Yet again we find the urgent changes needed for community pharmacy, in the shape of a new contract that provides appropriate funding and the promised changes to legalisation for hub and spoke dispensing, kicked into the long grass.
The lack of action and urgency from our appointed representatives and successive governments is astonishing. But it’s nothing new.
I qualified as a pharmacist in the 1990s, and time and time again I’ve seen support for pharmacy delayed, watered down, or shelved. It’s the same faces negotiating on our behalf – they lack vision and are seemingly only too happy to accept the same dysfunctional contract.
The feeling that community pharmacy is viewed as back of the pack was only further reinforced when I studied for my MBA with senior execs in the NHS.
Being fed the leftover crumb had given pharmacy a strong sense of resilience if nothing else. But even that’s now waning - replaced by anger as increasing number of pharmacies are forced to close or take on increasing debt to fund a loss-making dispensing service.
The delays by Westminster and the DHSC are as frustrating as they are out of our control. But I don’t think they’re the only reason community pharmacy is being hindered to move forward. I believe the industry dinosaurs and those who fear change and fair competition are causing us just as much harm.
Circling the wagons
For years we’ve been going back and forth about hub and spoke dispensing. And now due to the legislation being delayed, the debate has begun again.
This isn’t about making hub and spoke dispensing mandatory. Perhaps if it was, the grossly protracted timeframe would make sense. No, it’s simply to give all pharmacies the choice to use it – or not.
Currently hub and spoke dispensing can only take place between pharmacies under the same legal entity. An unfair rule which leaves many pharmacies frozen out of creating capacity.
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Of course, it’s right that the industry has a say on changes to it. But its disingenuous when the loudest voices belittling hub and spoke are the same pharmacy leaders currently benefiting from it. They’re circling the wagons because they know it provides them with an unfair advantage.
But perhaps even worse than those who fear fair competition, or the organisations who are supposed to represent the needs of all pharmacies showing little appetite to fight for equality, are the dinosaurs who tell independents not to bother trying something new. ‘It doesn’t work’, they say, ‘keep struggling’. ‘Keep closing’.
All hub and spoke operations aren’t created equally. Some haven’t had the proper investment, vision, and expertise behind them. Others are doing the job of creating capacity for clinical service delivery incredibly well.
Crying out for change
‘Hub and spoke isn’t a magic bullet’ – that’s a phrase the nay-sayers use a lot too. And it’s true. Pharmacy needs many lines of support, starting with properly considered funding. It needs representative bodies with far sharper teeth to deliver what we deserve.
Pharmacists are grossly underutilised by being kept on the dispensing treadmill. And many desperately want off it. It’s certainly a feeling I had as a pharmacist.
Read more: It’s time for frontline workers to be part of funding negotiations
I remember working for a large chain and after a morning of dispensing prescription after prescription, I was asked if I could hop on the sandwich counter till to cover the lunchtime rush. It wasn’t what I’d signed up for.
I didn’t want a career of feeling unfulfilled and undervalued, so I started out on my journey to disrupt an industry that hadn’t changed in hundreds of years.
I’ll never know where my career would have taken me if I’d had the clinical opportunities pharmacists have today. Or at least the opportunities they could have, if some of the dispensing pressures were taken away.
Uneven playing field
It’s shocking that with all the talk by government of economic growth, and healthcare being at its heart, that we’re being hamstrung by a lack of transparency from them about critical issues. Unable to plan, invest, and evolve.
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But it’s even more damaging when that’s combined with those within the industry also trying to hamper progress. Change not only needs to be embraced by those on the frontline of community pharmacy, it also needs to be driven by them.
We can’t afford to let opportunities for pharmacy’s survival and evolution be governed by dinosaurs who are scared or incapable of doing things differently, and those currently operating from a grossly uneven playing field. Which is why I’m urging the government to act now to provide the industry with the certainty it needs and grant the Model One change before more pharmacies close.
Then let’s rip up the contract and agree one that supports the new 10-year NHS plan and the shift to more care in the community.
Daniel Lee is CEO of HubRx, and pharmacy chain Pharmacy+Health.