Letter to Dr Ridge

In some way I would like to offer some support for change within community pharmacy. Years of poor contract arrangements and the period of contract relaxation has left us in a poor state. Unfortunately I believe that community pharmacy is mainly procurement driven with most of its income coming from the core contract. That is not to say that this has not delivered major savings to the Government and, from what I can see, we have some of the lowest prices for generic medicines across Europe. But it is too easy to focus on saving a penny on a pack of pills. So the government has benefited greatly from the situation, despite losing millions of pounds through inefficiency, such as the Alogliptin error and the failure to offer appropriate advice surrounding pregabalin.

What we actually need is a clinically driven community pharmacy service with pharmacists, technicians and counter staff, better educated and in patient facing positions. I would add that many pharmacies have tried to implement change through healthy living pharmacies, self-care pharmacies and several other local initiatives. And some, simply have inspirational teams who genuinely focus on their patients. There needs a way for their efforts to be noted and rewarded.

In my past, I have been critical of community pharmacy in their ability to deliver services across a locality. However, I have now seen service delivery data presented to senior managers in pharmacies and the full effect of peer pressure brought to bear to improve the quantity and quality of delivery. I would ask why it has taken so long to introduce peer pressure into community pharmacy, when we know how successful it has been employed in General Practice.

I understand that on the face of it a cost of £2.8b to deliver £9b worth of goods may sound expensive, but, as I have said the current contract does not reflect the important role that pharmacies have in local communities and to their patients.

Personally I do not think you have gone far enough. You will make community pharmacy look even closer at their procurement and how they can reduce overheads to maintain viability. The NHS Alliance has made it very clear that they understand the need for efficiencies, but General Practice is under pressure and we need a different clinically led community pharmacy in the heart of communities.

This is an opportunity to make ‘Now or Never’ happen – you were there and know this well. Please would you consider taking more money from the dispensing and retained profit side of the equation and releasing part of it to reward patient facing elements? The past chair of the RPS English National Board asked that 50% of the community pharmacy contract should reflect clinical and partnership work – I sincerely hope that you have heeded his words and perhaps have this target in mind.

As a minimum, I expect there to be some reward and stimulus for joint working. Community pharmacies within localities need to work together. They also need to engage with GP federations, PM challenge fund sites and the Vanguards. They need to be viable options to deliver area wide services if Mr Steven’s five year view is going to come to fruition.

I also expect a payment to be made to pharmacies that deliver a significant patient facing element.

I understand that you may think that there are too many pharmacies in England, but I disagree with you. There are, however, too many pharmacies which are procurement driven. I don’t want pharmacies to close, unless they really are unviable, but having watched two pharmacies close recently because of rent escalation there are other differences with the GP contract that show a real lack of equity in the system. I can also accept that some pharmacies which cannot embrace change may also have to sell to companies or individuals who can or close. It would be a shame is any small pharmacy that provides a valuable clinical service within their community is forced to close.

I also don’t agree with the PSNC. Practice Pharmacists are not a threat to Community Pharmacy. They are important for GP practice skillmix and survival – I can’t understand why every practice hasn’t got a pharmacist. I believe that they are an asset to community pharmacy and provide a valuable and missing link between the independent contractors.

I do believe that changes in the core contract have the ability to drive clinically led Community Pharmacy. Community Pharmacy should be a clinical speciality in its own right and as such requires a redefinition of medicines optimisation and a new form of training. There is still a lot to do, but Pharmacists demonstrate willingness and resilience

The time is right; the profession is willing; it is up to you; Now or Never.


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