There was a meeting – deep in the corners of the Department of Health.
“Free at the point of delivery”. It broke the silence. “Why does the NHS have to pay for everything – we just don’t have the money – and everyone is revolting”.
“Well that is not absolutely true Minister, we have a retail healthcare arm that we contract with that does sell healthcare products to members of the public”. Offered a rather smug junior.
“But that can’t be significant – what do you mean?”
“I think that we have over ten thousand retail outlets that we commission in England – it is called community pharmacy – and I understand that they are doing a little better these days”.
“What do you mean – ‘a little bit better’ – explain this”.
“Well George’s policies have created a little more consumer confidence and with that comes a slightly increased willingness for people to buy things that help their feeling of health and wellbeing, but….”
“What do you mean but…”
“But, Minister, we have been working so hard to drive people into the NHS that it one of the reasons why General Practice cannot cope and we have no money”. “We have hardly been supportive and innovative with community pharmacy of late – a publicity campaign, but generally we have driven policies that have reduced the time pharmacists have with members of the population – that is a bit of a shame and a bit counter-productive”.
“Never really thought about them – keep banging on about their dispensing contract – never mentioned that they see patients and sell medicines – go on”.
“Well the NHS probably spends half a billion pounds on simple medicines – you know that we spend £80million on paracetamol alone on prescription – that is about 1,000 GPs in common currency terms – and the ones we do have are spending their time looking after minor common conditions and prescribing this stuff”. “White mixtures, cough mixtures, antidiarrheals, some creams and many others. If we moved all of this then people might get the message – visit your pharmacy first – just make it non-reimbursable”.
“And there are so many conditions that we actually want patients to take control and make lifestyle changes, but we dole out the medicines like sweeties”. “There are a lot of conditions that people can control themselves if they had access to affordable medicines”. “Do you remember all the fuss about prescribing statins to lower risk patients – we if we made some changes the patients could make their own choice and buy something if they thought it important to them at a more reasonable cost”.
“And before you know it we will be paying for electronic cigarettes on the NHS and inflating the cost of the services, rather than spending it on front line staff”. “We have problems with gaps in many services like foot care and oral health problems in patients with diabetes – and lots of others – we might persuade community pharmacy to take this on rather than employing more people to do it”. “There are quite a few services that we commission that community pharmacy might be willing to take on at a lower cost to us if there is a retail element”. “Give it all to community pharmacy to sort out – that is what I would suggest”.
“So what actual value are you talking about here?”
“I don’t know offhand – perhaps we could save £500m on medicines and the same by decommissioning services or not commissioning additional services. I am sure that any saving in GP appointments and time would be most valuable at the moment”.
“Right then we give all of this to those Community Pharmacy fellows, free up significant resources within the NHS, reduce general practice workload and help to give people choice and more control of their medical conditions”.
“What a great idea Minister, when shall we get started?”