I was happy to be invited to the NHS Alliance AGM and policy day. It gave me two 30 second opportunities to speak to ministers – not a conversation, but two single bullet point opportunities. It is not that easy to blurt out two points, but here are my attempts:
To the Shadow Health Minister: “Please look at the legal framework for prescribing and get community pharmacists simple prescribing status, similar to district nurses so they can prescribe medicines to those who can’t afford to buy their medicines and are directed to general practice.”
I am not sure that she fully understood what I asked, but she duly looked interested and wrote it down. There is a level of ambiguity in what I am asking for and a level of confusion created by pharmacists themselves. Pharmacists often talk about ‘counter-prescribing’ which is a confusing term, much better translated into ‘we sell medicines to those who can afford to buy them’ – and probably to some that can’t, but are desperate. People understand this and those who don’t want to buy go to their GP and contribute to the bulging waiting rooms. It is a situation that is unfair to those on low incomes, unemployed, on benefits, retired – anyone who feels that they can’t afford the price. It is inequitable – if you are wealthy you go to the convenient community pharmacy – if you are poor, you go to the GP practice – simple! It doesn’t help those living in tough communities (I was told not to use deprived any more). I would agree that several localities have identified this issue and have minor ailment systems in place like ‘Pharmacy First’, but there needs to be over 200 systems throughout England, administered through 28 area teams, all with PGDs. And the two options are to commission minor ailment schemes nationally with huge bureaucracy or simply change the law/regulations. Give a community pharmacist a prescription pad and a limited list formulary and they will use it wisely to the benefit of their communities.
I do not understand how, post the Crown Reports, a system where community pharmacists were allowed to prescribe a selection of medicines from a limited list in line with the common conditions that they manage under minor ailment schemes at the NHS expense was not included. Just admit it – it was an error, an oversight – just sort it out please – preferably before general practice implodes.
When introduced to Lord Howe, he smiled and said that he was the minister responsible for Pharmacy: “There are over 800 community pharmacies with 100 hour contracts; many more that are open for 80+ hours a week and none of them have a specific contract for the provision of out of hours care.”
Well that’s another one that hit a quizzical face. No honestly, the regulations were altered to allow community pharmacies a contract if they were open to the public for at least 100 hours a week. And with the additional 600 that were granted last year, I have grossly underestimated the numbers – probably closer to 2,000 now. I thought that I understood the logic of forcing community pharmacies to open longer and provide a much increased service to the population for the same cost to the NHS. Access was the driver and it all made sense. But now I have to ask – “was the Department of Health creating a valuable asset for the NHS to waste?” – “Having a laugh” – “have they lost their way”.
I have read so many documents on urgent care that I now play community pharmacy bingo. ‘Commissioning the whole system (urgent care): why the big picture matters’ – not a single mention – hardly a big picture then. No one has twigged that some community pharmacies are open 100 hours a week with a pharmacist on duty. If the pharmacy had an out of hours addition to their contract; if they employed a pharmacist independent prescriber; if they co-located a nurse; if they co-located a GP – well you have a walk in centre, a minor injury unit, something that will make a difference.
I do agree with commentators that it is important to match supply to demand – the higher the attendances at hospital – the higher the admission rate. But to leave community pharmacy out of the mix – amazing!
Well, they were my two 30 second opportunities to ministers – what would you have said?