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James Waldron: ailing England must catch up

"Wales understands that financing new technology will create efficiencies elsewhere in the health service"

The Welsh national common ailments service reflects badly on England, says James Waldron

Do you ever get the sense that the United Kingdom isn’t so united? I’m not talking culturally or economically (although the debate around the Scottish referendum suggested that both are true to an extent), but rather in terms of how each government views its pharmacists.

This was brought home to me on Monday when the Welsh government gave the green light for every pharmacy in the country to deliver a common ailments service, with the initiative due to roll out later this year.

With England now the only country lacking a nationwide minor ailments service, National Pharmacy Association chair Ian Strachan was right to point out that the announcement has left the nation “isolated”. After all, Northern Ireland and Scotland have been running similar schemes for a decade (these launched in 2005 and 2006 respectively).

I don’t mean to detract from Community Pharmacy Wales’ justified sense of triumph – moments like this should be a cause of celebration for pharmacist colleagues across the UK. Welsh pharmacy bodies have long been trumpeting the potential of a national minor ailments scheme, an ambition that was given renewed hope last summer after a government review of a pilot across two health boards concluded that it could provide a “positive return on investment”.

Wales’ progressive Choose Pharmacy scheme doesn’t end with pharmacists treating patients for hayfever and headlice. The other key benefit of the scheme is one that must surely top every English pharmacist’s wishlist: access to GP and hospital patient records, plus the ability to share consultation information electronically, courtesy of a new £750,000 IT system.

The money for this IT investment has been sourced from the Welsh government’s “efficiency through technology” fund. The name speaks volumes about how the country intends to use community pharmacy. While Wales seems to understand intuitively that financing new technology for pharmacists will create efficiencies elsewhere in the health service, England remains obsessed with the quick fix of cutting costs by switching to hub-and-spoke dispensing.

More than anything else, a national minor ailments service is a vote of confidence by politicians in the profession’s future. In England, sadly, it seems that confidence is still lacking.

James Waldron is editor of C+D. Email him at [email protected] or contact him on Twitter at @CandDJamesW

How much faith do you have in the politicians in charge of pharmacy in England? 

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Angela Channing, Community pharmacist

James, I really do believe, with the 6% cuts, that the chance of a national minor ailment scheme in England is slim to none. We have them where we need them. 

Harry Tolly, Pharmacist

With England now the only country lacking a nationwide minor ailments service,


Well, the real problem is the PSNC. the minor ailments scheme if implemented in England would cost many tens of millions , even upto £100 million. The cost of the MAS service in Scotland has risen by some 80% over 5 years. Thus, the contract in England would need to change to allow for this. England's population is 10x greater than Scotlands.


We really need a totally new structure of contractual funding and I am afraid the PSNC is the obstacle in the Profession reaching the promised land.


Here,s a clue as to where the REAL problem lies. From C&D itself.


""" Ms Cox called for the business model for all community health services to be looked at and said of community pharmacy: "If we start from where we are we just can't get to the right place – you almost have to start with a blank sheet of paper."

The contract needed "more than a tweak", agreed Healthy Living Pharmacy project lead Deborah Evans.

But Ms Sharpe warned that shifting funding in a radical way would have an impact on pharmacy contractors.

"We wanted to establish a funding model that wouldn't have a massive impact on contractors around the country and every single model we looked at fell down on that point," she revealed. """"


HAS ANYONE apart from a select few ever seen these models ?? The profession has had ZERO say in this matter. Is this acceptable ? Serious questions which needs serious debate.


London Locum, Locum pharmacist

'Impact on contractors' There is the key part. Absolutely sod all to do with patients as I keep saying. 

Harry Tolly, Pharmacist

You are totaaly correct. Patients AND the profession need to be part of the process of how the money is best allocated. £2.8 BILLION being "negotiated" behind closed doors in a TOTALLY OPAQUE way and which favours large vertically integrated off shore domiciled entities.  This is how our NHS money is being squandered and it has to STOP.

Shaun Steren, Pharmaceutical Adviser

From C and D article 2010:


Scotland’s chief pharmacist Bill Scott took the stage to explain his vision for healthcare. “The model we have got now is not fit for the 21st century,” professor Scott warned, arguing that the current remuneration model – in which pharmacy owners are paid for contracted services – was a rate-limiting step to pharmacy’s success. Professor Scott said he had been considering how to contract for the future given the fundamental shifts in pharmacy practice toward service delivery.


His solution was to split the current contract into two pathways.  The first would see payments continue as normal, with the NHS contracting pharmacy owners for premises, stock equipment and support staff. But the second pathway would see an NHS contract with individual pharmacists directly to provide professional clinical services. Pharmacists would have a patient register, with remuneration based on the number of patients on their list.The proposal, professor Scott argued, would create a win-win situation for pharmacy owners, pharmacists and patients. It would still reward pharmacy owners who invested in their pharmacies and staff, but would remove the “perverse” performance indicators driven by turnover, professor Scott said. For pharmacists, it would facilitate professionalism and independence, as well as supporting the continuity of patient care, he claimed. The model could also encompass locums, as there was no reason they could not be contracted for clinical services, and larger multiples could form ‘group practices’, allowing pharmacists at a store to share lists, professor Scott explained.  


The proposal would also allow the sector to be seen equally by other healthcare professionals, he suggested. “Not only do GPs insult you by calling you shopkeepers, but also they say the only thing you’re interested in is money. You wonder why we have an uphill struggle – I say it’s part of the current model.”But to achieve the end result, some pharmacies needed to modernise and begin to offer services, Mr Scott added. “There are some pharmacies that if a martian were to land he couldn’t tell the difference between a  pharmacy and a pig sty. We must get rid of them.”     




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London Locum, Locum pharmacist

Contractors obviously don't like this even if beneficial for patients. They would most probably block any such moves. Not so easy to threaten a genuinely autonomous professional with drivel about 400 MUR targets. Sheer Greed and arrogance.

Shaun Steren, Pharmaceutical Adviser

The political class in Scotland can be trusted with the NHS, that is to say, they can be trusted to put the needs of patients first. With their typical straight talk and natural propensity for pragmatism, the Scots have got to the truth of the matter and have identified  a practical solution to the problem of vested interests. I feel sorry for NHS Scotland, they are held back by the donkey that is Whitehall. If freed from these shackles, I am sure they would achieve a world leading healthcare system in the same amount of time the English would manage to sell theirs to the most well connected off-shore multinational. 


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