Ten years ago, on 17 December 2015, the Department of Health wrote to the then Pharmaceutical Services Negotiating Committee, now reincarnated as Community Pharmacy England, announcing that while spending on health was planned to grow, pharmacies had to endure a cash reduction of nearly £200m.
There were too many pharmacies, officials said, and “efficiencies” had to be made. What followed was a decade of real terms cuts that has slashed the number of pharmacies serving our communities and left too many of those that remained struggling to survive.
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Years of fixed funding compounded the problems, leading to the dreadful position of pharmacy owners raiding their pensions or personal savings – sometimes remortgaging their homes – to keep their community pharmacies running.
The losers are those patients and communities left without services, or at least with a service that does less than it could. Huge potential, but unrealised for want of funding.
We’ve all heard it too many times before. More than 1,400 pharmacies have closed. The network has become severely challenged in some areas, where the threat of creating pharmacy deserts is a chilly spectre at this time of year.
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And for those who remain, life has been tough. There are many stories of people forced to raise their own incomes or pensions, work too many hours and invest too little, just to keep their businesses going.
It ought to be remembered too, that this challenging decade saw heroic efforts by pharmacy teams during the Covid pandemic – recognised by community claps alongside other NHS colleagues, but by no means fully acknowledged in terms of payment.
This cold reality is the ghost of pharmacy present. Damage has been done. The network is smaller, closures are ongoing, and the acute financial problems of the network remain.
The incoming government responded, not least because of the campaigning of so many NPA members, with a 19% uplift in April. A substantial uplift of course, but enough to solve the funding crisis after many years of austerity? No – there is still so much more to do.
We cannot accept managed decline. Or accept that funding is fixed, and let the network shrink and wither away. That is a black and white view of the present, not a colourful vision of the future.
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Already there are seeds of change. A generation of pharmacists will graduate as independent prescribers, government ministers are committed to shifting care into the community.
The network has become severely challenged in some areas, where the threat of creating pharmacy deserts is a chilly spectre at this time of year.
Henry Gregg, NPA CEOTheir preoccupations – community care, prevention – are the bread and butter of pharmacy. There’s strong evidence that a revitalised pharmacy network can save the health service billions, improve care and change lives for the better.
We want to focus on what ought to be a bright future for pharmacies and their communities - the ghost of pharmacy futures.
We want a world in which pharmacy funding can move towards closing the funding gap that has developed over decades, and where the vision of an expanded local service, rooted in the trust and professionalism of pharmacies, has been realised.
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In this version of the future, ministers have the confidence to invest in the pharmacy network. Pharmacists, GPs, nurses and hospital staff work in close harmony – each playing an enhanced role in the service of patients.
Treating minor ailments on the high street, not in some remote hospital or health centre, maximising the use of medicines and cutting waste, and delivering diagnostics and health advice where people are.
The 10 Year Health Plan for England presents a strategic opportunity for the community pharmacy sector. Ministers are right to want to shift resources to primary care and community services. Investing those resources in community pharmacy will deliver a major return on that investment, at pace.
After all, the NHS community pharmacy network, though tragically depleted by the attrition of the past decade, still provides the most significant community outreach in the health system.
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The way we can seize that opportunity is through working with real collaboration across the whole sector with effective representation that genuinely brings everyone together, rather than arguing and competing among ourselves. We’ve worked to give pharmacy more profile than ever before, taken our case direct to Treasury and the heart of government. We need to do that and more, together.
The winners will be clear: pharmacies, GPs, hospitals and the taxpayer, yes - through better finances and more efficient health spending. But mainly communities full of people living healthier, longer lives, supported close to home.
Let’s hope we have not only turned the corner on this day a decade ago, but that politicians have the courage and the vision to invest in the community pharmacies that we know will make a huge difference to people’s lives.
Henry Gregg is chief executive at the National Pharmacy Association