It had been a good day as Pharmacist Scrooge tucked himself up in bed and sleep came easily.
A ghost appeared and said “I am the ghost of pharmacy past” and he took pharmacist Scrooge by the hand. “Here you are two years ago as Head of Medicines Management” Pharmacist Scrooge looked at his image as a Consultant asked: Please Pharmacist Scrooge can I use this new medicine – it may help some of my patients”
No said Pharmacist Scrooge “it’s just unaffordable” “There is no pay back within year” and “there is just no data in the over 80′s”. The consultant dropped to one knee and said “please Pharmacist Scrooge, I just need some options to offer my patients”.”Options, options, you have the cheap generic, what more do you need, do you think I am swimming in cash”
At that point a community pharmacist drove past in his nice new car. “Hmmmph – community pharmacists – only focus on dispensing and won’t all deliver the services that I wanted to commission”, “don’t think that they will get anything more from me”. The cheek of it, last week one talked about getting some guaranteed clinical service payments to allow him to reshape his staffing to allow a clinical specialist to be available for at least 6 hours a day”, “ridiculous – just take the risk – does it matter if your business goes belly up – always will be able to get a job on my team”
A GP walked in and he watched himself eye the GP carefully. “Hope you haven’t been prescribing any hypnotics this week – you know that they are dangerous!”. “No coco and warm baths this week and I have a new sign, it says if you have insomnia don’t come in here as I can’t give you anything for it – the PCT doesn’t believe insomnia exists”.
“I hear that you might be considering appointing a pharmacist to your practice team?.”
“Well yes – an independent prescriber and one that will do our risk stratification for us”
“There my staff – why don’t you employ a nurse – they are cheaper”
“But are they as good”
“No, but they are cheaper and I don’t really want you taking one of my team away”.
At that point Pharmacist Scrooge shut his ledger and turned of the ePACT and left the room, meeting Bob, the chief pharmacist from the local hospital on the way out. “Hi Bob, what are you after now?”
“Well I just wanted to talk to you about two areas that I just need your support on”.
“Hmmph, I hope your not expecting me to fund anything – I have budget targets to hit. I expect that you hit yours from all that purchasing profit that you forget in the recharging” “That’s a little unfair, I have been asking about 50:50 sharing if we go to all the trouble of procurement – it is not as easy as you think”
“No nothing ever is – I caught a doctor from your trust asking a GP to prescribe a drug that was not on the formulary – disgraceful – cant you keep them in check?”
“Anyway, I want to get proper medicines reconciliation of the ground and then do something linking up discharge to the NMS service”.
“Bah humbug”Pharmacist Scrooge found himself back in his bed, happy and drifting into a deep sleep.
Pharmacist Scrooge was again awakened from his bed. A Ghost introduced himself as Christmas present.
“How are you – are you enjoying Christmas?”
“Yes I will get a job soon – don’t you worry, everyone wants a medicines manager, we have been the only people in the NHS to have been successful.” At that moment Scrooge was spirited away into a room deep in no 10.
“How do we get the economy going” said a worried Prime Minister, “the pharma companies say that they are making representatives redundant and not launching medicines in the UK” and “I have everyone saying that we are slow to take up new technologies even if they are recommended by NICE”
Pharmacist Scrooge’s face flushed with embarrassment. “They think it’s my fault!” “I was implementing evidence based cost effective medicines management and my budget fell every year”
In a moment he appeared in a community pharmacy and watched the discussion with an accountant. “I am afraid that things look a little tough. Corporation tax, personal tax and now reduced income” “Could you find other income streams to help”.
“Hmm I should have changed a while ago, but it is difficult to pay salaries to those clinical specialists when you can’t guarantee the income” ” we just did not get the right help and direction”
Before Scrooge could say a thing he appeared in a nice little room. “I’m sorry Tim, but it’s not been easy, I only get £16.50 an hour for locus now and there is so much competition”.
“But Mum, you are so clever, those courses and your independent prescriber status and all your patients love you”.
“I know Tim, but the GPs don’t employ many pharmacists and the community pharmacists are not even delivering MURs and NMS services and locally enhanced services are harder to find”.
“But there are always the hospitals”
“Yes, I know you are right, but they found it difficult to change as well and money is tight everywhere”
“So why do I have to go to the hospital every time I want some new medicines? The consultant is very nice, but he only smiles and asks how I am”. “I am sure the administrator said “kerching” the last time”.
“It’s not my fault shouted Scrooge”, but he soon found himself in his old office. The room was bare and the wind blew through the broken window. In the corner sat his old team. “I should have taken that job at the GP practice”
“Have any of you got your interview at the CCG”
“No, they only have 0.3 wte and that will be shared”
“Has anyone told Pharmacist Scrooge yet?”
“Tell me what”, shouted Scrooge, “what!”, but before he could answer he was in a plush new office.
“What’s going on in the profession?” Asked a tall man in a suit. “I don’t really know” “did you know that they haven’t appointed a pharmacist in the LAT yet”.
“We’ll no – just the specialist commissioning pharmacist, but no medicines optimisation pharmacists, not a single one.”
“Medicines optimisation pharmacist – what is one of those – we need good old fashioned medicines managers – drive down costs and control that budget
” “But doesn’t always driving down costs drive down quality? Shouldn’t we be supporting pharmacists to drive up quality? After all if you look after quality the costs will contain themselves.”
“Poppycock! I will write a letter to the LATs – tell them how annoyed we are”
Before Pharmacist Scrooge could say anything, he was whisked again to a different office. A man was sitting there with his head in his hands. “What should I do”. He moaned. “Lead – come out and lead” said Pharmacist Scrooge – we need to be lead to a better place” but he was just shouting in his sleep – a very disturbed sleep.
Pharmacist Scrooge suddenly woke up and saw two men at the bottom of his bed.
“Oh no, don’t tell me the ghosts of Christmas future”. One man stepped forward and opened his hand. A little badge sat on his open palm. “I am the RPS fairy”. “Take this badge and wear it all the time”. Just like magic the badge jumped into the lapel of his pyjamas. “And I am ‘the man’ “, said the other, “come with me”. Within a flash Scrooge and ‘the man’ was in an office watching himself when a GP entered. “Just wanted to thank you for helping me employ that pharmacist – she is fantastic – a great asset – I don’t know why I didn’t do it before. Did you know we earned all of our QoF points this year”.
He was suddenly in a front room, looking at a Christmas tree with presents under it. He recognised Tim. His Mum looked very happy. “It’s been a great year Tim. I have all the clinical work that I need in community pharmacy”.
“Yes it has been a good year, and I don’t have to go to hospital so often now that my medicines are delivered through the community pharmacy. And that pharmacist that gives me all the support through facebook – Xrayser – cool.
In a moment he was in the Palace. “Arise Sir Dispenser – for services to your patients”
“Thank you Ma’am, and how’s the tummy”.
“Splendid, it is a pity that all my subjects don’t get this level of service”.
“Oh they do Ma’am, IBS, GORD, Dermatology and Respiratory are all commissioned services”.
“Splendid – oh and Philip will be in next week for the MUR and blood pressure check”
The surroundings changed and he was again watching the accountant talking, “You have turned the business around”. “Yes”, said the community pharmacist, “the transition fund just helped me to feel safe. I now have two clinical pharmacists and I will have to build a new consultation room soon. Income from dispensing is still falling, but clinical has gone through the roof”.
A door opened and two men in suites spoke “Have you seen the news Boris – ‘massive boost to the economy – investment from the life sciences industries’. Another term?” “Hmmm – don’t mind if I do”
He looked through another door and saw Sophie with her tutor. “I can’t wait to start in my new job. Things have changed so much. Loads of interesting opportunities, I can’t make up my mind where I want to work. Her eyes sparkled and the tutor said “perhaps you will come back and help me, student numbers are up again”.
A representative from the pharmaceutical industry – no – he didn’t usually see them. And there he was looking at slides. “This training program is great” he heard himself say, “When will the first set of GPs see them?”.
“Next week we have the consultant from the local hospital dealing with questions and explaining the referral criteria”.
“Fantastic, well done”. He couldn’t believe his ears, but what was that? A little badge in the representative’s lapel. It glowed and sparkled – a little green cross.
And again, he saw himself in a room and listened to himself speaking, “The hospital have been working closely with the community pharmacists and the practice pharmacists to deliver medicines reconciliation and NMR and now every patient gets a face to face medicines review or MUR with a pharmacist”.
“Seven new services off the ground and we are working with several charities to deliver supervised self-care through community pharmacy. And the public health initiatives are starting to reduce the determinants of poor health”.
“Absolutely fantastic, admissions are down, referrals are down, patient satisfaction is up and the prescribing budget is still tracking to break even”.
“Our first year as a clinical commissioning group has gone so well, we are so pleased with your work.”
“I see”, said Pharmacist Scrooge, “you are ‘the man’, you came out and showed us the way to optimisation”
“No, I didn’t really need to. Once I explained that the currency of medicines optimisation was admissions and referrals, everyone knew what to do”.
Pharmacist Scrooge found himself in his bed again. The RPS fairy was still at the bottom of his bed. “So, was the badge magic” he asked. “No” said the fairy “it just helps you remember that you are a member of the greatest profession on earth”.
And as Pharmacist Scrooge drifted of to sleep, he could be heard saying, “I knew that, the greatest profession……..”