“PSNC still not agreed new price concession system,” ran the C+D headline last week. Although, to be honest, it could have been any week. “Same story different day” – that should be the motto of pharmacy.
More than a decade on from when medicines use reviews (MURs) were first criticised for being a payment for activity, there’s not been a single national service negotiated that truly demonstrates a PharmOutcome for patients. And before someone shouts “flu vaccination”, that’s still an activity, not an outcome, which is why Public Health England has admitted the vaccines used previously were less than effective and why this year’s vaccine ordering has been such a Sisyphean task.
Meanwhile, there continues to be this Machiavellian price concession system, and still we are in thrall to the wholesalers and extortionist orphan-drug manufacturers. Our own clinical commissioning group’s (CCG) medicines optimisation team has allocated £4 million of its £5m deficit to price concessions alone, so no wonder many CCGs have been forced to resort to branded generics in an attempt to stem the haemorrhage of cash that pays for these overpriced drugs. The only ray of sunshine has been for those contractors who have seen their gross profit increase, as instead of a 5% margin on a 90p box of tablets, they receive 5% on a £50 box.
The degree I took was all about drugs and so to succeed in a community pharmacy I thought I’d need statistics and knowledge of pharmacology, not of microeconomics. Now, instead of devoting time to MURs and new medicine service consultations, I have to work on medicines availability reviews and new medicine supply. It appears a situation either impossible to change, or one that our national bodies seem unwilling or powerless to.
The Pharmaceutical Services Negotiating Committee (PSNC) apparently can’t influence this profiteering, the Royal Pharmaceutical Society is toothless, the National Pharmacy Association seems to focus ever more on its commercial offering, and the Pharmacists’ Defence Association don’t care so long as the pharmacist has the final check – no wonder that any Pharmacy Voice we might have had has gone, both literally and figuratively. Understandable then, as well as admirable, that NPA board member Mike Hewitson decided he’d had enough of it.
We have seen many clinical innovations over the last 10 years, which have allowed community pharmacy to make a significant contribution to wellbeing. Transformational healthy living pharmacies, innovative local and private health services, and many more showcased each year at the C+D Awards. But fundamentally our essential contract still revolves around an activity-based supply service incentivised by a smoke-and-mirrors profit scheme, with the latest example – the National Urgent Medicine Supply Advanced Service (NUMSAS) – proving to be a service that’s as stupid as its name makes it sound.
To paraphrase Shakespeare, something is rotten in the state of community pharmacy, and until we see actual details of the proposed ‘care-orientated’ funding contract recently referred to by the pharmacy minister, I remain to be convinced anything is going to change.