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'We could support PSNC in its push for a service-based contract'

Steve Anderson: Phoenix UK is discussing a way forward with its customers

The sector can protest at the government's approach to funding or get behind PSNC and a service-based contract, Phoenix UK's Steve Anderson argues

Reports that the Pharmaceutical Services Negotiating Committee (PSNC) is considering negotiating a service-based contract with the Department of Health and Social Care (DH) in England is welcome news. It has become increasingly clear that the DH is no longer willing to adequately fund a contract that is largely based on dispensing.

Indeed, any new funding streams in recent years have been directed at initiatives such as creating practice-based ‘clinical’ pharmacists or the Pharmacy Integration Fund rather than the core contract itself. That tells me that despite the NHS’ dire financial state, there is still funding available, if only we can figure out how best to access it.

What is the agenda of NHS England and the DH? It is complex, but put simply it centres around three core objectives. Firstly, service innovation. Secondly, achieving improved patient outcomes more efficiently than achieved in the past. Thirdly, reducing the strain on GP surgeries and A&E.

Over the years, countless sector and academic studies and reports have demonstrated the unique role community pharmacy currently plays, and could increasingly play, in delivering those objectives, if only it was given the opportunity to do so.

Medicines use reviews and the new medicine service have proven their value. Flu vaccinations in pharmacies complement those undertaken in GP surgeries and reach communities – that with the best will in the world – GPs cannot reach on their own. The list goes on, and we are all familiar with it. Yet, the DH remains reluctant to commit to further funding at a national level – for example a minor ailments service – and stands on the sidelines, passing no comment as local services fail to be commissioned or are even decommissioned.

Why is that? The patient need is there, the ability of community pharmacy to deliver is there, the academic evidence is there. Perhaps it is because the very nature of the contract leads to extensive discussions about issues such as concessionary pricing, category M and list prices, which then push out discussions about service innovation. Inevitably that becomes a conversation about cold cash, rather than one that starts with patient needs and ends up with a deal around service provision, which provides a fair and sustainable return for community pharmacy.

Not all things north of the border are rosy by any means, but community pharmacy in Scotland has already crossed that bridge. Its funding is on a more stable basis and the frontline healthcare provision role of community pharmacy – such as the chronic medication service and minor ailments service – is an accepted part of core NHS provision well beyond any professional demarcation disputes with GPs.

Put simply, the services-led contract in Scotland has secured investment in the sector, whereas in England, the DH and NHS England appear determined to direct any investment available through channels other than community pharmacy - how on earth can the Pharmacy Integration Fund be underspent?

We could – again – express our frustration and anger, we could commission yet another report that demonstrates the value of community pharmacy, or we could support PSNC in seeking to change the dynamic of its relationship with the DH. But we need to do so with eyes wide open.

At a time when workload is increasing due to the growing numbers of older people with multiple conditions requiring medication – which not only means more work, but also results in more polypharmacy-related interventions – we need to consider how to maintain patient safety while working smarter, not harder.

Pharmacy supervision and hub-and-spoke dispensing provoke different responses, but the fundamental point is change is on the horizon – so do we seek to guide and influence that change or have it imposed upon us? We need to square the circle of increasing dispensing volumes, funding constraints and providing more services that the DH is prepared to fund.

At Phoenix, these are the issues we are discussing with our customers, in order to help identify a way forward, which provides all of us with a secure and sustainable business in the years ahead.

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

13 Comments

Ilove Pharmacy, Non Pharmacist Branch Manager

'Services' again haha...

 

Mohammed Patel, Community pharmacist

It seems as if pharmacy is the stinking, miscoloured, rotten apple amongst the rest of the professional careers in the UK.

Not only do you need to study hard for 4 years to get the masters, then you need to jump through the GPhC's hoops to pass the pre-reg. And I am talking about 2 A4 pages to decribe an interaction you had on the telephone for your pre-reg evidence, which is a total waste of everyone's time and effort.

And providing you pass the exam, you just have to spend the rest of your career looking over your shoulder because they want to strike you off the register.

Even the faintest whiff of blood seems to bring the vultures circling.

And to make matters even worse (which seems impossible), we are presented with a picture of a grinning man who wants us to to go onto service-based contracts. I would be grinning too if I were him!

It feels to me as if we are pawns in some kind of "Merchant of Venice" tale, except that our pound of flesh will be taken no matter what we do. There is no avoiding it. Prepare for the worst but hope for the best.

Jonny Johal, Pharmacy Area manager/ Operations Manager

Ummm I think this is the wrong move, looks like the PSNC is still devoid of ideas.

Paul Dishman, Pharmaceutical Adviser

Service based contract? So who is going to dispense the prescriptions?

Mohammed Patel, Community pharmacist

Well, you of course. On your breaks. Or get reprimanded when a patient complains.

James Vince, Pharmacy Buyer

PHARMACY2U.  Lol

Pharma Tron , Community pharmacist

The same people who thought of NUMSAS and the brain-fart asthma review part of QPs would be responsible for producing the said contract? Look how well thought out and consulted those were! I look forward to being proven wrong!

Valentine Trodd, Community pharmacist

"Medicines use reviews and the new medicine service have proven their value."

Eh, no they haven't Steve. Have you read the Murray review?

Mohammed Patel, Community pharmacist

A service-based contract is akin to what unscrupulous companies refer to as "commission based pay". And anyone with half a brain cell would run a mile at such a contract because it is just a way of bullying you into doing more, and more, and more.

Is it a coincidence that this is being mentioned just as we are taking a senior Dixons employee on-board? I think not.

Wolverine 001 , Pharmacist Director

The only way that a service based contract will work is IF ACT's can check and supply otherwise there is no time in a busy pharmacy - therefore dispensing income will be erroded even more and given silly "clinical" services to perform - a carrott given by the NHS to say that they see a future for our profession 

We have years of history in supplying medicines can we please be paid accordingly as at the moment PPA cheques are below the wholesaler bills which is ridiculous

Andy Burrells, Community pharmacist

I have to agree. Service Based Contracts WOULD work, if we weren't responsible for the timely supply of medicines and appliances, but my script numbers are only going up. Would I be expected to manage all those items then try and work even harder to make revenue through services? I can just imagine the emails and phonecalls from middle management.

No, while our primary function is supply, we need to be remunerated fairly for that process.

Clive Hodgson, Community pharmacist

A move to a service-based contract (and presumably at the same time a move away from the medicine supply role) could leave Community Pharmacy very vulnerable. It is a one-way door with no going back if it does not work out.

Let’s be honest. The value of the current services such as MURs and the NMS to taxpayer and public is to say the least doubtful. If the MUR and NMS services were defunded and disappeared today how much outcry would there be from the general public? Daily Express/Mail headlines of: “Pensioner FURY after being deprived of MURs”? I think not.

So, what services are there that would be considered essential and immune from further financial cutbacks? What services are there that could be performed only by a pharmacist and not by another health care professional? What is to stop a service subsequently being put out to tender with pharmacists competing with other health care professionals to deliver at the lowest cost?

Community Pharmacy has an unfortunate track record for willingly providing services for free or for trivial sums. I am sure the paymasters will have noted this fact.

 

Wolverine 001 , Pharmacist Director

This is total rubbish - service based contract utter nonsense 

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