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Graham Phillips: HLPs have not lived up to their hype

"Local commissioning leaves pharmacists at the mercy of variable and inconsistent commissioning strategies"

The illusory promise of securing new services left me out of pocket, says contractor Graham Phillips

External advocates for pharmacy are invaluable, so I’m reluctant to disagree with the points made by Shirley Cramer, chief executive of the Royal Society of Public Health (RSPH). Like her predecessor Professor Richard Parish, she is a strong, vocal champion of community pharmacy. But the truth is that healthy living pharmacies (HLPs) don’t have a better chance of winning service contracts, as she said last month. This is simply because there is no commissioning!


It’s not that I'm anti-HLPs – far from it. I was on the original HLP steering group and I’ve personally invested thousands of pounds in getting my pharmacies HLP-accredited. I have put money into staff training, IT upgrades and outreach sessions – all on the illusory promise of getting new services commissioned. But, despite pulling out all the stops, the services are nowhere to be found.


The simple truth is that I’m getting no return on investment. Worse than that, I’ve actually invested more than I’ve earned. Public health services only bring in a tiny 0.2% of my total revenue.


So, what’s the problem? It all comes down to the failure of local commissioning. Pharmacists are left at the mercy of variable and inconsistent commissioning strategies, led by local authorities and clinical commissioning groups (CCGs), which in turn are led by GPs who may be competing for services themselves.


It clearly isn’t working. National survey after national survey shows community pharmacies are losing commissioned services, and HLPs are not exempt from this trend – despite evidence of their success on every measure.


Public Health England says it wants “pace and scale”  of change in the healthcare system and the obvious way to deliver it is by national commissioning through the pharmacy contract. It may fly in the face of the government’s obsession with competition and the so-called “localism agenda”, but it clearly makes sense.


Of course, there must be room for local flexibility, but what part of the country doesn’t have a problem with smoking, alcohol, obesity or sexual health? Instead of having 250 different variations of a smoking cessation service, we could have one nationally commissioned template that could be modified, if needed, according to local needs. This consistency would rapidly build pharmacy’s public image as well as ensuring a return on investment for pharmacy owners and their teams.


Pharmacies must be demonstrably competent to deliver these services and that would be easily achievable by building HLP accreditation requirements into the pharmacy contract so – as with MURs – only accredited pharmacies would be commissioned. There will always be poor quality pharmacies that won’t get accredited or commissioned but that’s tough. At long last, those who made the commitment to deliver a quality community pharmacy-led service would reap the rewards they deserve.


Graham Phillips is owner of Manor Pharmacy Group (Wheathampstead) Ltd (@grahamsphillips)


JOHN MUNDAY, Locum pharmacist

This is spot on and it doesn't stop there. Dosette boxes and free deliveries are others. There is a perception out there especially in the multiples that if you don't do it, you will lose it. Well,lose it to who? Actually, these services are SO unprofitable that you would be far better off letting some other mug do it instead even if you lose the business form that customer. A GP will do not do anything unless it is paid for so why is Pharmacy such a total mug? Good on you Graham for questioning this. Every time you taken on a dosette patient without 7 day Rxs to pay for it, take out a £20 note from the till and burn it mentally - cos that is what you are doing!

Graham Phillips, Superintendent Pharmacist

I pretty-much agree. It needs to be economic to provide services. We could do so much more to save the NHS but then PSNC is doing us no favours in this regard. Their new 5point plan (which is actually rather good) doesn't even mention Public Health:

Clive Hodgson, Community pharmacist

In my area the CCG is now insisting that any Pharmacy currently performing even one advanced service will have to become HLP accredited. A lot of extra work and expense without the promise of any new service being commissioned in the future. No doubt someone in the CCG will be taking the credit for our effort.

Yo Palumeri, Community pharmacist

spot on again mr phillips

Angela Channing, Community pharmacist

I totally agree. When I looked at the list of HLP in my area, nearly all of them are multiples and small chains. I would imagine this is because Mr.Independent cannot or will not go on all the courses and do all the training needed to provide all these services. One group I work for has got some of the dispensers trained to provide some services. I also have tended to find staff in companies that are HLP and provide many services, are much more stressed than when I work in a different CCG that only provides MURs and Smoking cessation. Also, when you decide to hold an Alcohol Awareness day, no-one in the town drinks!!! Is Joe Public not interested in HLP? I sometimes wonder if we badger people too much? Maybe this explains the reason for more and more people opting for delivery?

Z ZZzzzz, Information Technology

Hear hear. Unfortunately it won't happen. CCGs love their new found power and won't want to give up any of it any time soon. The can run rings round public health bodies that have so far proved themselves useless.

Graham Phillips, Superintendent Pharmacist

I'm not sure that's true; CCGs are struggling, GPs are increasingly overwhelmed and disengaged. The area teams have been decimated and can't cope. If we offer positive alternatives we are in with a shout. One thing is for sure..moaning aint' gonna achieve anything

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