBC online “a licenced fee-funded service”.

At NESTA, Ms Morrison secured “an additional £75 million to be put into [its] endowment”.

“I can't claim huge success on navigating a new deal for social care, because I think that's still a massive issue,” she tells C+D.

She was, however, awarded an Officer of the Order of the British Empire (OBE) in the 2020 New Year Honours List for her work as founder and chair of a successful campaign to raise the profile of loneliness in old age and to promote solutions to it.

When announcing her appointment in February, PSNC noted that before Ms Morrison’s nomination was approved by the committee, members unanimously voted in her favour.

She was described as “an exceptional candidate” who had “a clear view of the job to be done” as well as “the skills to influence and lead effectively on behalf of community pharmacy”, by the negotiator’s chair, Sue Killen.

Ms Morrison says devising “strategy” and leading “transformation” has been key to her work so far.

"There's a lot of desire to strengthen our representation of the sector”

“I'm not saying that PSNC needs to be transformed,” she caveats, “but I think there's a lot of desire to strengthen our representation of the sector”.

PSNC is already on the precipice of an overhaul of sorts. In 2020, the Pharmacy Representation Review Steering Group (RSG) was established to help bring about potential reforms to PSNC and local pharmaceutical committees.

The first contractor vote is scheduled to take place online over a two-week period “in early 2022”, C+D reported, and will ask participants to approve or reject the proposals for representation at both a national and local level.

What impact the RSG’s work will have on community pharmacies in England is yet to be decided, but for Ms Morrison, a “pressing issue” within pharmacy “is to have a coherent, shared vision about the future of the sector”.

 

Linking pharmacy and NHSE&I’s goals

 

Establishing this shared vision should help with contract negotiations, and in turn perhaps help to secure appropriate funding for the sector, Ms Morrison hopes.

“There's been a serious question mark about the funding commitment from government and from the NHS” for pharmacy over the past few years, Ms Morrison says, even before the current CPCF was agreed in July 2019.

This year’s negotiations are set to be even “more challenging”, with COVID-19 exerting “pressures on public spending”.

The Treasury will be “putting pressure on departments to control ever increasing budgets”, Ms Morrison predicts.

This makes funding negotiations and the ongoing business environment for contractors “really hard”, Ms Morison admits, “but it has been hard for quite some time since those original cuts” in 2015.

“There's been a serious question mark about the funding commitment from government"

Despite the five-year funding deal promising to give contractors some stability and the ability to plan for their move to a more service-led business, Ms Morrison admits there are “challenges” with having five years of flat funding and a rethink of the contract’s length might be on the cards.

 

Read more: Is a five-year contract still working for community pharmacy? 

 

Earlier this year, PSNC vice-chair Bharat Patel said he was “deeply frustrated” by the government’s continued refusal to agree to “a much-needed broader funding uplift” following the first annual review of the five-year CPCF in England.

Despite the additional hurdles in obtaining more funding, PSNC is “making a very strong case about the [monetary] and capacity pressures” for pharmacy in its current negotiations, Ms Morrison tells C+D.

The negotiating team’s strategy is “not to see a funding request [for pharmacy] as separate to the longer term, broader goals for public health and the NHS”, she explains, but to “couple” them.

“It's clear that we have a really critical role to play in terms of relieving pressure on frontline NHS services,” she states.

In capturing “how much community pharmacy delivered” during the pandemic and aligning it to NHSE&I’s direction of travel, Ms Morrison hopes to “create a climate in which key negotiations take place later on”.

 

“Workforce pressures” and low-scale schemes hinder more service-led model

 

For Ms Morrison, the previous contractual frameworks showed the government was “moving away from seeing community pharmacy just as dispensing”.

However, “it’s really hard to say” how long it might take for the sector to move towards a fully fledged service-led model, she admits, particularly due to “workforce pressures”.

“Most businesses don't have the space and capacity to do anything other than really try and control costs and efficiencies and secure staffing to meet their requirements,” she says. “They don't have much capacity to think ahead.”

“Most businesses don't have the capacity to do anything other than try and control costs"

Any talk about an enhanced role for services will “have to be accompanied by a clearer picture of how community pharmacy can be sustainable”.

The first services that have been rolled out are “not going to deliver real scale and volume”, Ms Morrison thinks.

Of the services touted under the 2019-24 CPCF, the new medicine service (NMS) is working well and has seen “quite a lot of take up”, Ms Morison tells C+D. It has “potential […] to grow” even further, she says. Uptake of the GP Community Pharmacist Consultation Service (CPCS), however, depends “on the degree to which GPs buy into doing that and supporting that”.

“What we don't want is community pharmacies to have 20-30 different minor [ailment] service schemes, all with different requirements,” she says, “because that doesn't make sense business-wise”.

PSNC will have to work with the Department of Health and Social Care (DH) and with NHS England and NHS Improvement (NHSE&I) to “increase the scale of those”.

 

Contractors “between a rock and a hard place”

 

But this is easier said than done, as contractors have a lot on their plates right now, Ms Morrison says. However, they “do really care” about the best interests of their staff and understand how the “huge” pressures currently placed on the sector might affect pharmacy teams.

Those she has spoken with since stepping into her new role are grappling with employee burnout and continued absences due to COVID-19. They are having to consider whether they have the capacity to take on new services – such as the smoking cessation or hypertension case-finding service – or whether they should “slow [them] down” or pause them altogether.

If that wasn’t enough, there are competing sectors to contend with.

Posts in GP surgeries, hospitals and in the NHS might at the moment “seem more attractive, because they may be more flexible, [require] shorter hours, and not as pressured as working in a community pharmacy”.

So how can pharmacy employers continue to present community pharmacy as a viable career path?  

The sector must collaborate with the government, Ms Morrison states, to come up with “a strategy for workforce development for the future”.

Questions such as what part independent prescribers can play in the future delivery of services and what kind of efficiencies the implementation of hub-and-spoke dispensing might deliver, should also be addressed she says.

 

So, what’s next for PSNC?

 

As she settles into her role, Ms Morrison reiterates to C+D that she hopes to establish a “vision” for how community pharmacy can move forwards “for the next five years”, in collaboration with the DH and NHSE&I.

“Strengthening the opportunities for contractors nationally, regionally and locally to have influence and engage with commissioning at all levels,” is also something she is keen to explore.

And behind it all is Ms Morrison’s aim to build “wider awareness of the value of community pharmacy and what it's delivered”.

In the immediate, it’s back round the negotiating table with the DH and NHSE&I, in between more visits across the country to see pharmacy teams in action.

Ms Morrison seems intent on the many tasks ahead and is systematic in her approach to them. She speaks warmly of her team, who have ushered through her bustling first weeks at PSNC.

Luckily, she “really [is] enjoying it”.

We end on taking a Zoom picture to commemorate the interview. “I’d have done my hair!” she jokes.

 

 

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