Like many C+D readers, I watched last month's BBC Inside Out investigation into staffing levels at Boots wondering: “Is there a smoking gun?”.
Pharmacists came out well. Boots came out of it relatively unscathed. No doubt there were big sighs of relief at their corporate head office in Nottingham, and in Monte Carlo, where the chief executive of Boots' parent company, Stefano Pessina, lives. There was no shock-horror, revelatory sting in the tail at the end of the programme.
But in my view, there is a scandal at the heart of community pharmacy, generated at the top of the NHS.
It began in the heady days of mid-2013. NHS England launched the Pharmacy Call to Action, and held a series of meetings asking how patients and professionals could reimagine the NHS. Sadly, nothng ultimately came out of it.
The commissioner called for an honest and realistic debate about the future shape of the NHS in order to meet rising demand and patients' expectations, set against a backdrop of flat funding which, if nothing changed, would result in a funding gap of £30 billion by 2020.
Then in December 2015, England's chief pharmaceutical officer Keith Ridge wrote to the Pharmaceutical Services Negotiating Committee about the cost savings and patient safety benefits of robot dispensing. He later claimed that hub-and-spoke dispensing could handle two out of every three prescriptions in England.
In May 2016, while appearing in parliament before the all-party pharmacy group, Dr Ridge compared the 3% dispensing error rate in community pharmacies with a “0.00001%” error rate at “large-scale automated dispensing facilities in Sweden”. He later back-tracked and apologised for “inadvertently misleading”, and accepted that it was “not appropriate to draw a direct comparison” between the two countries, because of the way these error rates are recorded.
Around the same time, having buried the Call to Action he initiated three years earlier, Dr Ridge commissioned his own review of community pharmacy, by Richard Murray of the influential King’s Fund think tank.
It came out equally positive, and made some specific recommendations. The then pharmacy minister, David Mowat, waxed lyrical about the review and made numerous parliamentary promises about how the report would be responded to, and would shape the future of community pharmacy. “The Murray Review,” he told the House of Commons, “sets out a road map...and NHS England is determined to implement it.”
That was until October, when Dr Ridge (are you spotting a pattern?) declared that the NHS wasn’t going to respond to the review after all. C+D concluded at the time: “When it comes to the more ambitious, and pharmacy-specific, proposals – revamping MURs, a national smoking cessation scheme or pushing for greater minor ailments commissioning – NHS England has either done nothing or actively back-tracked.”
Contractors left to foot the bill
Move forward to this year, and the current turbulence in the generics market, combined with the refusal of the NHS to recognise the resultant price increases or grant sufficient price concessions, leaves independent contractors literally subsidising the NHS’s drugs bill from their own pockets, as the NHS pays contractors below the cost price for the drugs we purchase on its behalf.
The purchasing system that I subscribe to automatically emails me every time one of my branches pays over the drug tariff price for a generic drug. I’m getting tens of warning emails per day, but like you, I’m continuing to supply these medicines, because patients’ health trumps profit. But with each email I receive, a shiver goes down my spine, as the perfect storm of funding cuts and losses drives me ever closer to going out of business
So the true scandal is the utter failure of the NHS to consider the patient safety implications of deliberately under-resourcing and destabilising a system that dispenses over one billion prescriptions, and makes the same number of potentially life-threatening interventions, every year.
Independent research from 2012 showed that one in 20 GP prescriptions contains either a prescribing or a monitoring error, affecting one in eight patients. Although most errors are “mild or moderate”, one in 550 of all prescription items contain an error judged to be “severe”.
But the risk of a dispensing error is just the tip of the iceberg. What is the risk that, having been put under impossible pressure and utterly demoralised, community pharmacists either make an error, or fail to spot one made by a GP? As the BBC programme made clear, patients trust and believe in community pharmacists to spot mistakes.
Graham Phillips is director of the Manor Pharmacy group in Hertfordshire