Last week on the health and politics podcast I host with James Bethell, we spoke with NHS boss Sir Jim Mackey.
In a wide-ranging conversation, we did talk community pharmacy specifically but we got there courtesy of the wider ‘hospital to community’ shift so beloved of our Secretary of State; and particularly the promise in the Ten Year Plan (page 28) to “do more in the community - funded by a reduction in hospitals’ share of total NHS expenditure”.
Sir Jim’s response, and message to those forming neighbourhood teams, was interesting;
“If you want the outpatient budget, talk to us about it.
“And if you can find a new way of delivering that more locally, with less people traveling up to the hospital, great. Let’s just see how the maths works.
“Convince yourselves and us, you can do things in the community. Stop people being churned through the hospital system. I honestly think if we can do that, the biggest relief will be in the hospital sector.”
So, community pharmacy, assuming you can work out (and be part of) who these neighbourhood teams are, the brave new world is made for you. Right?
Read more: ‘We have to find a plan’ NHSE CEO Jim Mackey on the ‘casualty’ of community pharmacy funding
To many it’s a familiar tale. They want you to do more but, as I put to sunny Jim, community pharmacy is being hit hard by the rising costs of being private business - rising utilities, wages and business rates that have not been subject to the the rebate that the government have given to others.
So does the head of the NHS really think he can achieve the step change he and Wes Streeting want in the hospital to community shift without a step change in funding for community pharmacy?
Again, the reply was (to be honest) rather circular.
“I think this is really a casualty of the pressure on the money overall”, he told us.
Read more: ‘Concerned’: health dept to fund UK’s £1bn pharma deal with US
“At the minute, there isn’t an easy way of saying we can put more money into that without taking it from somewhere else.” You see my point!
He did say we need a “vibrant community pharmacy system to support all of the things that we’ve just talked about” but admitted “we haven’t yet” so that’s at least clear!
Muscular intervention
Very shortly Community Pharmacy England (CPE) will commence the next round of contract negotiations.
Sure they will argue Ministers must close the funding gap, with proper indexation for activity and inflation, and I don’t doubt they will stress the utterly unfair situation with regards to business rates disparity.
The very real risk in my opinion is, Ministers and NHSE think they already have moved money to the sector via last year’s settlement and are unlikely to go there again.
Read more: IPA threatens government with legal action over funding
The problem for CPE is not just a comms challenge - whereby if they only say it better - the Minister will open the purse once more, it’s now existential.
Community pharmacy has always been highly political but it’s more so now than ever.
2026 could be the year for coming together and what I’d call more muscular interventionism with government given an inflationary increase on core funding is perhaps the best community pharmacy can hope for.
Indeed you already have credible voices, like the impressive Nick Kaye from the NPA, saying pharmacy should “come together to say ‘No’ if we feel the terms we are given are not acceptable”. He’s got a point.
Read more: Real economic peril - CPE warns Kinnock
Playing nicely isn’t going to move the dial for a second year in a row and, given all your futures essentially lie in that contract, to believe so isn’t just naive - it’s dangerous.
In today’s NHS, under this regime in particular, if community pharmacy does not keep moving forward, it risks being pushed backwards.
Steve Brine is a consultant, trustee, former MP for Winchester & Chair of the Health Select Committee and co-host of the weekly podcast, Prevention is the new cure.