Primary Care Economics

The Department of Health has its master plan. It understands that General Practice has been underfunded for many years, while patient numbers grow and people have more long term conditions. There is now more than 4 million people with diabetes in the UK and, at least for a time, people are living longer. Lists are closing, it is difficult to find a GP to employ in some areas and a crisis is looming.

The answer is obvious. A new deal for General Practice – an increase in funding, support skill mix and try to stimulate GP and nurse training.

But where will the money come from to do this. The answer is less obvious. Cut community pharmacy funding by at least 6% while there will be an increase of 3 – 5% in workload. So perhaps 5% more prescriptions to be dispensed with a 6% cut in income. Quite timely since it comes on top of a 3.3% efficiency saving last year. Can any business survive with a 14% efficiency saving over 2 years?

So what will be the result? Business is a simple equation – income minus overhead equals profit. 60% of the community pharmacies in England are owned by large companies that are driven by profit – it is the way that it is. They will cut overheads by reducing staff numbers or salary rates and if that does not work they will sell or close unprofitable pharmacies. The 40% of independents and small chains will do the same, but it is their livelihood so they may hang on a little longer.

This is all coming at the time when local authorities are being cut and will be unable to commission primary care based prevention services and specific services for the elderly.

Will the community pharmacy network be maintained – perhaps there might be a fund to support this, although the essential small pharmacy scheme was scrapped recently. Will there by service development – perhaps there might be an integration fund – to support – well integration.

At the end of the day, patients are likely to find a longer walk to their pharmacy, less staff on the counter or available to offer advice, fewer services and a cut back in the freebies like monitored dose dispensing and delivery.

Where will patients go? Probably to their GP which may add to their problems. It would be great to see the analysis that has been carried out to consider the effect of cutting community pharmacy funding.

Mark Spencer from the NHS Alliance recently commented on the increasing funding for General Practice. Of course that is needed and welcomed, but he said that there is a need to increase funding and joined up activity right across primary care.

This robbing Peter to pay Paul economics within health seems crazy to me.



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