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)