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PDA: We're only group willing to 'crack a few eggs' on cuts

Mark Koziol: Great shame pharmacy bodies have not offered a viable alternative to cuts

PDA chairman Mark Koziol wants the government to "lift the curtain" on the money large pharmacy corporations make outside the global sum

EXCLUSIVE

The Pharmacists' Defence Association (PDA) is the only pharmacy organisation willing to “crack a few eggs” to fight against the cuts, it has claimed.

Other pharmacy bodies have not offered the government a "viable alternative" to its 6% cut to England's global sum, PDA chair Mark Koziol told C+D yesterday (March 1).

The PDA suggested last month that the government should scrutinise the finances of large companies that own both wholesalers and multiples to find the money needed for NHS savings.

Mr Koziol told C+D it is a "great shame" that other pharmacy bodies have not offered the government any alternatives to cutting the global sum to make savings.

"You cannot simply stand up and say, 'don't make the cuts'. You have to put forward a viable alternative – anything else isn't really a serious proposition," he said in an exclusive interview.

The PDA has urged the government to look at how large corporations that own wholesalers and multiples make money outside the global sum, he said.

Mr Koziol said he suspects it is not "natural territory" for other pharmacy bodies to challenge the government so directly.

Lack of government regulation

Launching its campaign against the cuts last month, the PDA called on the government to consider whether breaking up these companies, or regulating them, would reduce the amount of savings the NHS needs to make from community pharmacy.

Mr Koziol told C+D: "[It's] hundreds of millions of pounds that really need to be looked into. It's not regulated. We suggest the curtain should be lifted on that.

"If you do it in the way we prescribe, you don't have to cut patient-facing services, because you'll look at savings to be found elsewhere in the system."

"Overwhelming response" to PDA campaign

The PDA has had an "overwhelming response" to its campaign, Mr Koziol said. Non-PDA members, including members of local pharmaceutical committees (LPCs), have backed the PDA's campaign, he claimed.

"They're all saying this is something that should've been looked at a long time ago," he said.

“Everybody knew cuts in the offing”

Pharmacy bodies knew for “quite some time” that the cuts were coming, although “nobody knew the extent”, Mr Koziol added.

“[England's chief pharmaceutical officer] Keith Ridge has been saying consistently for the last two to three years that the winds of change are going to be blowing through community pharmacy. These were smoke signals that clearly evidenced where all this was heading.”

 

What do you think of the PDA's campaign against the cuts?

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46 Comments

Tom Jerry, Community pharmacist

It's worth a note and I'm only making assumptions that large wholesalers contribute immensely to UKs GDP with the export of pharmaceuticals worldwide , nowonder everything is on quota today, so if a wholesaler has an arm of pharmacies the explortation of quota means larger quantities fir export means more hidden profits

James Mac, Community pharmacist

The PDA membership fee is the best thing a pharmacist can pay for. Save your RPS money and you'll never regret it.

Gerry Diamond, Primary care pharmacist

ideologically a tory government is not an advocate of more regulation and so it's easier to make the cuts as they have been appraised that community pharmacies are too many in number and its easier to spill some blood now four years before the nest general election game over...

We’re all doomed, Locum pharmacist

On the back of centralised buying creating a substantial profit pot alongside pharmacy fees, consider a clinically funded profession that maybe receives repeat prescriptions dispensed from a robotic hub, the time saved can be reinvested in a proper clinical final check. My vision would extend to the use of the summary care record as the enabler ( get accredited now independents! ). With the potential for further information becoming available and a write to the SCR by the pharmacy team, we have a simple model that is paid a core fee for each clinical check with an enhanced fee for a significant intervention. Relieve the GPS of annual medication reviews, maybe evolve to reevaluating a patient's medicines based on blood test results, which maybe one day could be done in the pharmacy a community pharmacy based phlebotomy service would be very popular I suggest too! 

The current dispensing fee based model is broken, it funds a process, let's have remuneration based on clinical interventions and results. Pharmacies could build an expertise in asthma, diabetes etc.

 

Thoughts? 

London Locum, Locum pharmacist

Quite interesting to see that Shaun apart views I expressed weeks and months ago are now being repeated(even if more eloquently) by others. I was swiftly rounded on and some absurdly requested my removal from this site. Interesting what a little refelction can do.....

Stephen Eggleston, Community pharmacist

I feel Mark is showing a level of naivety which is, at best, disappointing. He may want the big companies to be scrutinised but why should the government stop there? Surely, they will w ork their way through all sizes of pharmacy businesses and the winners will be the Treasury and the losers will be Pharmacy. We have a service which is provided by all shapes & sizes of business but everyone seems keen to bash the big boys yet many people - Pharmacists, technicians, MCAs etc rely on them for their livelihood. Please remember that every time you kick Mr Lessons or Mr Tobin, it is more often those on store who actually end up bruised

Shaun Steren, Pharmaceutical Adviser

Pharmacists 'rely' on the 'big boys' for their livelihood because of a despicable control  of entry law. Get rid of control of entry and let everybody compete fair and square. If this happened I would happily help dish out a few extra 'kickings' to those who currently get a tax payer guarantee for what is very often a crap service. It is quite a thing to see contractors having to resort to scare stories about employee unemployment in order to garner any support for their cause. Of course they have no other option, they know if they asked employee pharmacists for their support in maintaining the status quo, they would be told to stick their government protected profits up their arse. Unity? Never laughed so much in my life. Strike? Yeah of course we will. Only a pharmacist could make another pharmacist  want to support a governments attempt to dismantle their own profession. 

 

Farmer Cyst, Community pharmacist

Spot on. The problem is they've driven the salary so low, and made the quality of life so poor, that many Pharmacists are bright and able enough to just leave to go and work elsewhere, doing 'other things'. It's absolutely what I'd expect of 'the big boys' though, having seen their attitude to the profession over the years. What's the best way to get a professional person on board? Promise them more autonomy, paint a realistic future where their skills are utilised? Just offer them more money? No! Resort to threatening them with the prospect of the sack, like the disposable shit you secretly think they are. Don't dissent, else you'll be out.....and be forced to find a similar paying job with much better conditions. It'd be a blessing in disguise for most people out there.

Mr Pharmacist!, Pharmaceutical Adviser

What you fail to ackowledge Stephen, is that this is not an equal playing field. 6% cuts applied accross the board effect some more than others. What the PDA is suggesting is that the government needs to apply an even hand.  ie. move away from blanket cuts and make them more targeted.  Absolutely, multiples enjoy an incestuous relationship along the supply chain and ultimately, if it werent for independents, then the whole pricing tariff would be molested by the multiples.  Fact is the creation of vertically integrated corporations means that the taxpayer eventually loses out, the employee pharmacists lose out and overall its a lose lose, except for the shareholders of these corporations.  The PDA have an absolute duty to bring this issue to the fore and confront the DoH and ask them to look into the excessive profiteering along the supply chain and how it creates unfair competition.  Future cuts should be heavily skewed to the multiples and this will not only create an equal playing field in terms of competition but also deal with the need to find savings.  Therefore, Stephen, it is probably you that is naive.
 

Yuna Mason, Sales

Well said Mr Pharmacist. The power of the fear of the reaction is amazing. An inquiry has been called for, that is all. It might find that the playing field needs to be levelled.How can you then blame person A for the actions of person B? Is person B really so powerful that some would dare not even question him?

We’re all doomed, Locum pharmacist

How about centralised purchasing for the benefit of the whole of the pharmacy network?

Dave Downham, Manager

Is that because the DoH has a proven track record of successful procurement? Remember Connecting for Health? £13bn I believe.

Ian Kemp, Community pharmacist

That would be nationalisation then.  Surprisingly popular from the % of likes.

We’re all doomed, Locum pharmacist

Summary care records anyone....see below...

Shaun Steren, Pharmaceutical Adviser

Off Shore Corporate ownership vs State ownership - I would have nationalisation every time. 

Dave Downham, Manager

If only the PDA had been an addressee to the Cavendish Ridge letter then we would feel that that had as much clout as PSNC and PV. Oh, wait....

Ex Superintendent , Locum pharmacist

These comments are very naive as is the posturing of the PDA. These cuts have been directed by the treasury and will happen. All of the main pharmacy bodies, including CCA, are working together to produce a proposal for how these savings can be generated without destroying the community pharmacy network and at the same time finding a way to guarantee the future of pharmacy as a profession. What we really do not need now is infighting;the GPs never attack each other publicly which is probably why they get better settlements than we do!

Farmer Cyst, Community pharmacist

I wonder if it might have more to do with the fact that GP services haven't been slowly but surely swallowed up by a few massive companies, whose business practices have absolutely destroyed any vestige of professional pride that Pharmacists might once have had. Put quite simply, GPs get a better deal because they give at least some thought to their broader profession when negotiating. For decades Pharmacy has been owned by MBAs, who don't care about the profession. GPs have NEVER tried to put local practices out of business in the hopes of getting their patients. GPs have NEVER agreed to do services for free, unlike blister packs, home delivery, all these other 'free' in store services designed to get punters through the door, and paid for by reducing salaries and staffing in the Pharmacy. Funny how the profession has started 'destroying itself' right around the time the members of the profession have seen their income fall into the range where leaving and doing some other 'office job' is actually a viable alternative. We individual Pharmacists are done for, our profession is over - the guy who used to run Carphone Warehouse who somehow became our area manager has won, he decides what goes on more in our dispensaries than we do. Probably the only 'power' we've got left as a profession is to destroy whats left in an effort to stop the people who drove us out from profiting from doing so. I say get on the news and slag each other off!                                                                                                                                   

Mr Pharmacist!, Pharmaceutical Adviser

This word "infighting" is really becoming a cliche for those who want to bury their heads in the sand.  This is NOT infighting, its having a debate.  The essence of the debate has moved on from "if" we are going to have cuts to "how big" the cuts are going to be.  Therefore we have moved on.  What the PDA is saying is absolutely right.  let the DoH see where the profit pool is and then let it rip into it equitably.
 

Chris Pharmacist, Community pharmacist

Nah, GPs have the BMA that are more than happy to ballot for strike action and aren't frightened of either public opinion or the govt. We have the completely pointless RPS and the PDA still in its infancy in terms of influence and authority over community pharmacists. Still, at least the PDA are moving in the right direction but probably not fast enough to save many pharmacists jobs. 

Ebers Papyrus, Pharmaceutical Adviser

Hhhmmm............. GPs act on a level playing field. My pet rabbit could tell me that the vertically integrated multiples are more resilient to these cuts than the rest of the sector. The playing field is anything but level. This isn't infighting it's simply stating a fact and then basing suggestions around it.

Bal Singh, Locum pharmacist

I wonder what the PSNC said when they heard these plans?

Probably " LEAVE US OUT OF THIS!"

Ash soni and Sue Sharpe take note, this is the kind of leadership a profession needs....not your constant non answers and weakness.

Farmer Cyst, Community pharmacist

Hey, leave Sue Sharpe alone! She didn't want to be in that room. What did you expect her to do - negotiate with the government about the provision of pharmaceutical services? That's madness, and not how it works at all. The government tells Sue Sharpe what it's going to do, then Sue's job is to sit down and write a really nice e-mail to us all, telling us why what the government is going to do is briliant. It's all very well and good pretending that you'd have said this, or that, to the government; but if you were in Sue's shoes you'd have looked at the big, scary government and just tried to hide too.

Caroline Jones, Community pharmacist

The large multiples should never have been allowed to get as big as they are...even 2 pharmacies on the same street has been allowed!!! The fact that wholesalers and pharmacies are one in the same is ridiculous.......maybe it should be like Australia where one company cannot own more than a stipulated number?

Grumpy Pharm, Community pharmacist

Can we please not make the departments divide and conquer agenda even easier. The full story on who made what from whom, and when , will never be seen so can we just fight this as an entire sector? Sort out the dirty laundry later but present how the whole sector can offer an option viable for all which is more likely to be noticed...

Grumpy Pharm, Community pharmacist

i've no intention of getting into a flame war here,  all i wanted was pharmacy to come together, even a temporary truce, to fight the battle that we all need to fight. And like everyone else who has asked for this ive been shot down, my word doesnt matter beacause of who i work for, personally i dont resort to linkedin searches to reply to a simple comment, oh the pain of all of those slings and arrows , i am rebuked by people who do not use their real names, the shame! When i comment here i do so purely as myself, a pharmacist, long standing LPC member, former chair of a PDG, former president of a local RPSGB branch and former president of the Hull pharmacist association , i even spoke at the big EGM the society had back in the day in support of the SOS agenda Koz was behind at the time. But that counts for nothing, this is why divide and conquer always seems to work with pharmacy. I shall now take my bruised ego away and find that rock i apparently crawled out from under. I think stephen fry said it all quite well after the baftas, enjoy your pool...

London Locum, Locum pharmacist

I'm afraid who you work for is all important. It's why insignificant Nazi guards are still prosecuted as they approach 100 years in age. Not quite enough to say I was only following orders guvnor it would seem.

Grumpy Pharm, Community pharmacist

I think its generally understood that once anyone brings Nazi's into the discussion then its over. I really won't be checking this thread again so feel free to let the festering chip on your shoulder flow free, we all have chips but sometimes common cause creates strange bedfellows- who ever thought that russia/china/USA/anonymous would be united against ISIS, I dont deal in generalities and try to avoid assumptions based on little evidence , especially on fellow professionals motives, but you fill your boots...

Yuna Mason, Sales

Pharmacy could come together if the multiples were transparent and open in supporting the call for an inquiry, which shouldn't be a problem if there is nothing to fear. Don't you want to support that option? You instead seemed to be suggesting that everyone should rally behind the PSNC, NPA, Pharmacy Voice or the RPS, all of whom are influenced by the multiples and therefore I expect would have difficulty calling for an inquiry themselves. Three of those bodies directly represent contractors, not pharmacists. Accept the cuts but pile on more services to keep the money the same - how is that really the right answer for the profession or patients at this stage? Personally I support improving the range of clinical services delivered by pharmacists, but not just to keep the funding the same - which now appears to be the essence of the PSNC's proposals if they can't stop the cuts.  Perhaps you sir are the one trying to divide and conquer? As an LPC member (CCA?) I'm sure you're aware that Alistair Burt said that smaller independents would likely close before multiples, in spite of the higher overheads some multiples have? I imagine you're also aware of the different way that multiples and independents have been treated in the contract since 2005, and yet you don't seem to want that issue raising? 'Sort out the dirty laundry later' you said, and get an option viable for all? I think you meant an option viable for multiples, as you didn't seem to want to support an option that might actually strike a balance that's also viable for independents? If you use your real name and you have a public profile you should be mindful of what you say or be prepared for others to do a lowly search on LinkedIn (it wasn't hard).

Farmer Cyst, Community pharmacist

I'm with Paul. As a Senior Manager at Boots in Hull (I don't know why you didn't mention that Paul, you'e so modest! Stop being so shy, you've got loads of great ideas! :-D) I think people like him are best placed to offer advice on what would be best for Pharmacy. Boots has done more than anyone to improve Pharmacy as a profession - it's not like it was them that created the awful dog eat dog, do your 400 MURs, 3 for a £1 awful commercialised excuse for a profession we have now. People like Paul are who we need to listen to right now - because NO ONE is more eager to see Pharmacists uniting to bargain with the people who pay them than Boots - that's why they were so happy to let the PDA represent their Ph.......ohhh.....

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