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Pharmacy still not viewed as part of 'NHS family', says Simon Dukes

Simon Dukes says thousands of pharmacies should be administering COVID-19 vaccines
Simon Dukes says thousands of pharmacies should be administering COVID-19 vaccines

Most community pharmacies have been excluded from the COVID-19 vaccine programme partly because the sector is not considered an NHS family member, says PSNC CEO Simon Dukes

Community pharmacies across England have been clamouring to help the nation administer COVID-19 vaccines. Pharmacy organisations have estimated that the sector could jointly administer at least one million vaccines a week, but NHS England and NHS Improvement (NHSE&I) has only committed to commissioning 200 out of more than 11,000 pharmacies to provide the service.

The underuse of pharmacy made national headlines earlier this month in a media wave sparked by The Telegraph publishing a front-page article featuring Simon Dukes, chief executive officer of the Pharmaceutical Negotiating Services Committee (PSNC), saying pharmacy’s efforts to get involved in the vaccine drive had been met with “silence”.

C+D spoke to Mr Dukes for a podcast about his frustrations with the situation, the progress that has been made with recognition from politicians, and the need for more funding to prevent further closures (article continued below).

 

The entry of pharmacies into the COVID-19 vaccination programme has been slow compared with other healthcare providers. Some 65 pharmacy-led hubs joined the national effort this week, following six pharmacies that went live last week.

On January 21, NHSE&I deputy chief pharmaceutical officer Dr Bruce Warner said: “After our successful launch in pharmacies last week, scores more sites are now offering the life-saving jab.

“As more vaccine supply comes online, we will be able to open even more helping us to vaccinate vulnerable people even faster.” But it is not clear when this will happen or how many pharmacies will eventually be involved in the service.

Mr Dukes says community pharmacy being largely overlooked for administering COVID-19 vaccines is due to it not being seen as a core part of the NHS. “It’s part of the wider, ongoing challenge that we as a sector face in trying to persuade officials, NHS and the Treasury, to see pharmacies not just as part of the NHS family – which the pharmacies see themselves as – but as a hugely valuable part of it,” he says.

“On the [pharmacy] front, you'll see people wearing NHS lanyards around their necks. Pharmacy teams regard themselves as part of that wider NHS family effort…I think it is desperately sad that we are not viewed as a sector in the same way by the NHS, as part of that NHS family.

“It does a disservice to every community pharmacy up and down the country when they're not seen in that light.”

The initially minor role of pharmacy in the COVID-19 vaccination programme was the latest in a long-standing history of the government snubbing the sector. Pharmacy professionals were disheartened by their treatment from the authorities in spring last year when the government failed to directly mention them as “key workers”.

“What more could we do?”

However, Mr Dukes hopes the sector’s role in the pandemic and its attempts to administer COVID-19 vaccinations might place it in better standing with the government in the future. “The praise and the thanks and the warm words and everything that we get from the public and from the politicians – that's fantastic.

“I want to see that turned into tangible financial support for pharmacies, because I think if it's not, the sector, quite rightly, will say: ‘Well, what more could we possibly do?’”

PSNC asked the government to waive the £370 million in advance payments of COVID-19 funding made last year, a request that the Department of Health and Social Care (DH) is “carefully considering”. The negotiator is also requesting that the government increase its annual funding of £2.592 billion, which is set to remain at this level until after 2023-24.

Further pharmacy closures are “inevitable” as a consequence of funding remaining at current levels, Mr Dukes says. Earlier this week, the PSNC chief revealed that more than 200 pharmacies in England had closed over the 12 months up to October last year. “How can that be right?” Mr Dukes asks.

There needs to be a sustainable increase in funding to stop pharmacies from losing money and to enable them to help the NHS long-term plan through improving health inequalities and supporting prevention, Mr Dukes says.  

Signs of progress?

Long-term funding will determine whether pharmacy is able to help in future pandemics. Mr Dukes has been frustrated by the sector’s absence from the COVID-19 vaccination programme, but says there are signs of hope that it could have more of a role in the wake of the media furore.

“We’ve seen a number of signs of progress, not just ministers and the Prime Minister expressing support for the sector, and its ability to play a role, but we’ve had meetings with ministers and the NHS. We are working out proposals as to how a wider programme might work and we look forward to discussing that with officials in the coming days.

Thousands of community pharmacies should be involved in this work, but it really is...ultimately for the NHS to decide.”

On January 6, Prime Minister Boris Johnson told parliament how “a vital role can be played by pharmacies” alongside GPs, hospitals and the army. The next day, health secretary Matt Hancock acknowledged how pharmacies could help spread vaccine access to all corners of the country. But these words have not yet led to substantive action.

Community pharmacy contractors have told PSNC they want to play a part, Mr Dukes says. “The Prime Minister has set an ambitious target for vaccinations…and therefore it really is ‘all hands to the pump’. You've got a network of [approximately] 11,400 pharmacies across England, each one, pretty much, containing a clinician who is able to provide vaccines, so why aren't we using them?

“During the course of the interviews that I've done on this topic, both politicians and indeed media commentators have said words to the effect of ‘well, this is a no brainer, why aren't we using pharmacy?’ And I would have to agree with them.”

Throughout the pandemic, pharmacy has been repeatedly disappointed by its treatment by the government. Mr Dukes makes clear that the cost of the government continuing to ignore the sector’s pleas for funding will be further closures

And ultimately, “it'll be patients that suffer” as a result, he says.

Listen to the full interview below.

14 Comments
Question: 
Do you feel part of the NHS?

Shilla Shah, Superintendent Pharmacist

 

Pharmacies forced to operate at loss after government CUTS £321million- back in 2017. 340 million is owed to pharmacy 

Chris Pharmacist, Community pharmacist

A lot of decision makers do not like the idea of companies such as Boots and Tesco profiteering from administering Covid vaccines. They prefer to keep it in-house and away from the private sector...

I don't take it personally, its just the way it is. They'll change their minds when they need to. I doubt the government will make these vaccination centres permanent but its likely vaccination will be an on-going annual process. GP surgeries will not be able to cope alone.

Saj Raja, Primary care pharmacist

Pharmacy is more a part of the NHS now than it has ever been, let's not be so negative.

Pharma Tron , Community pharmacist

In the context of pound signs, the only difference between us and the GP contractors is (crudely put) the fact that we don't get an NHS pension scheme. CP has been brilliant value for the taxpayer through category M alone, let alone the fact that superannuation isn't in our lexicon therefore we don't command multi-million pound pension pots until the day we die. Self-sufficient, value adding profession let down by our legacy negotiators being unable to move away from where we are still today, fifteen years on from the new contract- this in part has a lot to do with the lack of evidence base such as QOF, built up over the years because GPs are great at proving what they do. That said, if our new voice with Dukes riding the crest of a huge opportunity in COVID to prove value isn't heard at DoH and NHSEI, what else can we do? The writing was on the wall for us because of a beaurocratic chief pharmacist trying to prove his PhD, coupled with a disgusting secondary care pomp that has plagued us for years. Who knows what the answer is, but something is happening somewhere in the media- time to capitalise on this. Good luck Simon, all eyes are on you.

Emma Harrison, Pharmacy owner/ Proprietor

Simon Dukes has been in charge of PSNC for some years now but not much has been achieved really. I won't be keeping my hopes up. Everything outlined here about what NHSEI and DoH think of pharmacy were known to us already so not sure why people are reacting like it is news. We should instead demand change and hold those like Dukes to account to deliver. We are paying him a good salary. 

Angela Channing, Community pharmacist

And has Mr Dukes even considered the work force issues in us providing X vaccines per day? Along with the storage requirements of minus 70 degrees if the Pfizer vaccine is used, along with the size of most pharmacies meaning elderly people would have to wait in long queues outside in 3 degree weather. Perhaps he could explain those points to the NHS. It is all very well saying we can do this, but has he even considered those basic practicalities. These are the reasons we are overlooked.

Meera Sharma, Pharmacy owner/ Proprietor

I think the focus is on AZ/Oxford vaccine 

 

Paul Dishman, Pharmaceutical Adviser

Pharmacists are ignored because of the indifferent attitude of senior civil service pharmacists and looked down upon as shopkeepers by NHS bureaucrats.

Caroline Jones, Locum pharmacist

Don't take this the wrong way, but I love you MR Dukes. You are so on point and not afraid to tell the NHS, press and policy makers so. You have clearly done your homework and are being well informed and advised. This must be such a shock to them after the flaccid performances by Sharpe, Ridge and Rudkin which have allowed the NHS to exclude us or use us as a cheap dumping ground for all the services the GPs et al don't want to bother with. Keep up the good work mate and give them both barrels. The rank and file of hard working pharmacists are right up there with you.

Emma Harrison, Pharmacy owner/ Proprietor

speak for yourself. You clearly know very little to be so easily enthused by those who talk the talk but don't walk the walk. 

MrR Patel, Community pharmacist

Since you clearly love what he says, can you please articulate what he has actually achieved except for wise words? This is the sad thing with our profession, someone comes in and says what we want to hear and we fall in love with them instead of holding them to account! Sad!

 

Dave Downham, Manager

Sanitation, medicine, education, wine, public order, irrigation, roads, a fresh water system, and public health...

Meera Sharma, Pharmacy owner/ Proprietor

Are you an independent pharmacy contractor who is working their socks off to keep their head above the water, to keep the business going and ensure the staff are paid on time? Try that and see if you still love him!!

Kevin Western, Community pharmacist

The only thing I'd say is we now need another round of publicity, only this time not so polite and taking the NHS to task, naming names - you must know them and asking why they won't admit they are wrong.
Put it out there in public about the 370 million and the lies and half truths spouted by politicians...make them sweat! The GPs would be in this situation

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