Its great that we finally have one of our own (a community pharmacist) in Parliament, and its really interesting to hear Sadik Al-Hassan’s views from inside the Westminster bubble.
As two truly committed pharmacy contractors with a long history of innovation in patient care its difficult to convey just how close to the edge we all feel.
Beyond being Responsible Pharmacists at a time of unprecedented demand, we also have the stress of paying the bills and trying to ensure that we can continue to provide safe and effective care for our patients.
So it is unsurprising to see that we have a different perspective on many of the issues Sadik raises in his interview.
First let’s explain the context: Its been 11 years since pharmacy funding last increased, during that time the Government has increased the National Living Wage a total of 11 times, a near 200% increase.
Not a penny of this increase has been funded by the NHS contract.
Staffing is the single biggest cost in any business, and ours is no exception.
Not only have wage costs risen massively because of Government imposed mandatory pay rises, but we also need more people to cope with the higher workload, a completely dysfunctional medicines supply chain, and the extra services we are expected to provide.
That’s before we’ve even get to the National Insurance and Business Rates Relief changes in the October budget. All told these changes alone add up to at least £400m for 2024/5 and 2025/6 alone. Since 2019 the National Living wage increases alone have added more than £800m to the pharmacy wage bill.
Read more: ‘Actions speak louder than words’: MPs rally to halt NICs hike
It is absolutely true that it was the Conservative Government that started the current disastrous funding trend, but the sector has been left sorely disappointed by the failure of the new Government to supply anything other than warm words during their first 8 months in office.
By comparison the Junior Doctors were in through the front door before Wes Streeting had even unpacked.
Community pharmacy it seems is just not a priority, despite the rhetoric about the three big shifts that the new Government say they want to see.
Unless something changes neither of our businesses will be here in 10 months time, let alone to help implement the NHS 10 year plan (more on that later).
That is the sense of urgency that we all feel is missing from the Labour Government’s approach. Community pharmacies are running out of cash by the day, with some unable to pay their wholesale bills, staff bills or are having visits from the bailiffs.
Read more: ‘Impossible to absorb’: Cat M to slash pharmacy cash by £34m
Ask yourself if this was happening anywhere else in the NHS would this be acceptable? While someone else caused the problem, we are not seeing solutions, any sense of urgency or even a realistic assessment of the size of the funding gap.
By any token, and using the 2010 Cost Of Service Inquiry as the most recent published assessment of where fair pharmacy funding should be, our funding should be starting with a 5 for next year. (£5bn that is! )
It needs to double, to keep pace with inflation and to recognise the inexorable increase in activity that the Health Service demands of us. Talking about a few percentage points is simply not realistic.
The sector has endured a 40% funding cut in real terms since 2014 . No other part of the Health Service has come anywhere near to this.
A few hundred million pounds will not solve this problem, and worse still the gap is only going to get worse unless we embrace radical reform of the outdated volume and margin based pharmacy contract.
We need to be careful that any “deal” offered (or more likely imposed) on the sector is not a further real terms funding cut because we simply will not survive further attrition of our funding.
Read more: IN FULL: CPE sets out April to July ‘timeframe’ to deliver new contract
Even if it causes more pain for us, and for our patients, CPE must not sign us up to a bad deal which will guarantee more pharmacies closing either through choice or more likely through necessity.
Sadik points to the fractured nature of the sector’s representation. He has a point but there is no easy answer to reconcile a sector as disparate as ours.
We want to work with Sadik and with the Government to deliver something radically different from the current framework: preventing long term conditions, stopping waste at source, deprescribing and ensuring that clinical activity is front and centre.
Dispensing is important, but it can’t be the only thing – 85% of our current contract is spent on volume related fees and margin.
We need a programme to bring all of the stakeholders together to find something that is sustainable for us and provides maximum benefits to patients and treasury alike. This will require bold leadership, and trust between all parties while working towards a longer-term vision. But this is impossible while we’re worrying about running out of cash.
To Labour MPs it might seem like we are being unrealistic about funding, but they’ve just found nearly £900m for General Practice which has not had anywhere near the level of funding attrition that we have.
Crucially the GPs were also able to remove a lot of the workload making it easier to deliver.
Read more: Just 13% of two-year Pharmacy First budget spent in 8 months
By comparison Community Pharmacists are being asked to put their hands into their own pockets to subsidise the supply of medicines to NHS patients, while dispensing volumes are going up. At the same time we’re mopping up 100,000s of patients who’ve been “dumped” on us informally by General Practice.
While I’m pleased for them that they have a funding deal sorted for next year, as we write we are less than three weeks away from the end of this year and we don’t yet have a funding agreement in place.
Our negotiations are always the last of the NHS cycle, by which time we are inevitably told that it is ‘too late to do anything for this year’.
By the same token, the next time the NHS will re-engage with the sector will be in January 2027 to deal with 2026/7 funding.
We have to ask why the Government is refusing to publish their own Economic Review of pharmacy funding
So our challenge to Sadik and his Labour colleagues is to increase the urgency. Publish the economic review now and begin an honest conversation with the sector about what is possible.
Graham Phillips and Mike Hewitson are pharmacy contractors in Hertfordshire and Dorset respectively