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Insider's view: Pharmacy minister's funding meeting

Paula Sherriff: There was no negotiation

Labour MP Paula Sherriff tells C+D reporter Annabelle Collins what really happened at the government's meeting on funding cuts

Labour MP Paula Sherriff was in the room when pharmacy minister Alistair Burt admitted up to a quarter of pharmacies could close because of planned funding cuts.

Mr Burt made the comments to the all-party pharmacy group (APPG) on January 13. APPG treasurer Ms Sherriff told C+D what really happened at a meeting the Department of Health described as private and confidential...

“When we met Mr Burt there was no negotiation over what the cuts would be. I asked how they had [decided on] the level of cuts, and Mr Burt said the Treasury told him, ‘you have to make some cuts’, so he negotiated what they would be. I think [he was] reasonably comfortable with the figure they reached. 

“We talked about the impact, but it felt like a done deal. We had a good go at challenging it, but there was no negotiation. [Department of Health official] Jeannette Howe was clearly leading the conversation about how this would play out.

“I don’t think any of these cuts necessarily add up and I don’t think [the detail] has been considered – that is what concerns me.

"I asked a question about how many pharmacy closures this will equate to, and they were very ambiguous about [exactly] how many – between 1,000 and 3,000. This concerns me.

"It is almost like [the government] will make the cuts and then think about what that means [afterwards].”

 


What do you think about the government's attitude to pharmacy?

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46 Comments

Pupinder Ghatora, Pharmacy owner/ Proprietor

Same sh*t different day!!!!!!

Jonny Johal, Pharmacy Area manager/ Operations Manager

.

Anne Glover, Accuracy checking technician

What a suprise.... they are execting pharmacist to take on more and more responibilities to help with patients medical needs yet once again we are the poor relations in the NHS world. However why worry as there our professional body does not seem to fight for us in any shape or form and the pressure keeps on building. How can any pharmacy carry on providing all the services they do without the appropriate funding.

Tariq Iqbal, Accuracy checking technician

DOH have nothing better than to think they know it all. Sitting on their rear end. The DOH - Bury your head in the sand 

Farm Assistant, Community pharmacist

I recently watched a documentary featuring a prostate operation carried out by the surgeon using a robot. What was even more interesting was that the operator could have been anywhere in the world. It makes dispensing a sealed pack of tablets pale into insignificance. Lets face it pharmacists are on the way out just like gas light bulbs. It will be technology that kills us off although all the other usual idiots have helped the process. So as I have said before, if you are a pharmacy student GET OUT NOW.

Marc Borson, Community pharmacist

There is not much we can do, the sad thing is that the internet in the US is now demonstrating  that it is more cost effective to open up bricks and mortar premises. Business rents and rates have frozen for several years and the cost of e marketing is very high which ;eaves a very damaging effect on profitabilty. If you keep current, you will note that even Amazon has begun to launch bricks and mortar stores.

The amazon instant programme now offers delivery of select item within the hour in major cities, Including London and Manchester. In order to facilitate this Amazon have adopted a decentralsied distribution model now. The decentalised model puts a quantum of top selling SKUs within city based warehouses on good transport links. 

It is likely that they will merge there decentralised distance selling shipping depots into guess what- wait for it, its totally original- its killer.

Amazon call it Social Hybridised Operational Places, for short SHOPs. Yes Amazon are going to open shops conveniently located in towns and cities across the UK. In these SHOPs people will be able to actually "go-in." Once IN the SHOP they will be able to touch items, see them work and actually speak to someone straight away. If they decide to buy they can negotiate a better price instantly and purchase the product using paper or metal money they saved in a "Piggy Bank". A Piggy Bank is a novel idea created by a group of young high tech entrepeneurs that realised that there is now nowhere to store real money or "cash."

As part of their creative downtime they decided to take up clay modelling and one of the geniuses shaped and painted a pink animal shaped object. The object looked extremely like a PIG. The clever thing was that he placed a long slit like opening in the top just big enough to be used to slide coins and paper notes in the hollow animal, but enough allow some to put his fingers in to retireve the cash. The Pottery was glazed and baked. Once the Pig was cooled the group realised the real the genius of their invention. It had no way of getting the money out. Therefore inorder to make best use of the pot people will fill it to the top and then break it to reveal their savings. Without realising it the group had created the first single use micro bank for non digital currency (sumbnondic). The sumbnondic micro bank is now looking for crowd sourced finding and it is hoped it will end poverty for millions of familes around the world that spend billions of dollars or pounds on digital material they never use. CTO Keith Ridge said " finally hard working families will be be able to save money in their own home without the need of a bank. It could bring billions out of poverty. A bit like the internet did 20 years ago. There have been a lot of enquires from around the world particulary from Governments. In the UK they are thinking of some how applying this novel technology to the distribution of vital medicines." CFO Mr Cavendish said for a long time just two mega corportaions have had the monopoly on the distribution of drugs to patients in the UK, they are too big to fail and they keep demanding the UK governemnt pay more and more for dispensing each item. The Dispensing fee is now £150.00 per item. It is hoped that these new pottery Piggy Banks could bring an end to the monopoly's dominace and allow a much more a diversified and competitive community based network located throughout the UK with immediate access to 99% of the population."

 

Ebers Papyrus, Pharmaceutical Adviser

Pharmacists have been saying we're doomed since time began. One thing that's certain is the profession is very resilient and some of us view things more optimistically than others in spite of the ridiculous stance taken by government. For those who haven't seen the NPA webinar then I suggest you listen to it for a more rounded view of current events. Ian Strachan and the whole team inspire hope and it's clear significant work is being done. It's clear that pharmacy groups that have rarely engaged with each other are now doing so. There are discussions surrounding the legality of the cuts and other proposals and also the mechanism by which a strike could take place. Not everyone views 'Hub and Spoke' as a peril to the network or profession either, it could signicantly improve the working environment. These are challenging times for Pharmacy, however the idea that we are approaching the apocalypse is one that I find hysterical.

M Yang, Community pharmacist

David Reissner actually suggested that strike action may be illegal for contractors, from a technical point of view it would contravene their contract with the NHS. However, I've commented previously in another article that contractors do reserve the right to close their pharmacy with prior notification to their health board. With this in mind, a day of unrelated closures due to "unforeseen circumstances" could bypass the need to officially call it a strike. In a strange turn of events, employee pharmacists (the ones with least power within the profession) are easiest to rally as a high percentage are PDA members but this would depend on overwhleming commitment to a coordinated day of action, otherwise a piecemeal effort would quickly succcumb to retaliation against small groups of individuals.

Hadi Al-Bayati, Locum pharmacist

Shaun is right. Public don't "like" corporations but in the modern first world, convenience is everything.
Regarding MUR's, everyone knows how many are done to satisfy middle and boardroom management and how many are done for patient benefit. I like the idea of scaling them to script items.

It is clear there are too many pharmacies and lots are not needed. How many 100hr opened up next to a standard hrs pharmacy?? How many of those 100hr do 4-5000 items so they get all the practice payments but aren't making a lot of money, if any at all? The government should look at buying some out. Lots of these contractors may accept 200-250k for a failing 100hr pharmacy and over a 10year term the NHS saves money. Then the remaining pharmacy could increase hours to make a 70-80hr pharmacy. That's a more strategic way to cut rather than blanket cut everyone. I'm sure I mentioned the UK just got a deposit from Google, maybe they could use that...

On a side note who exactly is the UK government in debt to??

Shaun Steren, Pharmaceutical Adviser

We have a growth problem. Our debt to GDP ratio will improve by increasing the GDP, not by buying back debt. We have a growth problem in our country because our productivity is awful and has been for decades. Is community pharmacy highly productive? I would argue not. Individual contractors make claim for high levels of productivity on this site and others, 'we are good value' is a common evaluation. Maybe they are, they may well be doing things very differently to the multiples that I have experience of.................Do MURs and NMS save money for the NHS in the long run? There is no published evidence for this, quite the opposite in fact. From my experience they are tick box events carried out by employee pharmacists looking to avoid disciplinary action. Furthermore, pharmacists were already making the same level of clinical intervention before the advent of services, just in a more targeted and less bureaucratic way. So whatever the case, they certainly don't make community pharmacy more productive or 'better value'.....................The information technology in community pharmacy can only be described as primitive. The PMR systems are antiquated and make no use of valuable patient data. The use of checking technology to improve checking speed and accuracy is completely absent. So, information technology, one of the most powerful ways to improve productivity, is grossly deficient in community pharmacy.....................Finally, the general operation of a typical dispensary can only be described as chaotic. Most dispensaries are not built for purpose and are kept in a manner one could only describe as a bomb site. As a locum, each location brings a different form of confusion that has to be navigated, not understood................... So, we are left with the people. It has been my experience that pharmacists and their staff work very hard. It is also quite obvious they take their responsibility to the patient very seriously. However, one often wonders if the pharmacist is actually the person in charge of some dispensaries and this lack of authority appears to be the origin of some of the chaos. Overall, I have been impressed by the people I have worked with................. So in my evaluation community pharmacy consists of competent, hard working and well meaning people who do work in the interest of the patient. The personal touch is hard, if not impossible to measure, and I would not discount its importance nor ubiquity for one moment. Indeed, instant access and human contact may well be the biggest strength of community pharmacy. But I don't accept the good value claim. The people who work in community pharmacy have their expertise, hard work and customer focus wasted following pointless government plans and commercial targets whose sole purpose is to maximise profit. They operate with a chaos that only a monopoly could produce. So we have chaotic means to achieve pointless, but profitable, ends. If we had channeled all this expertise, hard work and patient care through a culture of intelligence, innovation, pragmatism and openness, we would operate in way unrecognisable to the way we operate today. We were led to where we are today by government bureaucrats and corporate spivs, and if you look at who has benefited, one has to wonder whether it was done with a degree of purpose. 

We’re all doomed, Locum pharmacist

I wonder....if the treatment to remove pharmacy profits from dispensing which appears to be the core of this will be similarly meted out to dispensing doctors? They certainly won't take it lying down! 

Furthermore the removal of establishment payments to 4000 Boots and Lloyds pharmacies, will this finally be the time when they too start to support the profession rather than than their own self centred off shore profit agenda? That's a lot of money off the bottom line, or have they been co-conspirators with the DoH and PWC for the remodelling to strengthen their causes? 

Relieved I'm not at the start of my pharmacy career, 33 years and I'm out thankfully. 

I've said for many a year there is no 'N' in PSNC, sadly disunited we stand and thus easily exploited. That said this government also appear to be hell bent on breaking the medics too! 

 

Graham Stretch, Primary care pharmacist

Remembering back to the OFT enquiry into control of entry, our pharmacy probably got 50 or more patients to write into their MP, I met the MP some months later and he said his mailbag from the OFT debacle dwarfed the letters he had received about the Iraq war.

The DoH may have decided already but we mustn't take this lying down or we will get further cuts down the line. At least let us make this an issue they can't simply ram through without some debate and due consideration.

 

 

Altaf Vaiya,

If the treasury have negotiated with Mr Burt that a funding cut has to be made and have indicated that a proportion of pharmacies will close… we should take that as the treasury have some indication that these current funding cuts and most probably the ones that will follow in the next few years will make a direct impact.

The Treasury have previously worked on the infamous ‘Cost of Service Inquiry for Community Pharmacy’ the disclaimer in the report stated ‘This Report has been prepared by PricewaterhouseCoopers LLP solely on the instructions of its client, the Department of Health (DH), and with only the DH’s interests in mind.’ The information analysed from this report has allowed the treasury to know how much funding needs to be cut to cause closures. The only part they cannot ascertain is how much actual funds pharmacy owners have and how much individual contractors can manage their business/operating costs with the decrease in funds. In the end this will lead to all pharmacies being more competitive, fighting against each other to survive, which is not good for the profession and in the process pharmacist will have to deliver a lot more for a lot less making them less profitable. This is why I believe the figure of 1000-3000 closures has been mentioned.

 I agree with some of the other readers that NMS and MUR services are sometimes costly services and do not always have the intended impact. However the way that the contract has been written many years ago pharmacy had no choice but to deliver on this because there are no actual costs in doing MUR’S for most it is 100 percent profitable service for businesses. In our region in the midlands, it has been stated that pharmacies are doing on average about 200ish MUR’s so there is a few million pounds of money that is allocated for this service in our region but does not get used fully. I think the PSNC need to raise this issue because I agree some of the funding cost money could come from better structured concept of MUR’S & NMS without having targets and top caps to reach, it makes no sense that a pharmacy doing 10,000 items a month items only gets to do 400 MUR’S a year and a pharmacy doing 1,500 items a month has the same top limit. A new structure that makes more sense and allows for genuine consultations to support patients with thier medication needs to be developed, a system that will allow pharmacists to feed into the GP system the information we gather to make use of the concerns we have during our consultations with the patient.

Even today (30th January 2016) we are seeing in the news that hospitals are inundated with patients that are being referred by 111, patients are turing up to A&E with common minor ailment issues that patients would normally visit the GP for but because GP surgeries don’t have appointments they are ending up at the hospitals. The government including our pharmacy minister need to look at how the skills of pharmacists could help deal with the over flow GP’S are facing and look at how they can upskill community pharmacists to help support the NHS deliver the five year forward view. If they are going to take reduce our funding they need to reinvest some of that money to support members of our profession.

Our profession needs to stay united and even if you are locum pharmacist, pharmacist manager, business owner or a member of cooperate multiple. Funding costs will impact on every field of community pharmacy and will have an impact on many people’s livelihoods. Let’s stay united and support each other and not over speculate on funding cuts until we get a clear picture otherwise our emotions will speak and will delude the forward thinking we need. 

Shaun Steren, Pharmaceutical Adviser

Sorry, but the difference between what ought to be the case and what is the case should not  be confused. You can make whatever case you want for why you think independents ought to survive, but I suggest none of those factors will actually influence whether they will survive. We need to dispel the myth of a 'discerning general public'. If you compare the  actual behaviour of consumers (sales) to how consumers describe their own consumption, the two things don't match up........ The public at large always describes the loss of independent bookshops as unfair, but they nearly exclusively buy their books from Amazon. It is well known by bricks and mortar retail businesses  that people come into their shop to see the physical product and then leave and buy the very same product online. The public decry the loss of butchers, fishmongers, bakers etc but they themselves give their business to the supermarkets. Yes, coffee chains have avoided tax, but even in the light of this, who do the public give their business to - the independent coffee shop or the chains? The retail data shows overwhelmingly the chains. It never fails to amuse me to see the irony of a protest to ban a coffee chain opening in a small town - if nobody wants it, surely nobody will go in. Of course they do go in, producing the further irony of how they ought to have protested against themselves and their own uncontrollable desire for big business. Following the patient data scandal at pharmacy2U, patient recruitment went up! I am very sure they will recover and rapidly expand post-latest screw up..............Amazon is growing at a gargantuant rate and its founder aims to sell everything that a consumer could ever want. The data shows the public are hopelessly in love with Amazon, they love the prices, they love the laziness of the click and buy dynamic and they love the comfort and assurance of shopping with a leviathan business. If they could make it economically viable, the British public would follow Amazon with their prescriptions at the drop of a hat. The British people, like their American cousins,  love their big business.   

Brian Austen, Senior Management

Shaun, I agree with you 100% about the publics attitude. I would add that the government attitude to pharmacy will be the same as it was to the post office network; they don't give a damn!

Shaun Steren, Pharmaceutical Adviser

Brian, quite correct , a neoliberal government such as this was always going to see community pharmacy as an anachronism that had been allowed to slip through the net. For the last 10 years, pessimistic community pharmacists have been proven to be right in nearly every prediction they have made. The optimists have been proven wrong in nearly every prediction they have made. At every juncture where another positive prediction was falsified, the optimists avoided debate and continued on as if nothing had happened. Amongst the pessimists this created a split: did you think the optimists genuinely believed what they were saying and so should be considered credulous or did you believe they were being disingenuous, saying whatever they thought would personally benefit them. In this context, the pessimists, apart from being vindicated, feel a strange sense of relief that the charade of the last 10 years has finally been brought to an end and the truth, however brutal, has finally arrived. 

Gerry Diamond, Primary care pharmacist

That NHS consultation on the NHS plan which just mentioned pharmacy as a parentheisis and there was a kick off as there was meetings organised up and down England. Turned out to be a pointless exercise as I had pointed out and it appears to be the government could not give a toss about community pharmacy.

The pharmacists who have wasted time and effort doing a post grad diploma in community pharmacy, or public health when in effect community pharmacy will be desimated and the public health budget delivered by town halls now competes with pot holes and elderly care for cash.

A complete hash of a job if there ever was one!

 

Ebers Papyrus, Pharmaceutical Adviser

I have to say that is pretty cynical and glass half full/completely empty. The Amazon model works in some respects but there is ZERO immediacy, it can't cater for emergencies and the need to supply there and then. People buy pharmacy medicines and collect antibiotics because they need them at that point, there and then. The model doesn't work in many cases, imagine developing hayfever and ordering an antihistamine online and then having to wait a few days before it shows up, if at all. For that reason alone local access to pharmacy medicines and pharmacy advice will have to be retained. If it is to be retained big brother has to pay for it and make it viable. As I've said before this will end up costing Her Majesty's Government more in the long run, it's robbing Peter to pay Paul.

Shaun Steren, Pharmaceutical Adviser

With respect, 'if it were viable' was within a paragraph that was not discussing actual viability, but one whose point was to illustrate and contrast the actual preference and behaviour of the British public against their self-claimed preference and behaviour. The British public falsely signal virtue with regards to their support of small business, and this is not as you claim 'cynical', but a statement of commercial empirical fact......... As for the OTC example you present, the public has already spoken: they 'self-select' their 'emergency' antihistamines from the aisle of a supermarket.

Neeraj Salwan, Superintendent Pharmacist

Its the ones who have borrowed cash and are on tight bank covenants that I feel sorry for.. Without contractors investing in and operating bricks & mortars pharmacies then pharmacy would not have any independents and all there would be is the tax dodging profit led multiples...it's obviously the usual short sightedness from the Government, pharmacies will close, jobs will be lost, patients will get a substandard service as staff do ten times the work for the same or less money, patients will be at greater risk of ending up in hospital, this will put further pressure on the NHS/ hospitals etc etc you get the gist...

Simon MEDLEY, Community pharmacist

yes, cruel isnt it that previously sound businessess  that banks have lent to safely over the years could go down the pan due to  austerity measures caused by the same banks lending to unsafe investors recklessley then being bailed out by the tax payer i.e these small businessess. But hey, we're all in it together as  '' call me Dave '' says.

Doubtless the Pharmacy Minister is an honourable chap who fought tooth and nail to keep the funding and is even now contemplating resigning his ministerial position in protest at these damaging cuts......

 

 

 

janak jethwa, Superintendent Pharmacist

This government reminds me of Idi Amin's goverment of Uganda in 70s.No discussions of consequencies,no thinking of  who or what it would affect,just straight implementation.Idi Amin had a dream one night and implemented it next morning but for us it turned out to be  a night mare.This seems very similar.

M Yang, Community pharmacist

The difference being that Idi Amin was actually a charismatic leader. A sociopath, but charismatic. Half of that applies to our honorable Prime Minister Mr Cameron.

Hadi Al-Bayati, Locum pharmacist

If up to 3000 pharmacies close, will the government still be able to claim forever falling unemployment levels? Manufacturing, steel works are closing but employment is apparently going up. If that's true then welfare bill should be going down and they shouldn't need to cut so hard so quickly.

£170mil cuts to global sum
£130mil raised this week in backdated corporation tax from Google

C A, Community pharmacist

Which was apparently a fraction of what they owed... though that doesn't surprise me, look at Vodaphone, Amazon, Starbucks and Boots... Pretty sure if their tax minimisation schemes/loopholes were closed there would be enough money to fund all of Pharmacy's wildest dreams (gold dispensing triangles anyone?)

Samir Patel, Community pharmacist

I think public opinions need to be heard in this action once they understand the potential impact this could have on other services. I have been speaking to a number of my patients today (and will continue to do so) who have been engaged in a reasoned discussion. They feel strongly about the value they receive from pharmacy - access to the pharmacist was highlighted to me as a valued service. Those I spoke to today will all put pen to paper. I will send to my local MPs. If every does (which I know will not happen) then we may get some common sense. We can only try instead of moaning about cuts, ACT.

Chris Mckendrick, Community pharmacist

Samir,

you are right. Public support for community pharmacy is essential. Every letter to an MP is a shout from a voter. Customer self-written letters are worth 100 petition signatures/ photocopied pro-forma letter just signed at the bottom.

I have been talking to my customers throughout January and estimate at least 50 letters have gone off so far. There will be many more. It is worth it. DO IT. 3,000 pharmacies x 50 letters = 150,000

We did the same during the OFT market entry investigation. When I met our local MP it was clear that the number of voters who had taken the time to write had influenced the political decision making. I know we still got 100 hours, internet and OOT shopping centre pharmacies, but it could have been so much worse.

Similarly, we will still have to deal with this "jumble of ideas", but with public support we are more likely to be able to fight back. Consultation finishes March 24th so now we've finished "Dry January" let's have "Write to your MP February" - catchy title eh?

Surely you want to tell your Grandchildren you survived the Battle of Cavendish Ridge?

Nalin Shah, Community pharmacist

Easy targets

Robert Miller, Pharmacy technician

This is shameful. No concern for the needs of patients. Pharmacies will close and other will cut back on staff and opening hours.

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