Here we go again. In the most exciting saga since Dallas asked “Who shot JR?”, Northern Ireland is facing a JR of its own. But, rather than a Texan oil magnate, our JR stands for judicial review. Contractors in Northern Ireland are all too familiar with this term now, having experienced three in the past five years.
JR3, as I like to call it, is really the unfinished business of JRs 1 and 2. JR1, you might remember, was a win for contractors – monies that had been extracted were repaid, and the Department of Health, Social Services and Public Safety (DHSSPS) appreciated its mistakes and changed its processes so that money could be extracted legally.
This led to JR2, which did not reach court thanks to a compromise: the DHSSPS would undertake a margins survey, a cost-of-service inquiry (CoSI) and a pharmaceutical needs assessment to establish the right level of funding for the community pharmacy sector.
It agreed to pay £6 million annually into the system until the CoSI was completed. But the agreement was not upheld for long – CoSI has not been completed, yet no such payment was made in September 2014.
All of which brings us to JR3, which was heard in June. However, delays mean it is unlikely we will learn our fate until the end of autumn.
The advent of JR3 has prompted the DHSSPS to progress the CoSI. Negotiator Community Pharmacy Northern Ireland (CPNI) is keen for contractors to comply fully with the inquiry, so the real costs of our services are known. It is confident that, once the inquiry has been completed, it will give weight to the claim we are not getting "fair and reasonable" returns on the businesses we run. Few of us would disagree.
Damaging to sustainability
But it may not be that simple. One of the accountants advising CPNI on the issue gave an enlightening overview of the CoSI processes at a contractors’ meeting earlier this year. She delivered a three-paragraph answer to the simple question: what is a fair and reasonable return?
Once she had finished, our brains tried to absorb the accounting technicalities she described, and we all arrived at the same conclusion: it is whatever you make it out to be.
I am unhappy with JR3. I see the logic in taking the approach, but I do not support it. It is severely damaging to the long-term sustainability of our contractor network. Ironically, there is every chance that the results of the CoSI will be available before the JR3 judgement, which renders it redundant.
We are already seeing the consequences of this legal battle. These are illustrated by a recent meeting called to discuss a business case for supporting frail, elderly patients taking medicines in their own homes. Medicines support is key to keeping these patients out of hospital, and community pharmacy, through a commissioned service, is the right place to provide this support.
But it was telling that the Health and Social Care Board had little appetite to do business with pharmacy contractors, seeking out any other solution than commissioning a service from its legal nemesis.
We might win the JR3 battle, but we are losing the war.
Terry Maguire is a community pharmacist in Northern Ireland with 30 years' experience. He is recognised as a pioneer in the development of pharmacy services in the UK and beyond, having developed a model service for pharmacists in screening for raised cholesterol in the 1980s, and a smoking cessation programme in the early 1990s