In 2015, the government announced pharmacy funding cuts. The end game of these, in my opinion was to have less reliance on bricks-and-mortar branches. In turn, this would reduce vital face-to-face interactions with patients.
But none of us should ever doubt that maintaining the access, convenience and value from seeing patients in person is as crucial today as it was back in 2015.
The plan to close pharmacies had scaled automation of the hub-and-spoke dispensing model of medicines at its core. I believe that ambition remains a policy doctrine of commissioners.
I suspect the COVID-19 pandemic sweeping the nation will be viewed by some as an opportunistic moment to address the unfinished business of hub and spoke and, in so doing, loosen the grip of pharmacies across the communities we serve.
To dismantle the local provision of medicines by decoupling community pharmacy from the fabric of patients’ lives represents a wasted opportunity, one which is firmly against the tide of public opinion. For an administration so firmly welded to pollsters and public attitudes to policy, the government must tread carefully when it comes to fiddling with community pharmacy.
I ask NHS England & NHS Improvement:
Who was it who kept working when the lights went out on primary care? Who was it who protected shielded patients when the lights went out on the vulnerable? Who was it who maintained medicines supplies when the lights dimmed on distance-selling pharmacies?
Who was it who met the health needs of the public when a nation grew fearful of A&E? Who was it who ventured into so many unknowns with professionalism and courage despite the scant provision of personal protective equipment and the inability to social distance?
Throughout COVID-19, the pharmacy profession has shone brighter and so have the possibilities. The pandemic affirmed the profession’s place in society as part of the very fabric of people’s lives.
As pharmacy organisations prepare their visions for a world post-COVID-19, it is more critical than ever that our leadership produces a robust vision for the sector.
Pharmacy leadership must be radical in its thinking. As the owner of four pharmacies in north west England, it is clear to me that there is a role for us to extend the models of personalised care for at-risk groups like shielded patients.
Delivery services could be modified to enhance patient outcomes, while virtual consultations in the right context also present opportunities. Distance selling of medicines should not be dismissed altogether – it can extend the reach and scope of pharmacies. But we are not and never should aspire to become like Amazon. The profession is better than that.
COVID-19 was the catalyst for GPs in my area to deploy electronic repeat prescriptions as pharmacy teams responded overnight. Indeed, the pandemic became a showcase for the possibilities of pharmacy. Now it’s the turn of our leadership to articulate its confidence in the potential of its members.
For me, innovation must be built around the retention of supply with services evolving to relieve pressures on other parts of the NHS. This will not happen without real integration with other providers. It is becoming increasingly apparent, with the demise of small business, how localism and community leadership will become more evident across our towns and villages. Community pharmacy must be part of that community renaissance.
The actions of pharmacy during COVID-19 have illustrated the potential for the sector to have new patient-facing roles, but in addition to investment there must be a degree of regulatory freedom to make it happen by relaxing unnecessary bureaucracy.
There is a fixed cost to running a community pharmacy, but the funding model is broken. The model does not give contractors the headroom to focus on anything other than costs, margin and the Drug Tariff. We need financial stability, security and focus to take this sector to the next level. Action is needed, not platitudes.
The disparity in approach to community pharmacy between England and the devolved nations points to the need for structural change in NHS England. It seems that those commissioning community pharmacy require a fresh pair of eyes to oversee the possibilities and opportunities without prejudice or dogma.
I have felt for many years that it isn’t the politicians who don’t get the value of the sector but rather civil servants. There appears a lack of trust in community pharmacy and lack of confidence in its ability to deliver. This thinking needs to be replaced by leadership that is willing to invest in our communities.
Community pharmacy isn’t frightened of change, especially the independents. If we don’t get change then we will see more distance-selling pharmacies, hub-and-spoke dispensing, remote checking of prescriptions and relaxed supervision, with less face-to-face patient contact.
This vibrant sector is enjoying more respect and recognition than the rest of primary care right now. Let’s not waste it.
Ian Strachan owns Strachan Pharmacy, which has four branches in North West England, and was National Pharmacy Association chair