The headline sounded great, however the underlying messages in the letter from NHS England and the Department of Health dated December 17 were not the clear vision for the future of the sector that the owners and employees of community pharmacies in England would have hoped for. What it was is a wake up call.
We understand that the NHS has financial, quality and access challenges and it was broadly accepted that the recent government spending review would have some impact on funding for the sector. However, many were unprepared for a £170 million cut (6% of the global sum) to be delivered in the 6 months from October 2016 (equivalent to a 12% cut in the period) and potential further cuts in the future.
How this will be delivered has yet to be negotiated, one can but assume it will come from fees and retained margin so difficult to predict the impact on individual pharmacies. In addition to the uncertainty that accompanies the lack of clarity, one big concern is the expectation that it will not impact quality or access to pharmaceutical services, something that the dedicated pharmacy workforce will always strive to maintain. We are already hearing plans to reduce investment in people, technology and premises at a time when access to healthcare services is already under enormous pressure.
The letter highlighted several other plans for the sector including a Pharmacy Access Scheme with an intent to reduce the number of contracts (the Minister stated between 1000 and 3000 less at a recent APPG meeting). How this will happen is apparently down to the sector itself based on viability in the new funding landscape that also includes the phasing out of the Establishment Payment currently worth around £25,000 per annum and meant to underpin some of the core running costs of a pharmacy.
The letter also refers to Hub and Spoke arrangements and large scale automated dispensing – we have yet to see any robust evidence of cost-efficiencies from such initiatives but should keep an open mind on the potential of remote assembly. Optimising prescription duration and online ordering of prescriptions with click-and-collect options are also mentioned. These may have some merit given the ever increasing volume related workload but will require a different funding model based on care including supply, not just supply activity. However, we should be concerned at the thinking around increasing home delivery. We must do nothing that reduces the opportunity for a face-to-face pharmacist-patient interaction and thus intervention to improve outcomes from the safe use of medicines; medicines are not commodities!
We must embrace technology and innovation; releasing the talent and time of pharmacy teams is highly desirable so that we can further increase and improve the delivery of pharmaceutical care, clinical services and healthy lifestyle interventions. However, these will need funding to appropriately incentivise and reward the value of such services.
Finally, it will be interesting to see the outcome objectives of a Pharmacy Integration Fund. I have always sought greater intra and inter-professional collaboration and the recent investment (£40+ million) for pharmacists in GP practices should be an opportunity both for patients and the profession as a whole, but this must operate within a culture and an enabled joined-up framework with all pharmacy sectors to succeed.
The pharmacy bodies, the sector and the profession have an important job on our hands to ensure that this potential burning platform is turned into a burning ambition and opportunity for community pharmacy teams to improve the health and wellbeing of their communities. We must create a compelling and relevant offer for a modern health and care system; one that meets the needs of the system and the population and delivers quality, value and a sustainable future.