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Pharmacy network could ‘fall apart’ if specialist contracts adopted

Professional The PDA’s proposal to separate pharmacy's clinical and supply roles with specialist pharmacist contracts could cause the network to fall apart, contractor Graham Phillips (pictured) has warned

The PDA's proposals to contract specialist pharmacists to take full responsibility for patient care could create more opportunities for the sector but could also cause the pharmacy network to "fall apart", pharmacists have said.


The plans outlined last week in the PDA's road map for England, which called on the government to create separate roles for "patient-facing" and "clinic" pharmacists, had "a lot of potential" for both pharmacists and patients, according to pharmacist Clive Hodgson, manager at Sunningdale Pharmacy in Stockton-on-Tees, Cleveland.


However, contractor Graham Phillips warned that separating the clinical and supply roles of pharmacists could cause the pharmacy network to "fall apart".


"We need integration between dispensing and the added value of medicines optimisation. As soon as you start to disintermediate the process, you've lost your public health network," said Mr Phillips, owner of Manor Pharmacy Group (Wheathampstead) Ltd in Hertfordshire.


Integration between dispensing and the added value of medicines optimisation was needed, said contractor Graham Phillips

More on visions for pharmacy's future

Government could save millions under PDA plan for specialist pharmacist contracts

Lloyds chief rejects Scottish plans for patient link to a named pharmacist

Scottish government's independent prescribing plan hailed as 'visionary and groundbreaking'



Earlier in the month, Celesio UK managing director Cormac Tobin called the Scottish government's plans for patients to register with a named pharmacist "the wrong move", and Mr Hodgson predicted the multiples will oppose the PDA's plans for a similar initiative in England.


"I doubt [they] will be too enthusiastic, as this would mean them losing revenue, power and control to individually contracted pharmacists. They have a lot of influence and will act in their own interests," he posted on C+D's website.


Another pharmacist commenting on the website agreed the multiples might oppose the plans at first, but predicted their opinion could change over time.


"They'll soon take up the idea when they realise the category M clawbacks will not stop, hence they will require more streamlines of income," the anonymous pharmacist said.


The PDA's road map called for clinic pharmacists to hold an individual contract with the NHS to provide specialist pharmaceutical services, particularly focusing on patients with long-term conditions. Under the plan, patients would register with a clinic pharmacist – who would be an independent prescriber – to be seen on an appointment basis.


Community pharmacist and independent prescriber Gerry Diamond said this would offer him a chance to use his prescriber training, and contractor Aniruddh Patel told C+D he would pay for prescriber accreditation if the PDA's plans were put into practice.


 "If it's contracted and it's a clear role, I think it's a brilliant idea – and it's totally within our capabilities. We don't want people to perceive us as glorified shopkeepers,"said Mr Patel, owner of Savages Pharmacy in Burnham-on-Crouch, Essex.


Patient-facing pharmacists could provide a service to walk-in patients, the PDA said on Friday (October 11), dispensing prescriptions and treating minor ailments under a nationally commissioned scheme.


The PDA released its road map just over a year after it called on the Scottish government to adopt a similar model that also involved separating medicines supply from clinical care in the pharmacy contract.



How could the specialist roles affect the pharmacy network?

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27 Comments

MESUT OZIL,

“They have control because they sell something everyone has to buy. We have no choice about buying it,” he told the Mail on Sunday. “With that amount of power comes huge responsibility to serve society.”

These comments were made by Justin welby with regards to fuel price increases.

This is exactly whats happening with the Pharmacy multiples exploiting their position and making lifes of pharmacists a misery.

It will never be a fair playing field with the current conditions. The contractors have too much influence.

Luckily I saw this coming and saved for the rainy days. I pity the newly qualified pharmacists and most if not all must regret what they have let themselves in for.

Is it my problem??? No............ as everyone is looking after number one...be they locum, contractor or employed pharmacists.........

MESUT OZIL,

NOT ALL DOOM/GLOOM

Pharmacist Pharmacist, Community pharmacist

I work for a very successful private company which works in primary care to provide pharmacy led clinical services, and the profit from such services totally outweighs the money made from retail pharmacy. There is no standing on your feet for hundreds of hours a week, no shouting customers demanding their prescriptions within seconds of handing them in, no managers on your back, there is increased respect from other healthcare professionals and overall a better job

MESUT OZIL,

Pharmacy will never reach its maximum potential witht he current rules blocking any future applications to open a pharmacy. With an ageing population, the demands for access have never been so great. The entry rule must be scrapped, pharmacists roles must change and adequote funding needs to be in place.
I have seen new 100 hr pharmacies del mediciation which the previous multiple fail to supply when it had sole rites to dispense medication and they only changed policy when another pharmacy was allowed to open.
The multiples wil always put profilt before care....and it's vital vibrant independent pharmacies work together and move the profession foward and new pharmacies are allowed to open.

Pharmacist Pharmacist, Community pharmacist

Del Boy unfortunately on this matter I beg to differ. Opening more pharmacies is not the answer. More pharmacies will just mean more supply function. We need to move out of the shop floor and focus on services delivered in more clinical settings. No doubt, it is brilliant for services to be delivered in community pharmacy settings, but the opening of new pharmacies is not the answer

MESUT OZIL,

You seem to be confused...Competition will move services forward...

The multiples WILL NEVER SUPPLY A SERVICE IF DOESN'T SEEM IT A REQUIREMENT
I gave the example of collection and delivery where the multiple only started a del service when the local 100 hr pharmacy started to take away its prescriptions...

Get it into your head......The multiples will always put profit before patient care...
YOUR JUST A NUMBER.....!!!

Pharmacist Pharmacist, Community pharmacist

Yes I agree competition will move services forward, however can you tell me how you will survive by opening another pharmacy with a diluted number of items? Do you realise how many hours you have to put into the pharmacy to make a bit of money? I agree totally with you that competition is good, but currently the competition is for items, not services! And I dont see that changing very soon.

I agree with Sue Per, that if the whole payment structure was changed and more remuneration was given for services then it would be ok to open another pharmacy premise.

Del Boy you have to realise that services can be provided outside the pharmacy premises, in clinical settings, in GP practices etc, or if the new specialised contracts come up then in a separate entity in a Pharmacist Surgery, which doesnt need to be in a community pharmacy or a GP practice, it could be somewhere totally separate.

So, the bottom line is, opening a retail pharmacy is not the answer.

Please all vote if you agree or disagree, write your comments below because I am very interested in the views around this topic

MESUT OZIL,

Who are you to tell me if it's OK to open a premise. I pay my income tax/NI...I can spend my money as I see fit...

Some ppl prefer to buy alcohol/ciggies/95% morgage. I prefer to have an opportunity to purchase a pharmacy.

unless you want to continue to be led by the multiples and not lead???????

MESUT OZIL,

Diluted no. of items????

scripts have exceeded a billion for the first time
script numbers inc by 3% per annum

30 MILLION INCREASE PER ANNUM!!!
If the rules changed, there would be many more 100 hrs opening.....

Pharmacist Pharmacist, Community pharmacist

Ok Del Boy, you continue counting tablets if thats what you're happy with. Maybe you and Mr Philips can join hands

Mike Hewitson, Superintendent Pharmacist

I think you need to take the personalities out of the discussion. Graham is entitled to his opinion, as you are to yours. There was no need to derogate anyone because they don't agree with you.

I'm all for a full and open exchange of views to debate the issue. Can't help but think, that even valid contributions are devalued because they are not attributed to a named individual. If you believe what you say, why not post under your own name? Some of the responses, not just on this thread, but in general are spoiled by petty and vindictive comments from anonymous contributions, akin to trolling.

MESUT OZIL,

Here here..stick and stones may break my bones etc etc

Well said........Mike

I am in favour of expanding roles of pharmacists but also understand the need of the requirement to dispense...

Dispensing/checking is an art...!! Don't devalue the profession by saying it isn't MR PHARMACIST/PHARMACIST!!!!

Holding hands with mr philips..sorry I'm not that way inclined...

MESUT OZIL,

I don't know who rattled your cage...!!

I am in favour of enhanced services but dispensing is bread/butter
I'm glad your not in charge of pharmacy as you probably give the job to ACTs..

Sooner or later the entry rules will need to change!!

The population is living longer, and the size is increasing. Peoples expectations are increasing.

COME ON YOU GOOOOOOOOOOOOOONERS...
RAMSEY IS A REVELATION, SO IS CARZOLA/OZIL/FLAMINI/GIBBS !!!!!

Sue Per, Locum pharmacist

Del boy should have added this to his comments "there should be remuneration policy which is inverse of dispensing volumes" in other words dis-incentivise dispensing factories, and robotic working enviroments.

M Yang, Community pharmacist

Completely agree with so many of the comments here. Pharmacies are essentially prescription factories at the moment and when working for the shoe company I don't feel I can provide services such as EHC in a manner that inspires confidence. I'm dashing between the consultation room and the checking area, then jumping in to serve on the till because the pharmacy only has one counter assistant.

With the volume of prescriptions these days, the only way to prevent backlogs is to have a second pharmacist as double cover. Unfortunately that costs money and getting double cover at a multiple is like asking for a flying pig.

Dividing pharmacists into more specialised roles is a novel idea.

Pharmacist Pharmacist, Community pharmacist

M Yang I totally know what you are talking about, I feel exactly the same, I have to split myself three ways when working in community, in the consultation room, the dispensary and the healthcare counter.

We are a Jack of all trades!

Stephen Foster, Community pharmacist

I couldn't agree more with Pharmacist Pharmacist! The days are long gone when pharmacies could focus on prescriptions alone, making their profits from saving a penny here and a penny there on generic purchasing. The future is about clinical service provision alongside a supply function, and I welcome talk of specialist commissioning to enable our more clinically minded pharmacists (obviously not Mr. Phillips) to innovate and work collaboratively within a wider Primary Care family.

Pharmacist Pharmacist, Community pharmacist

Pharmacy needs to look beyond services which are predominantly provided OTC, squeezed in and amongst waiting prescriptions during the dispensing process. Of course we are best placed to provide services such as EHC,stop smoking etc based on ease of access, however we have much greater capabilities. That is why the idea of specialist pharmacists is brilliant. It gives us greater use of our clinical skills and builds a greater positive reputation of the profession to the general public and other healthcare professionals alike

Ian Kemp, Community pharmacist

Don't understand Graham Phillips' reasoning, surely GPs would argue that there's a greater need to link medicines optimisation to prescribing than to the supply function. Not sure what kind of clinical future that would leave for 'public health ' pharmacies. Again not sure what Celesio's problem is, they provide advanced services which require individual pharmacist to be named as the provider to ensure the provider is registered as competent, don't see what's so significantly different. The clue is in ' take full responsibility'. Like with your registered GP it doesn't mean the service will cease if the named pharmacist goes on holiday [though it might mean an end to the ' our way or no way' mentality of Celesio which, unfortunately, means that most Clinical Commisioning Groups will say NO WAY thanks].
For once I agree entirely with Gerry Diamond. Yes, lets let the Scots do all the hard work of trying to mould it into a workable contract first but those who would reject it need to come up with a better alternative. Not sure Cormac Tobin would accept his employees just saying no to an idea of his without them coming up with a better option.

Gerry Diamond, Primary care pharmacist

How kind Ian, it is never my intention to be disagreeable :-)

Pharmacist Pharmacist, Community pharmacist

If the GPhC and the RPS held the profession together correctly then it would not risk falling apart! Unfortunately time and time again it is brought to our attention that the GPhC and the RPS are not fit for purpose. We need a proper robust governing body who will stand up for the rights of pharmacists and lead us into the future.

I know a number of private companies who are working in the primary care sector and providing high quality clinical pharmacy services, medication reviews, anticoagulation clinics and God knows what else. They are very successful, unfortunately such work is not recognised by the GPhC and RPS.

So, by simply stopping pharmacy moving forward as a profession to maintain unity is a disgraceful idea.

Dave Rushton @ Paradigm Shift,

There is definitely a lack of coherent leadership that holds back the profession.

With too many active bodies and “leaders” who have their own agendas, whether it be self-promotion, business development or any other desire, your profession will always struggle to have a voice that is heard by those who hold the power to change, be they commissioning groups or MPs, or the Health Minister.

That’s not to say that there aren’t those who are genuinely having the interest of the profession at heart, before their own aspirations, but it strikes me that it’s little more than a bun fight at times, and with separate bodies lobbying, who gets heard and what gets actioned?

There is also, in the opinion of many, a huge gap between the realities of coal-face pharmacy, especially for those who are owner managers/1 shoppers, and many of those who are "representing" your interests, so subsequently there is a lack of engagement.

Why would you wish to follow the advice of someone who appears to be out of touch with YOUR realities?

From a non-pharmacist standpoint I feel sorry that you are not better utilised as a profession, but without solid and UNIFIED leadership that engages with the commissioners and provides a UK-wide model you're always going to be fighting an uphill battle.

I see some projects on the horizon that offer hope, but where you have a commissioned project opportunity there will be those who put money before patient and will potentially mess it up for those who genuinely wish to engage with the project and provide quality outcomes.

Whether you develop a clinical focus and become an IPP or engage cost effective PGDs to deliver private healthcare (sorry IPPs), or you are lucky enough to receive commissioned services... or you work towards becoming a script factory (not an aspiration for many I know)... you need engage and have passion for what you do and wish to achieve, because if you don’t, someone else will.

The world has changed and you need to change with it.

GPs and Dentists run the private and NHS model very successfully, why shouldn't you?

Not to offend, but if you sit and wait for commissioning you may get a sore bum waiting.

Many pharmacists will never even get to attend a commissioning meeting, let alone benefit from commissioned services.

Look at flu commissioning as an example... all of London was commissioned, but what happened UK wide? The base of the quality pyramid for COPD and a missed trick.

Shift your paradigm, before someone else does it for you.

Graham Phillips, Superintendent Pharmacist

This is a suprisingly ill-infomed comment from a registered professional. The GPhC is there as a regulator - no more no less. It is NOT a representative body. The RPS is there in a Royal College role and its doing a pretty-good job I think. If you want to provide extended services AND be professionally recognised for doing so then can I suggest a look at the RPS Faculty. As for moving forward - what's stopping you? We are already providing many of these services in my pharmacies and the individual pharmacists are recognized and supported in their roles. No need for separate "specialist roles" just good pharmacists and some intelligent commissioning.
Regards
Graham Phillips
Supt, Manor Pharmacy Group Herts

Pharmacist Pharmacist, Community pharmacist

Graham Philips cannot think beyond the supply function of pharmacy, hence why he cannot, will not and is unwilling to see anything beyond the dispensing of tablets. Of course this requires little clinical knowledge and a greater business mind. Maybe Graham is not confident in taking up these roles or is afraid that his employed pharmacists will leave him to take up the clinical roles, resulting in him being left all alone to look after his little empire. Worry not Graham, remote supervision is probably around the corner so you can look after all your groups remotely (maybe thats why you are such a big fan of the GPhC?)

Sue Per, Locum pharmacist

The views are typical this master, and other of Lloyds ET AL who do fear the prospect of loosing control over their slave pharmacists who would otherwise escape form their control of the "ring-fenced" NHS contracts!!.

Pharmacist Pharmacist, Community pharmacist

Totally agree Sue

Pharmacist Pharmacist, Community pharmacist

Excuse me Graham? But what world do you live in? Obviously within your own world of Manor Pharmacy Groups.

Maybe you are more recognised in your role seen as you own the company, but as employee pharmacists we require more recognition. Anyway I think you've fallen out of the topic of discussion.

I don't know where you get the notion that the RPS is doing a damn good job, is that why thousands of pharmacists decided against renewing their RPS membership?

Mr Rudkin is destroying the profession, I'm seriously concerned about YOUR ill informed views of the RPS and GPhC as a registered professional

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