As an observer of the community pharmacy contract negotiations, I often wonder – what if?
You have to criticise the way that the letter was presented – almost as a done deal – with the near celebration that between 1,000 and 3,000 community pharmacies would close. There has been some serious backing off on these claims and quite rightly too!
You also have to congratulate the NPA on their campaign. A plethora of MPs have promised their support and the public have come out in droves to sign petitions. Even the RCGP and the NHS Alliance have been clear to ask whether this makes sense when the NHS is under such pressure in primary care. Have they put all their eggs in one basket – where is plan B?
But what if – NHS England pushes on with the cut to core funding? Will between 1,000 to 3,000 pharmacies close – that is the basis behind the whole argument. What if – will we be asking for volunteers?
Of course we can all view the core funding discussions as a ‘lever for change’. Certainly the threat of going out of business is a significant lever for all businesses. But what change? Certainly some of the multiples have started a change program, but is it to late to turn this whole tanker around and are the players breaking rank?
There are other fundamental problems that will not be easy to deal with. We have very little clarity about what clinical community pharmacy practice is. There are a lot of things a pharmacy team can do – but few seem to have a ROI or a funding route or deliverable without access to medical records and prescribing authority. And what is ‘medicines optimisation’ in a community pharmacy setting? Talk to me about outcomes that can be delivered in a community pharmacy setting that are funded. There is little recognition and reward – we have no career structure for clinical pharmacists within community pharmacy. We have a workforce that desperately needs someone to understand their aspirations and a little voice, seldom heard, that says ‘I am a pharmacist trained to interact with people to improve their outcomes and create health’. Tell me – who speaks for the individual pharmacist here?
On a structural level we need a mechanism for pharmacy federations to develop as commissionable forces within the NHS. Collaboration and not competition – common causes not everyone for themselves.
So much to do, so much at stake, so little time – but what if?