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We deserve an explanation for why we've 'moved on' from minor ailments

"Current funding problems should not be used as an excuse for lack of action on minor ailments"

If things really have "moved on" from minor ailments commissioning then pharmacy needs a formal explanation, says Phoenix UK's Steve Anderson

During a debate in the House of Lords last month, the health minister, Lord O’Shaughnessy, stated that community pharmacy must “play its part” in helping the NHS find £22 billion in efficiency savings. Given the current precarious nature of NHS funding – with more trusts finding themselves in deficit – Lord O’Shaughnessy’s comments are hardly surprising, but they rather miss the point.

If ministers want to achieve such ambitious efficiency savings then they need NHS England to fundamentally redesign patient care pathways. For example, there are countless authoritative reports and studies which demonstrate beyond doubt that community pharmacy can provide a high-quality minor ailments scheme at less cost to the NHS than current arrangements, which funnel patients into GP surgeries already struggling to meet patient demand.

Redirecting patients to community pharmacies would also allow GPs to spend more time with patients who have complex conditions. That improves clinical outcomes by helping patients understand and manage their health and medicines better, which in turn reduces avoidable complications resulting in hospital admissions.

This ultimately means it is good for patients: with improved access to healthcare; good for GPs: with better outcomes for those patients who need their support most; good for hospitals: with fewer costly admissions; good for community pharmacists: providing them with a stronger clinical role and income stream; and it would contribute significantly towards the government’s £22bn efficiency target.

The logic is compelling, so are we likely to see a national minor ailments service in England any time soon? Probably not, if chief pharmaceutical officer for England Keith Ridge’s and pharmacy minister Steve Brine’s recent declarations that “things have moved on” from minor ailments commissioning are anything to go by.

“Salami-slicing measures”

Much of the national commissioning budget is, of course, devolved to clinical commissioning groups and the reality is their focus is on short-term cost cutting, not achieving long-term efficiency savings. That is why we see salami-slicing measures such as decommissioning services from community pharmacy. It is always much easier to manage a problem – or at least be seen to be trying to do something about it – than actually solve the problem itself.

My response to Lord O’Shaughnessy is this: community pharmacy and the medicines supply chain already operates very efficiently and provides the NHS with incredible value for money. According to a 2015 PricewaterhouseCoopers report, 12 services provided by community pharmacy delivered £3bn of net benefit to the NHS, the public sector, patients and wider society.

So, Lord O’Shaughnessy, if you want us to do more, then the government has a role to play in unlocking the full potential of community pharmacy. A national minor ailments scheme would be a good starting point.

Current funding problems should not be used as an excuse for lack of action on minor ailments. NHS England just needs to look north of the border, where NHS Scotland has managed to achieve a national pharmacy-based scheme within the financial constraints it has faced.

As for Dr Ridge and Mr Brine: if things really have “moved on”, then surely that reinforces the need for the Department of Health and NHS England to respond formally to the ‘Murray’ review, in order to set out clearly what exactly has “moved on”, why and what it means for community pharmacy, and the sector’s place going forward in providing primary care services.

Steve Anderson is managing director of Phoenix Healthcare Distribution Ltd in the UK, part of the Phoenix group of companies operating across Europe

16 Comments

Leon The Apothecary, Student

Minor ailments never really gained any traction. I think many of us would agree it was dead on arrival.

Wolverine 001 , Pharmacist Director

Pheonix Director advocating MAS - its a waste of time no CCG or NHS exec is going to give this any kind of thought.  The new model should be reduced number of pharmacies in any town with large scale delivery models - but this may affect pheonix profits no??

Edward H Rowan, Locum pharmacist

Minor Ailments schemes are all unpopular with pharmacy staff - they're seen as a waste of time when we've got more important and more interesting things to do. It's basically just selling P or GSL meds and getting a patient to fill in a convoluted form to acquire them and enable us to claim payment. The NHS ends up paying ridiculous money for a box of Paracetamol. Give the doctors some vouchers saying on them 'Paracetamol' or 'Simple linctus' so they can dish them out to the people with runny noses and let them bring them to the pharmacy. We send them all to the PPA at the end of the month and they pay us. Simple, no records, no arsing about with silly forms, no NHS paying huge amounts for cheap meds.

Gerry Diamond, Primary care pharmacist

Hi Paul, I must admit that I fell for the clinical role, funded myself through a clinical diploma and MSc but did not find a foothold as a community pharmacy role so jumped ship to NHS. Even in that context hospital was a supply and technical role, some more clinical stuff. I would be really interested to know more about how the clinical has failed in pharmacy, Thanks

Chris Locum, Locum pharmacist

...don't think you were the only one to fall for it...

Jay Badenhorst, Superintendent Pharmacist

I think wasting public money like this is a serious breach of our GPhC standards:

2 work in partnership with others
3 communicate effectively
5 use professional judgement
6 behave in a professional manner
9 demonstrate leadership

Why the GPhC hasn't taken this up yet goes beyond me. So much for upholding our professional standards!

Ilove Pharmacy, Non Pharmacist Branch Manager

GPhC are controlled by a 3rd party familiar with all community pharmacists.

Ebers Papyrus, Pharmaceutical Adviser

Steve Anderson is spot on here it’s clear to see where the main barriers in pharmacy progressing are: CCGs, DH.

I’m sorry to say it but locally commissioned minor ailment schemes however well-intentioned were set up to fail. Sketchy uptake, limited training events, bureaucratic procedures, GPs and patients unaware as poorly advertised.

The only way the vital service works is a mandatory national scheme where GPs systems prevent them prescribing or taking appointments for the agreed conditions. Win for patients as immediately seen by any pharmacy, win for GP as appointments reduced, win for pharmacy in integration and developing role and a win for NHS in cost and service level.

Hemant Patel, Community pharmacist

I never believed for 1 minute that there would be a national MAS. I do not believe that MAS had quality outcomes embedded in them. I do not believe that ‘devolved monies’ to CCGs would go back to a central pot. I always believed that the current contract is a supply contract and not a care provision contract. A care provision contract would recognise the cognitive part of work from an employee or a proprietor pharmacist and not just the product supply. The world has moved on and what is going to hit community pharmacy owners is beyond their imagination. Dispensing fees devolved to STPs and built into care pathways for acute and LTCs. So, my advice to Comm pharmacy network is understand the NHS agenda better and prepare for big contractual changes. We should start from the botttom. What does the patient and communities need from pharmacies? How do we respect and empower our employees so they feel they have a stake in the system. Then what the owners want. At a time when the public and the NHS is demanding greater use of pharmacists intellectual capital it’s a folley to talk about services when GPs are talking about care. 

It’s rightly claimed community pharmacy network is efficient. Does that mean it cannot be even more efficient using technology, robotics, better incentivised workforce and re-structured network?

 

Using technology you can now access a doctor 24 hours s day. But, meds only 9-7 pm and not on Sunday. 

 

Pharmacy workforce needs recognition and adequate reward. In the past few years, if anecdotes are to be believed, some independents and particularly multiples have treated employees badly. When new care is demanding professional accountability as well as contractual obligations there is a need for an improved balance with autonomy at work and transparency of income and better agreements with employees. 

 

Returning specifically to MAS, the CCGs are not interested in system savings (if they actually exist) so the decisions will remain local where cost-containment and quality is increasingly important. A local proposal based on providing better access, at a constrained cost and of high quality may be a way forward but that is not what the multiples want. They want one size shoe for all different feet! 

 

So, is community barking up the wrong tree?

Chemical Mistry, Information Technology

Because allMAS are crap just allows the society think that everything is for free and has we know anything for free has no value.Sp I know grassroots pharmacist rejoice when MAs  are scrapped it's just contractors who want to keep it so fleece the nhs more.Hemant I can assure you they are not anecdotes employees and locums are are treated as crap but thinking like a contractor ! And why do never support doing things for free, all this you say but do not state the obvious every click and  collect charge so tell pharmacy to stop doing things for free!!

Jay Badenhorst, Superintendent Pharmacist

I suggest we all should get rid of the word 'free' with any NHS service. We should substitute it with 'a taxpayer funded' service.

Ilove Pharmacy, Non Pharmacist Branch Manager

That horse has long since bolted.
 

Valentine Trodd, Community pharmacist

Time pharmacy put away the begging bowl and toughened up a bit - start withdrawing 'free' and non-contractual services. No other sector would allow itself to be used as such a doormat.

Paul Dishman, Pharmaceutical Adviser

What pharmacists should not do is any more work for "free". For years we were promised that if we became more "clinical" then we'd reap the rewards. What a joke that was.

Chris Locum, Locum pharmacist

What a ploy that was. Pat on the head. Go forth and tick boxes. The 'éxperts' that are now so silent about our great future -  rather less visible now eh...Pharmacy won't get an explanation. It will get more financial cuts.

Ilove Pharmacy, Non Pharmacist Branch Manager

One of the BIG lies many fell for

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