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Xrayser: Government's approach to pharmacy puts the whole NHS at risk

"Online pharmacies and collection lockers are unable to provide meaningful patient services"

The D-Day anniversary serves to remind Xrayser about the founding principles of the NHS – and consider whether they are at risk

I’m writing this article on June 6. On this day, 75 years ago, my father landed in Normandy, France at the intersection of Gold and Juno beaches with his company of Royal Engineers. His was the skilled and detailed engineering work of a sapper that included bridge building, airstrip construction and bomb disposal. He was kept on after the war ended to help rebuild civil infrastructure, coming home just months before the formation of the NHS in 1948.

For 70 years since my father came home, the NHS has provided health services. I’m proud to be a part of that. A sign in our pharmacy says “providing NHS services”, but I fear that if commissioners continue not to recognise the law of unintended consequences then that sign may no longer be true.

Pharmacy provides patient care, wellbeing, health advice, support for self-care and healthy living on the cheap. Pharmacies make huge savings for the NHS every time their staff advise patients about medicines, preventing them from visiting A&E and GP surgeries.

Increasingly we also must support patients of my father’s generation, who are confused by increasingly complex access to repeat medication. This leads them to order drugs not yet needed, or require an emergency supply of medication that they do. The NHS Urgent Medicine Supply Advanced Service (NUMSAS) figures aren’t only increasing because of greater engagement by pharmacies, but because of greater need, as conventional primary care services are lost.

For a long time our portfolio of services and patient support was possible through retained dispensing profit, funded by a combination of buying margin and dispensing fees. But then NHS England was persuaded that dispensing meant counting smarties into a box and posting through a patient’s letter box, a task requiring no margin and but a minimal fee. As financial pressures upon the NHS led to reduced fees, they also led suppliers to increase their prices by a variety of mechanisms, until any surplus in the system became a deficit.

I fear that those the Pharmaceutical Services Negotiating Committee (PSNC) negotiates with are not only unable to comprehend the economics of healthcare service provision, they also have no understanding whatsoever of the very patients for whom they are supposed to be commissioning services. The people who have the greatest healthcare needs are the elderly and infirm, those with physical or mental disabilities, and those experiencing social deprivation. They need accessible support from patient advocates found in pharmacies. Such patients are least able to access medication online or via collection lockers – neither of these dispensing methods are able to provide meaningful patient services.

Soon after coming home in 1948, my father saw the formation of the NHS, the largest publicly funded healthcare system in the world, whose guiding principles include that it meets the needs of everyone. If NHS England continues with its way of commissioning pharmacy services it will meet the needs of few, and there may be few pharmacies remaining to provide them.

A long-running C+D contributor, the identity of Xrayser remains a mystery, but his irreverent views are known by all. Tweet him at Xrayser

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