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DH froze funding on belief there are still too many pharmacies

DH: Funding is still supporting more pharmacies than necessary in some parts of England
DH: Funding is still supporting more pharmacies than necessary in some parts of England

The DH froze the sector's funding for a further five years based on the belief there are still too many pharmacies in England, it said in a document containing the contract.

The contract for England was unveiled on Monday (July 22), with the annual global sum remaining at its reduced level of £2.592 billion for the next five years, and medicines use reviews (MURs) phased out in favour of new clinical services.

In a document containing the contract, the Department of Health and Social Care (DH) claimed that funding “is still supporting more pharmacies in some places than may be necessary to ensure good access to NHS pharmaceutical services”.

DH’s view on “clusters” unchanged

In a list of frequently asked questions published alongside the funding contract, the Pharmaceutical Services Negotiating Committee (PSNC) said the “government’s view on pharmacy clusters remains unchanged”.

The DH used the term “clustering” to justify the 12% cut to pharmacy funding in England in 2016, claiming that “40% of pharmacies are in a cluster where there are three or more pharmacies within 10 minutes’ walk”.

Since then, PSNC estimates there have been 233 confirmed pharmacy closures – with hundreds more expected.

“Whether a pharmacy closes or not is a business decision…and the government and the NHS have not been prepared to discuss their ambitions or expectations for pharmacy numbers as part of these negotiations,” PSNC explained on Monday.

Make merging “commercially beneficial”

The DH also suggested that merging pharmacies could make financial sense for some contractors and proposed amending regulations to “strengthen the protections offered to pharmacies wishing to consolidate”.

“It is recognised that some pharmacy contractors, particularly those with other branches of their own or a competitor’s pharmacy closely located, could consider it commercially beneficial to consolidate,” it explained.

To achieve this, the DH will “look to remove any unnecessary administrative requirements…for example, looking at current prescription endorsing requirements to examine whether these could be simplified and ceasing routine opening hours”.

It is also looking to make “administrative improvements” to the Drug Tariff and update some of the “approved particulars” in the contract.

In a briefing with journalists on Monday, PSNC director of operations and support Gordon Hockey said the proposed regulation change is to protect patient access to pharmacy services and make consolidations “more appealing to contractors”.

19 Comments
Question: 
Have any pharmacies closed in your area recently?

Watto 59, Community pharmacist

The PSNC webinar attempts to put a gloss on this deal but it comes across as endorsement of the DoH.  There is little detail on how many hoops will have to be jumped through to provide and administer the extra sevices which have to be funded through an already seriously overstreched and under invested pharmaceutical service. 

Independents do not have the luxury of head office departments to churn through a morass of service provison specifications so this looks seriously onerous to comply with. The future for medium and smaller volume contractors is bleak .

PSNC have indicated they were close to walking away... which is what they should have done.  They  should then and now be talking to contractors (especially the multiples) in an attempt to organise a concerted response in protest against DoH tyranny.  The PSNC response intentional or not almost looks like enthusiasm for  the DoH and government's psotion.. 

Chris Pharmacist, Community pharmacist

Perhaps the govt should withdraw NHS contracts to pharmacies they perceive as unnecessary. Or is that too simple because the multinationals will simply cut staffing yet again to maintain profit margins with busy pharmacies becoming even more overburdened and unsafe.

Chris Locum, Locum pharmacist

Community pharmacy is like Theresa May. Neither had the cojones to say "no deal." When the opposition smells weakness, they trample over your position. There will be no turning back. Tax avoiding pan-European operations will eventually be the only operators. While there is every advantage in knowing the next five years of financial return, it does not translate into any particular gain. It is a pay cut in the face of rising workload (against a long-running out-of-stocks over several years) and frustrated patients venting on staff. Pharmacy ministers regurgitate the same speech with empty platitudes.

Charles Whitfield Bott, Pharmacist Director

I may be missing something, but reduced numbers does not reduce DoH costs. Global sum remains the same and there is no practice payment any longer.

Consolidation = efficiency savings = excuse to reduce funding going forward ??

Were will the PDSA cycle end?

Reminds me of the mangment saying "How do you eat an elephant? Bit at a time" Pharmacy = elephant (white one if you are the DoH)

Mark Boland, Pharmaceutical Adviser

'I may be missing something, but reduced numbers does not reduce DoH costs. Global sum remains the same and there is no practice payment any longer'

The global sum remaining the same is a funding cut in real terms. Equivalent spending in the NHS has increased. The theory is as follows:

1) Inefficient low volume 'high street' pharmacies will go under

2) The remaining pharmacies will gain volume

3) The additional volume will be additional profit because the work will be completed without additional costs (staff etc) through more efficient work practices

4) This process continues until a much smaller number of efficient pharmacies are able to maintain net profit with real terms funding cuts

5) They (government ministers) envisage these remaining pharmacies as highly automated and vertically integrated collection stations that will maximise economy of scale and minimise human costs

6) History will not distinguish between the useful idiots in community pharmacy who believed the 'bright clinical future' and those with a brain cell who did not

 

Ranjeev Patel, Non Pharmacist Branch Manager

The cost of everything I buy goes up rapidly. My hairdresser has put his prices up by 1.50 in the lasy year alone. Fish and chips now costs me over 7 quid. A short taxi ride is 12 pounds. It's disgraceful that pharmacists, a once respected profession, are now being sold down the river and being forced to absorb cuts whilst the bosses of various multi national conglomerates sail around the Med in their yachts.

Even more galling is seeing well-paid desk jockeys patting themselves on the back for agreeing to what is essentially a pay cut for pharmacists in real terms, when most contractors are already at the limits of what they can do financially. They don't care about pharmacies and their staff, they just want that bonus and pay rise at the end of the year which is practically guaranteed when a pharmacist couldn't dream of such things. It's the patients who are going to suffer.

Mark Boland, Pharmaceutical Adviser

'The cost of everything I buy goes up rapidly. My hairdresser has put his prices up by 1.50 in the lasy year alone. Fish and chips now costs me over 7 quid'

People need and want to have their hair cut, they dont need or want an MUR, quite the opposite in fact. When MURs are finally gone, do you think a single customer will care or even notice?

You can ask for more money when you are offering something people want or need as a basic essential. The 2005 contract sealed the fate of community pharmacy when it took away money from the 'supply' that people needed and then offered it back through 'services' that nobody wanted.

The community pharmacists who saw through this slight of hand were shouted down at the time - by other community pharmacists. They were the 'clinical visionaries', we were the luddites. French and German pharmacists, much more astute than their UK counterparts, fought strongly to protect their essential supply function and safeguarded their profession for future generations.

Lucky Ex-Locum, Superintendent Pharmacist

'You can ask for more money when you are offering something people want or need as a basic essential.'

I think you'll find we already are. Try being a pharmacist instead of a worthless advisor then you might understand what we actually DO and the value we bring to the community.

C A, Community pharmacist

DH “It is recognised that some pharmacy contractors... with a competitor’s pharmacy closely located, could consider it commercially beneficial to consolidate” 

Pharmacy - You What?!? 

Tired Manager, Community pharmacist

There are 3 Boots, 2 Well, a rowlands and a Superdrug on my local high street all within walking distance of each other. I take the DH’s point but surely we just need to introduce a competition-related clause that states no contractor may have multiple pharmacies within a certain radius ... sayyy 2-3 miles? This idea of “merging” could then be targeted at the problem rather than causing suffering for all.

Reeyah H, Community pharmacist

I must immediately contact my neighbouring contractor and merge. Apparently this will be made easy as we don’t have to endorse prescriptions like before. It doesn’t make sense does it?! This useful and valuable information has been taken from the article! 

John Willetts, Locum pharmacist

So the cat is now out of the bag. As you didn't get the message before, we will now employ the tool of finanacial attrition to ensure that you fold your tent. As the toothless dog [Poodles Secure Nothing for Chemists] has ensured an effective 5 yr  pay cut (inflation erodes the 0% pay rise) it shdn't be long before a stream of pharmacies seek to close.. But who wd buy them? And at what price if they all want to sell simultaneously? What happens to the pharmacists now looking for work? The current shortage will soon become an oversupply, with an inevitable reduction in pay. And for this lesser pay, you will have to study twice as hard and long to provide the, as yet, unknown and lengthening list of services. Good Game huh?

Reeyah H, Community pharmacist

The rude awakening : when the ones who put this in place are in their 80s and have no one to turn to apart from an automated response. 

Brent Cutler, Manager

The DH are naive thinking that cuts alone will reduce pharmacy numbers.

It was the DH that allowed many of these pharmacies to exist in the first place with their ill conceived 100 hour rule, most likely as a result of lobbying from major supermarkets whose only interest is store footfall and not public health.

Community pharmacies are really suffering, many have been around for 30-40 years providing a lifeline to communities and the DH are threatening their very existence because of their own failed policies.

The sad thing is that there isn’t a single body representing pharmacy that have the balls to do anything about it.

When the DH realise that we don’t have enough pharmacies to provide the services needed they will then do a U turn just like they did with doctors in the 90’s, we still have a shortage of doctors today 30 years on.

Reeyah H, Community pharmacist

Last in, first 100. Bye bye 100 hours. 

Lucky Ex-Locum, Superintendent Pharmacist

Trouble is, the 100 hour contractors also tend to come with convenient parking, late opening (obviously) and fit in with modern lifestyles, however bad we think they are. Those are the ones that will survive and the good old high street chemist will die because it can't survive on the housebound pensioners (who can't go anywhere else) alone. 100 hour contractors (i.e. supermarkets) have taken the cream and left everyone else with the non-profitable but essential bits which are left, like deliveries and MDS. The result of all this will be that the people who have the greatest need of our services will become the least able to access them.

Ranjeev Patel, Non Pharmacist Branch Manager

What?

N patel , Non Pharmacist Branch Manager

DEAR ALL,,,,, NEXT TIME A MINISTER OR  THEIR FLUNKIES TELL YOU THAT PHARMACY IS A VALUABLE UNDERUTILISED RESOURCE THAT THE NHS CAN TAP INTO..PLEASE SHOW THEM TIHS ARTICLE.... THE BARE TRUTH IS THAT ALL IT IS ABOUT NOW IS HOW MUCH MONEY THEY CAN SAVE NOT ABOUT SWEET MEANINGLESS WORDS THAT OUR GULLABLE NAIVE AND FRANKLY FINANCIALLY ILLITERATE NEGOTIATORS AND LPC BOARDS FALL  FOR AND ARE FLATTERED BY TIME AND TIME AGAIN

Lucky Ex-Locum, Superintendent Pharmacist

Personally I'm more inclined to show them my middle finger.....oh, and please stop shouting....

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