Is it still now or never – or has the rush passed and are we still calling to action? All I know is that we have to think differently in community pharmacy. We are where we are, some might say, but it is neither where we want to be nor what the population or the NHS wants from us.
So let’s start with the negatives. We have a community pharmacy contract that is dispensing focussed. The DH believes that there are too many pharmacies and that dispensing is not economical. The provision of clinical services is hugely variable in volume and in quality and we are losing our way. There is money in the system, but it is not going to flow in a manner where it could end up in owners’ pockets. The politicians are not confused as to the role that they want community pharmacists to play in the future, but they can’t see a path.
And the positives. The government seem hell bent on driving patients to the pharmacy before booking an appointment with the GP or out of hours provider. Areas have built new services against the trend and many community pharmacists are providing services that are above and beyond our basic expectation. Community Pharmacists are engaging more, but are still a way from building integrated multi-professional services within primary care other than in PM Challenge Bid Projects. The government will invest in pharmacists to support primary care or at least in GP practices.
One sad fact always comes to mind. A procurement pharmacist in a multiple can make more money for the company in one trade than a whole team of clinical specialists over the year. Remember this as this is important.
If there is little new money, then it may be about trading and compromise, working towards a new definition of community pharmacy that suites the population, the government, the profession and the owners. Perhaps the owners are the key to change – have we understood this?
So what are we going to do about dispensing? Here is just one suggestion. We split prescriptions into acute/first or repeat – it is easy to do. We slightly increase the dispensing fee of all acute/first prescriptions and reduce significantly the fee for all repeat prescriptions. The money saved goes into two separate pots. The first is an establishment payment that supports any pharmacy to upgrade to a ‘Healthy Living Pharmacy’ or ‘Self Care Pharmacy’ – I don’t care which, but these pharmacies have additional features and additional standard services. We can bundle ‘Pharmacy First’ or MASchemes into this, along with staffing and training requirements. The second is a clinical services pot which supports the pharmacies becoming a clinical service point within the system – it might only need to be a pump-priming fund and could sit under the control of the Chief Pharmacist. No more dabbling in asthma or pain management – a fund that can support pharmacists to develop and deliver specialities in the pharmacy.
Yes it is about a choice – repeat dispensing will be less profitable and factories may take a larger role – but community pharmacies have the chance to develop and provide additional services. And yes CCGs and LAs that already invest in community pharmacies must embrace this move and we work out how their commitment is rewarded. A community pharmacy must be able to survive dispensing fewer repeat prescriptions (or sending them to a factory) and increased clinical services.
Community pharmacy also needs to think independently and locally. Joining as members of federations they can play an active role in the delivery of multi-professional providers within primary care. Through this route, community pharmacists will bid alongside GPs, Optometrists, Dentists, Community Service providers and the voluntary and charitable sectors for contracts. This is the way forward and if it doesn’t work then hospitals will take it over (whatever that will mean).
I am hearing that the multiples are split – some see that dispensing is their future and some see that clinical services hold the key. That’s fine – there is room for both views and perhaps, in the future, owners will be able to make a choice, knowing that both can thrive.