Dispensing on the Titanic

Today the RPS funded Commission launched it future models of care document and the RPS ENB gave its strongest commitment to support the interests of pharmacists. I have to say that David gave a closing speech that was delivered with sincerity, believing the commitment that he was making. I know he will really try.

I loved Judith’s quip that pharmacy has had more ‘visions’ than in the Old Testament, her view that the window of opportunity was now, the naming of the document ‘Now or Never’ and her plea to ‘just do it’.

It was Stephen Dorrell MP that asked the audience – ‘which group of healthcare professionals see more people each week than all the rest put together’. Really – even I hadn’t used this statistic before – something to be think about with pride.

I was chatting to Nick Kaye – he is always an inspiration – a clear ‘can do’ pharmacist, but it is undoubtedly the time for all the profession to do.

There were, however, some things that were not said. Dispensing is dying, the contract is a disaster and the government, DH, NHS England, Uncle Tom Cobley and all agree. I reflect that dispensing has changed. The need for pharmaceutical compounding skills is gone – we no longer make much and measuring out water to make up an antibiotic mixture is as complex as it gets. Let’s be honest – we put labels on original containers. The clever and important bit is the patient interface before and after the dispensing.

Keith is clearly right. There is now a clear and growing view that the dispensing element is not considered good value for money. Community Pharmacy has saved millions of pounds for the NHS through good procurement, but it is not enough. The government feels that big business will bring in automation and additional discounts through purchasing power which would be reflected in increases in the National Average Discount Rate and money will come rolling back into the coffers. I am not sure that I agree with them, but that is hardly likely to matter – it is an iceberg coming our way. They might even consider putting dispensing out to tender when the electronic transfer of prescriptions is routine. And the vultures are circling.

It’s like dispensing on the Titanic. It is sinking and we are still playing. Bright new pharmacists are drowning under the pressures and are not realising their aspirations. So Captain Smith is saying it’s Now or Never – just do it! Now that is a strange coincidence isn’t it!

Where Keith is wrong is saying that there are 3,000 too many pharmacies and we should go back to earlier days. This is assuming that pharmacies are only there to dispense. Pharmacists are much more than dispensing. Pharmacy technicians are much more than dispensing. Pharmacies and the whole team are much more than dispensing.

We actually have a strong and vibrant network of pharmacies. The old rivals of multiples and independents are working together, led by visionary pharmacists. There is a real opportunity to link up groups of pharmacies with groups / federations of GP practices and look to solve local community issues. All primary care contracts are a disaster – we must show NHS England how we can work together so they can align the contracts to facilitate progress. Heaven knows, they can’t do it on their own – we have to show them the way – lead by example.

Let’s look at people who want pharmacists and pharmacy owners to step up and solve the problems:

  • Jeremy Hunt needs to solve the A&E crisis. He has thrown some cash at it, but he knows that he has to manage demand. Only community pharmacy can change the flow of patients to A&E and prevent the swamping of General Practice. Common condition services with proper access to medicines and technology support is the answer. Don’t complain about 100 hour pharmacies, they are the solution to out of hours care
  • Professor Kevin Fenton said that he would like to see 5 new services (public health based – non-transmissible disease related) in community pharmacy within the next 5 years. Too slow Kevin – people are dying – let’s do it quicker
  • Sexually transmitted diseases, safe sex advice, emergency hormonal contraception, contraception, services for women and children – where else, but in the community pharmacy – local, discrete and effective.
  • Duncan Selby looked disappointed hearing that there were so few healthy living pharmacies – I think he hoped I would say 5,000 – if you want more just ask
  • Jane Cummins pledged further action to protect patient safety. With 1,700,000 serious prescribing errors each year, the failings of care homes – surely she will turn to pharmacists to help.
  • Dr Mike Berwick says we are not doing enough for the 15m people in England with long term conditions. If there are real problem in medicines selection and adherence – think pharmacist – just saying. Even Paul Dinkin in monitor said that skill mix was the answer
  • Patient organisations, such as Diabetes UK who spoke at the launch today all say that their members value the advice and support that community pharmacists offer – pharmacists change lives – tell your MP.
  • National Voices talk about supported self-care. Who is better positioned to help you with this agenda?

I can’t wait for the community pharmacist and the pharmacy technician to remove the chains that keep them in the dispensary.

So national frameworks, area implementation and local flexibility is the answer. If we remove the problem, perhaps everyone will see community pharmacy as the solution.



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