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2022: The year of the missed Pharmacy First opportunity, PSNC says

Pharmaceutical Services Negotiating Committee (PSNC) chief executive Janet Morrison provides her reflections on 2022 in the fifth of our C+Dmas series

“No single ‘best’ moment”


It's very hard to isolate a single 'best' moment from this year. The things I have enjoyed the most have been the pharmacy awards that I have been present at and there have been a number of those.

It is great just seeing the recognition of staff who've put in so much effort and energy during COVID-19.

It does matter and it makes a difference to people to see themselves being recognised.

But I think it's also the sort of innovation, the enterprise and the commitment to patients that they have demonstrated that has been great to see.

We obviously hear so many stories about pressures on the sector and the difficulties community pharmacists are facing and being able to see people's commitment and energy is shining through even though they're facing real difficulties is also great.

It has also been great to see a variety of teams in a variety of settings be involved. They have served as a reminder of why everyone's doing what they're doing and why they work so hard. They do so to be agile about finding solutions for patients.

Read more: Taking the pressure off: What do pharmacists want their future to look like?

“A fork in the road”


As community pharmacy colleagues will know, we are at a fork in the road and if the government pursues one path, we are facing unimaginable outcomes.

If they pursue the alternative path, they can build on achievements made during COVID-19 and be much more ambitious with funding relief and Pharmacy First. This will enable us to be a cost-effective and very direct solution to NHS problems.

Understanding the constraints on the sector on every side of the equation has been the biggest community pharmacy lesson for me this year. It feels like there are traps on every side.

You've got a funding deal on one side that was talked about as flat but is actually reducing in real terms.

Then you've got workforce and rising demand pressures along with price concessions and the gap between what community pharmacies pay and what they procure.

Then on the other side of it, unlike other businesses, community pharmacies can't pass on any additional costs to their customers. Nor can they change any of their activities or hardly any of their operating constraints.

Community pharmacies cannot say ‘oh inflation is going up, so let me increase my prices’.

They can also not open fewer days a week so as they can get the staff.

Finally, with exit costs really high, community pharmacies can't just say ‘this isn't working so I am leaving’.

As we see out the year, unfortunately these conditions are only worsening.

So what is going to give and what is the government going to give to safeguard a vital service?

Read more: ‘Critical situation’: PSNC moots reduced opening hours amid NHS strike chaos

Pharmacy First


When I arrived at the PSNC in March, we went straight into negotiations and we presented two very worked-up bids.

One was a broad funding bid, which was only to bring us back to the levels we were at in 2019 and what would be needed to safeguard services and capacity.

The second bid was a very detailed business case for what we called the walk-in service, but is effectively Pharmacy First.

We presented those and went through them in great detail with the Department of Health and Social Care and NHS England.

However, it soon became apparent that while they were listening and engaging and probing what was in those proposals, they were operating within set parameters that had already been agreed with the Treasury and there was no take-up on either of those bids.

That was very depressing and disheartening and was definitely a low point of 2022 as both bids were good, detailed evidence-based proposals.

Read more: What could England’s national Pharmacy First service look like?

As readers will know, we are now facing a worse situation.

However, we will continue arguing and making the case and we're not going anywhere.

We saw the end of the negotiations that had started in March and having new ministers and all of the shuffling as a chance to restart and say the book isn't completely closed.

We must ensure that we don’t have another missed opportunity with Pharmacy First in 2023 like we did this year.

We know that ministers want it and we gave them a proposition. They keep flirting with it and they just need to pick the business proposal up, look at it and get on with it.

This service would recognise current core funding problems as well as core capacity problems and the demand we are already facing and help address that.

Read more: Steve Barclay: Pharmacy First an ‘opportunity’ to solve GP appointment crisis

“Price concessions are not a symbolic issue”


I know that winter pressures are always a big factor for the sector at this point in the year.

But what’s really struck me is how price concessions are not a symbolic issue or symptom. It's a very fundamental challenge at the moment.

And I think it's quite unprecedented. This month we have put in 199 drug lines for review, 30 of which are antibiotics.

To be closing the year with such a serious crisis on our hands is unprecedented.

We are engaging with the DH really urgently to say this needs to be reformed because clearly some contractors can't afford to pay their drug supplier which is serious.

Contractors are obviously pretty angry about it and scared.

Read more: PSNC to rebrand as Community Pharmacy England in April 2023


“The road ahead”


Hopefully 2023 will enable us to get ministers to understand that they're at a fork in the road and really value and need community pharmacy and recognise that.

This includes getting them to engage with the vision and strategy work we're doing with the Nuffield Trust and the King's Fund and thinking about all of the potential for delivery.

They also need to be thinking about what we need to safeguard the sector to enable it to deliver it.

In addition, hopefully they will understand what funding is required and be more open and honest about the part community pharmacy could play in primary care and do something to safeguard that part.

Read more: Pharmacy leaders issue urgent funding plea as pharmacies 'struggling to survive'

Janet Morrison is chief executive of the PSNC

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