Community pharmacy has had a very challenging couple of years, with funding cuts, category M changes, Brexit uncertainty and the Falsified Medicines Directive (FMD), to name just a few. There’s absolutely no doubt that we are no longer able to sustain a profitable pharmacy from dispensing alone – those days are gone.
So what impact do NHS England’s ambitions have on future pharmacy profitability, and how do we need to adapt to ensure we are primed to maximise opportunities for remuneration when they arise?
I guess the starting point – notwithstanding being laced with assumptions – is to interrogate where community pharmacy could play a role in its long term support of the NHS.
While NHS England’s 10-year plan – published last month – requires some reading between the lines, what is abundantly clear is the intention to continue switching funding away from dispensing activity, and make more of the role of community pharmacists – both in and out of the pharmacy setting. Indeed the phrase ‘clinical pharmacist’ has reared its head a number of times, not least as the focus of a recent BBC article: “The GP substitute will see you now.”
The intention for NHS England to work with the government to make greater use of pharmacists’ skills is encouraging, but it is very difficult to see where funding will follow. NHS England’s recent campaign, ‘Help us, help you’, is designed to raise awareness of the support community pharmacy can offer at a local level, and has ambitions to re-educate patients that their GP surgery doesn’t have to be their first choice for treatment and advice for minor ailments.
It is important that community pharmacy gets on board with these campaigns. However, what of our role in the future? With the announcement of a £4.5 billion increase in GP funding to support the establishment of primary care networks across the country, covering 30-50,000 patients each. Essentially, this investment will fund practice-based pharmacists, who will be a key part of the GP team working alongside a range of healthcare professionals.
On one hand, I worry for the traditional community pharmacy model. Not least the single paragraph in the long-term plan that references community pharmacy and reads “exploring further efficiencies through reform of reimbursement and wider supply arrangements”.
What the pharmacy sector now needs is for the government and the Department of Health and Social Care to commit to a new multi-year funding agreement that provides the certainty that community pharmacy desperately requires to invest for the future. This funding commitment is vital to enable pharmacy to maximise its role at the very heart of primary care networks. At present, the funding element is concerningly absent.
On the other hand, we must also focus on the more encouraging element of the government’s ambitions. If you are interrogate the 10-year plan, for me it seems that community pharmacy does indeed have a critical role, of tackling health inequalities: “In community pharmacy, we will work with government to make greater use of community pharmacists’ skills and opportunities to engage patients”.
As the saying goes: “The journey of 1,000 miles begins with one step.” We are not only a vital path along that journey, but critical to those ‘first steps’; educating our ‘future patients’ about smoking cessation, weight management and early onset diabetes. We are the frontline of health and pivotal to the government’s overall ambitions, and making sure future generations don’t contribute to the NHS crisis 20 years from now.
While we continue to face challenges, I’m optimistic for the future of community pharmacy. We should not sit idly by and accept the hand we are dealt. We must grasp every opportunity, and we must push for every penny – whether that’s through the Quality Payment Scheme, delivering medication reviews, vaccinating patients or digital integration. Let’s show the NHS what we can achieve.
Certainly, from our perspective, we will continue to lobby government, and fight for each and every pharmacy contractor to be fairly and equitably remunerated to reward and recognise their contribution to the health of their communities day in, day out.
Jeremy Meader is managing director of pharmacy support group Numark