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