I hate it when I’m lied to. It happens with patients, it happens with company reps, but it’s worst of all when it happens with NHS England, which lied repeatedly about the official intention of the Department of Health and Social Care to put 3,000 pharmacies out of business. However, it seems enough time has passed that they can now imply the truth of their policy regarding pharmaceutical services.
I know that we’re not the only vocation to have experienced this. Since 2009, the government has obviously thought there are too many police officers, too many nurses and too many service personnel in the armed forces, and reduced their numbers accordingly. Seemingly content to allow the health and security of the country to suffer, they have now moved onto the high street chemist, with a funding freeze that sets out a five-year programme of pharmacy closures.
There’s no denying that there are clusters of pharmacies, many of which are the direct result of the incompetently planned and obviously flawed loophole that was the 100-hour contract. Inherent additional costs of maintaining extended opening hours meant that these pharmacies inevitably opened where it was most financially viable. Consequently, the attrition of the pharmacy cuts is more likely to close the altruistic contractors who are providing a necessary and desirable healthcare service for smaller or more deprived populations.
As happens so often in the NHS, the cart is put before the horse, summed up by Sir Robert Francis QC who chaired the inquiry into scandalous care at Mid-Staffordshire NHS Foundation Trust and said: “The answer is not to get the people to fit in with the service – you need the service to fit in with the people.” Therefore, pharmaceutical needs assessments are now redundant, because NHS England will never restrict funding for pharmaceutical care to only where it’s actually needed, and is too scared to close pharmacies they deem unnecessary or poorly performing for fear of the inevitable legal challenges to any such decisions.
All that being true, I am still optimistic for the future of community pharmacy. A pecuniary natural selection will force us away from loss-making supply into a service-based model, and while the five-year funding agreement retains income on the floor, at least we have surety that it won’t fall through into the basement. If you’re not already six feet under, maybe it’s reassuring that you should survive another 60 months, particularly if you have a degree of autonomy. In contrast with accountant Umesh Modi, I suggest that independents are best suited to survive, being without the overheads of corporate structure or the need to drive shareholder return, and an ability to respond and react more quickly.
But I can only react quickly if I am freed from much superfluous bureaucracy that inevitably accompanies new services demonstrated, for example, by the NHS Urgent Medicine Supply Advanced Service. As never before, pharmacy needs to benefit from the red-tape reductionist promises of Prime Minister Boris Johnson, unless that is yet another government lie.
A long-running C+D contributor, the identity of Xrayser remains a mystery, but his irreverent views are known by all. Tweet him @Xrayser