I was going to use the standard term – at the crossroads – but community pharmacy has been at the crossroads too long and I wonder whether things have gone too far and we should really think the unthinkable. I was stimulated to write this blog for a number of reasons:
– a small chain of community pharmacies going into administration
– a general feeling in community pharmacy that ‘things are tough’ – when many seem to be facing quite severe financial and cash flow pressures.
– the Locum rates falling to a point where you can comfortably earn more as a tube train driver
– a series of worrying stories of pharmacies entering into ‘sharp practices’, often I would suggest at the instigation of businesses under severe economic pressure.
Community pharmacy has always been the most effective procurement arm of the NHS, but with the introduction of category M, the NHS earns large amounts of money through community pharmacy procurement. And with ever increasing prescription numbers, prescription complexity and current out of stock problems, the workload is increasing with a fall in total income.
But who cares? Everyone in the NHS is facing the same problem. GPs are always telling us this. Well I care and we need to talk about this openly. We also need to ask the question about what we now want from community pharmacy going forward.
I have spoken recently, some might say frequently about the rich community based asset that community pharmacy is. Usually located in the places where people live or shop – a cornerstone of our communities at a time when communities and high streets are under tremendous pressure. We want community pharmacy to play a bigger role in public health, out of hours and providing advice and treatment to patients relieving the pressure on general practice and in turn hospitals. The accountants say its tough, but community pharmacy will pull through – but that does depend on an improving economy and additional money diverted into community pharmacy based services. I wish I shared their optimism – but then they are accountants and a business closed is a client lost – so they shout ‘hold on in their and keep paying the accountancy bills – it will get better’.’
But the community pharmacy contract is not helpful and does not shift the focus from procurement profit to service delivery yet. England is miles behind Scotland and many of the locally enhanced services have moved ownership. These services are fragmented and localised. I know that localisation is good, but administration is increased and duplicated when I thought that we were going to sort out innovation and spread of good practice following Innovation, Health and Wealth? I know that the Chief Pharmacist is looking at ways of relaxing supervision requirements, but that is tinkering with airspace rather then a solid solution.
So where might we end up? Well smaller community pharmacies will become unviable. They don’t have purchasing power and without the additional service contracts, they might close. Don’t think that the multiple chains will take over – they will ‘divest’ their least profitable pharmacies. It’s business! So you might not find a community pharmacy near your home, within your community, on your high street. You may have to travel further to get your medicines dispensed, your questions answered, the support you value. I hate the thought, but your medicines may plop through your letterbox in the ubiquitous Jiffy bag. You may need to spend more time in your GP practice.
But it doesn’t have to be like this.