The announcement of almost 200 Lloydspharmacy closures, an average 13% drop in income for four in five contractors in England, and dispensing drugs at a loss because of delayed or inadequate price concessions – for many in community pharmacy, 2017 was an extremely tough year.
Will the sector fare any better this year? There may be potential causes for optimism. C+D's Salary Survey 2017 found that average UK locum pay rates have increased very slightly for the first time in a decade. Early this year, parliament looks set to pass long-awaited legislation to create a legal defence for inadvertent dispensing errors. And top of the agenda for Simon Dukes – set to take over from Sue Sharpe as Pharmaceutical Services Negotiating Committee (PSNC) chief executive in May – will be to improve relations between England's pharmacy negotiator and the Department of Health (DH).
So how hopeful should community pharmacists dare to be in 2018? We’ve asked key pharmacy and political figures for their predictions for the next year – and how they think the sector will adapt.
Click on each of the four tabs below to read our panel's thoughts.
Julie Cooper, shadow minister for community health
“The biggest challenge is communicating the sector's full potential to government”
All parts of the NHS are experiencing increased demand and community pharmacy is no exception. Coping with this demand with a vastly reduced budget will be a big challenge, but perhaps the biggest challenge lies in communicating an understanding of the full potential of the sector to this government.
Cuts to the global sum alone have dealt a massive blow to the sustainability of community pharmacies [in England]. Add to this the recent issue of the reimbursement of [drug] costs that exceed the drug tariff and it is clear that community pharmacies are at risk. Some will inevitably close, and others will reduce their services. This will have a negative impact on communities, and place additional pressures on other parts of the NHS.
But I believe community pharmacists will do their best to rise to the challenge. They will endeavour to protect patient services wherever possible, and minimise the impact of the budget cuts. Community pharmacists have demonstrated their desire to work with the government, and have repeatedly offered to extend the range and scope of their services. If the government were willing to meet with pharmacy professional bodies to discuss new and extended roles for community pharmacy, there would be the potential to both reduce overall NHS expenditure and improve the patient experience.
Salim Jetha, CEO of pharmacy support group Avicenna
“More cutbacks will have to be implemented”
From a patient’s perspective, continuing shortages and rationing of drugs will cause lots of anxiety. Drug shortages and commodity prices, driven by the weaker pound, will drive up prices – which will impact the NHS budget. To balance the budget, more cutbacks will have to be implemented, which could adversely affect the patient.
On the pharmacy front, the cuts will threaten the viability of some pharmacies in England. In the first instance, they will react by reducing costs: such as staff and delivery services, and by reviewing non-profitable services such as smoking cessation, health checks, and warfarin clinics.
In the areas where community pharmacies are forced to close, this will have a profound effect, causing a reduction in accessibility, choice and specialised services. Independent pharmacies will have to work longer hours just to keep business limping along.
However there is hope. Pharmacy services are much cheaper to operate than that of other professions and offer greater accessibility. But services will need to be properly funded to ensure their longevity. It will take great courage for decision-makers to make better use of pharmacists.
Paul Day, director of the Pharmacists’ Defence Association Union
“Community pharmacy must settle its internal arguments”
The work on decriminalisation [of inadvertent dispensing errors] that we saw in 2017 was welcome, but it was merely work in progress – as it has left intact sections of medicines legislation that still mean there is the prospect of a criminal prosecution for pharmacists in the event of a dispensing error. So we will be pushing for more action in 2018.
We welcome general practice-based roles for pharmacists in 2018, and we hope that NHS England can make these roles more integrated within the secondary, primary care and community pharmacy network.
But in 2018, community pharmacy must finally settle the argument between those who want to shift large quantities of medicines and maintain a consumer-supplier relationship with customers in a retail outlet, and those who want to develop a healthcare professional-patient relationship based on pharmaceutical care.
We don’t want to see pharmacies running in the absence of pharmacists, hub-and-spoke dispensing, further cuts to government funding, or pharmacy closures. This is why community pharmacists must develop clinical relationships with their patients based upon pharmaceutical care, public health and population health management.
John D’Arcy, managing director of pharmacy support group Numark
“We need a proper strategy for pharmacy’s contribution”
Community pharmacists in England will be glad to see the back of 2017 – when a war of financial attrition affected the sector.
We know the NHS is bursting at the seams. As demand for services outstrips supply, the case for investing in community pharmacy has never been more compelling. But, rather than making this investment, the government in England prefers instead to persevere with their poor understanding of the potential of community pharmacy, and to adopt a cynical and ill-conceived view of pharmacists as inefficient box shifters.
We need a proper strategy for pharmacy’s contribution, and a funding model that encourages some certainty. In England, there is clearly a large amount of work still needed to get our message across – something that is not helped by the fact that the DH and PSNC are not speaking to each other. I hope that 2018 will see a change in attitude to pharmacy – and the appointment of a new CEO at the negotiator may help with this.
In mapping out the future, we could do well to follow the lead adopted by Scotland, where a much closer partnership between community pharmacy and the Scottish government (and a much more supportive chief pharmacist) has resulted in a national pharmacy contract.