Thinking flu – community pharmacy

Well another season has passed and another set of targets missed. It is just as well that it was another fairly light year. Hitting the 75% of over  age 65 years group proved just as illusive this year, and we are still miles from the under 65 years and at risk group. We couldn’t immunise 70% of the diabetics under 65 and we missed more than 60% of the pregnant women in England.

Immunising care workers crept above 50%, but that is hardly something to shout about. We can’t achieve a 60% immunisation rate in GPs. And don’t mention the program in 2 and 3 year olds as 42.6% and 39.5% is hardly a great result.

I am hearing about General Practice almost on its knees, but, I am mildly optimistic.

London Area Team are again commissioning community pharmacies across the whole of London to support the national flu program again. Where last year was a little last minute, this year the notification and awareness is early. I was impressed by the effort of community pharmacy last year and expect, with the advanced warning, even greater things this year.

I saw a couple of examples where innovative community pharmacists helped hospitals to deliver their targets, but I expect that to be a more common activity this year. It would seem to me an important step to increase the immunisation of healthcare workers in all situations where they have regular contact with patients to be immunised

I have also been pleasantly surprised that the shingles vaccine will also be available to community pharmacy. And I will check the paperwork to see if pregnant ladies and children are also included within the specification. Perhaps that is too much to ask for. However, next year I hope that community pharmacy, through their core contract, may be asked to work in partnership with General Practice to deliver all immunisations within the national program.

At the end of the day this all about giving more opportunities for people to access appropriate immunisations. I will be expecting community pharmacists to be asking – “have you had your flu vaccine this year” to more people this year, followed by the invitation – “ you can have it done at the local GP practice or if you want, I can give it to you here”.

So if you want to ask me the question? The answer is yes – my community pharmacy is closer to my home than my practice and just three doors up from the newsagent where I get my paper!


Urgent and Emergency Care

I was invited to speak at the future of urgent and emergency care services. It is unusual for a pharmacist to be invited to this sort of event – well I wasn’t directly, but Dr Michael Dixon felt that I would answer the brief about pharmacy to compliment his opening. As expected, there wasn’t a single pharmacist in the audience. The first batch of speakers talked exclusively about new ways of working in A&E and urgent care centres – somehow I didn’t expect anyone to mention that pharmacists are employed in these services, as well as out of hours and General Practice to provide care for patients with common acute conditions, but as usual community pharmacy was not mentioned.

Feathers slightly ruffled from the start. I had to explain that there was slightly more than General Practice within Primary Care – General Practice is only one of the four independent contractor contracts within primary care – and they all provide urgent care for patients. I had to explain that within NHS England’s report they clearly suggested that a shift all the way down the line was needed with increased focus on self-care and community pharmacy to relieve the increasing pressures up stream. And, with more than 438million healthcare interventions in community pharmacy (2008/9 data) – this was more than any other profession added together. You do realise that the community pharmacy estate is huge – more premises and open longer than GPs and often more convenient for patients.

I mentioned data around the symptom checker – just to remind people that most members of the public who used the symptom checker were young and female. And that 44% still went for a consultation. There is a hint there, that putting symptom checkers in unsupported environments, like libraries might just increase demand on general practice and other services.

I offered a solution of putting NHS Choices symptom checker into community pharmacy, backed up with access to an assistant or technician that can support navigation and a pharmacist should further explanation or an intervention be necessary. Link this to the Healthy Living Pharmacy initiative with qualified health trainers and you could really start to change behaviour and attitudes towards better health.

I talked about minor ailment services – renaming them ‘common acute condition services’ and despite over 1,000 pharmacies being open 100 hours a week and many more open 80 hours a week, this service was commissioned in only 10% of pharmacies. There was service specification variability and access to medicines was generally poor. Access to medical records is still zilch, although access to the summary care record is on the horizon and will help in the future. As a side comment, if I had £1 for every patient that had been passed over to the GP for a prescription, I would have retired long ago! It is also sad that a pharmacist at 21.55 in the evening can’t book a patient into the GP next day or skype call to an out of hour’s service for support – so you can guess where those patients go.

I mentioned that the first minor injury training program, specifically for pharmacists was to be delivered this summer. Not requested by the NHS, I might add, but by pharmacists who, no doubt, will pay for their own training to deliver a higher level of service to their patients.

I was openly critical of the lack of working together in these services and suggested that it should be a basic requirement that GPs and Community Pharmacists work together to develop these services to the level that they need to be. In my opinion this is a serious flaw and limits the success of services. If the GP, Practice Nurse or receptionist simple enquired – “what did the pharmacist suggest” to patients with common acute conditions, perhaps we could turn this tanker around.

I questioned the use of NHS 111 where I am still not sure offers community pharmacy as a disposition. And the very few CCGs that underwrite the supply of medicines from a pharmacy in an emergency situation. There is no more of a heartsink moment in A&E when a patient turns up and says – “I am on holiday and I’ve forgotten my medicines and I’ll die without them”.

Those professions at the ‘bulk’ end of the scale –  General Practice, Community Pharmacy, Optometrists and Dentists must work together to create capacity and deliver more effective and more integrated care. We must share the load, and support more effective self-care to give those clever people at the top end of the system a little more space and time.

Reworking the NHS

I am going to make this simple. The NHS is not set up right and the current change has not improved much. Everything is still commissioned/contracted in silos; the organisations do not have real cross-commissioning capabilities and as for performance monitoring – still poor.

So we need a different solution that drives integration and supports joint working. Well that is not too difficult really if you think about things slightly differently. And it is not too difficult to divide up existing contracts into parts so that they can be managed and driven in different ways. So her is my thinking:

‘Primary Care’. Primary Care is the delivery of the first element of care. There are several services that provide primary care by this definition. It reflects the continuum that NHS England describes from NHS Choices, through community pharmacy and general practice to out of hours and A&E. Why can’t they be commissioned together? Bring every contract they we hold in which any person rolls up and ask about their health or needs acute care. Include the police, ambulance and paramedic services and others. Fix the total budget and manage it in such a way that co-operation drives profitability and creates a will to manage demand. Look at the capability of each element of the service to one-stop manage as much as possible without unnecessary transfers, signposting and referrals. Build capacity in the most accessible and least expensive elements of the continuum.

‘Continuing Care’. Again there are several services that provide continuing care for patients with medium and long term conditions. General Practice might be considered the backbone, but many patients are admitted to hospital – so called unplanned care – or to care homes. So again, let’s bring all of the contracts together – health and social care. Commission Consultants to work side by side with GPs, community pharmacy, community services, social services, housing with voluntary and charitable organisations. For it to all work people must remain well and in their own homes where possible.

‘Planned and specialist care’. NHS England is already commissioning a range of specialist services to look after people with rare and complex disorders. In this same pot I would commission all planned care from hospitals and the trauma and emergency response services. They should have national standards, national comparisons and controlled providers

‘Public Health’. All services that maintain and improve the health of nation are already commissioned from public health. Is this the one thing that we have right and are they moving in the right direction? Probably yes – they are gathering all of the contracts under their wing, stimulating providers and commissioning across boundaries and silos.

The big question is will it happen? The NHS does not need radical reorganisations and structural change. It just needs a better focus on what it needs to achieve and a better mechanism to drive cross-silo commissioning and inter-service dependency.

Primary Care and Community Pharmacy

Primary care is where a member of the public receives their first (primary) element of their care. Acceptance of this definition is important before moving forward and we must not get confused with the word ‘primary’ when it is taken to mean ‘most important’. Although we could argue that the first element of care is always the most important in determining the pathway, the outcome and the cost to the NHS.

This means that general practice, community pharmacy, optometrists and dentists form the core elements of primary care. We must add into this out of hours services including hospital based accident and emergency services, ambulance services and a wide range of other provider services including housing and social services.

We must also build into this the person themselves, knowing that many people make their own primary care decisions either alone or supported by family and friends or by internet based information such as NHS choices.

There are two important issues to consider:

  • Can people access information from reliable sources and make their own primary care decisions with minimal support. Many people can access the NHS Choices website, but I am surprised that we provide so few opportunities for those who cannot access the internet, have poor computer literacy, limited ability to read or are unable to make a decision without some support/advice.
  • Are all providers of primary care working together to make the first contact count.

The answer to both of these issues is simply no. I think that we know that and have known that for years, but made very little progress. There are some simple solutions that the NHS could consider:

  • All community pharmacies should make a move to healthy living pharmacy status and the availability of a touch screen computer linked to NHS Choices should be a fundamental requirement.

A community pharmacy is an ideal place to direct people who wish to explore their symptoms or better understand their condition and available treatments. Healthy living pharmacies can supply advice, a variety of services and should have easy access to a range of treatments.

  • All services that provide primary (first contact) services should be supported to work together within a locality based contract that operates 24/7.

A number of publications on emergency care have described primary care services into a continuum, from self-care through to A&E, but none of them have suggested contracting first contact services together as a group. From a single budget all providers can offer first contact services, but each provider must be able to offer a full service for a defined population. The starting point is an understanding of the triage principles – who goes where and for what. Each contract has a target number of first contact episodes such that to share in the profits of the contract all providers are interdependent. The positive metric is completed first care episodes in the appropriate environment and the negative metrics are referrals to other providers. The local population must be involved so they can better understand where they could go and what each provider can actually provide.

If we focus on the person then they should understand when to visit the optometrist service, the dentist, the community pharmacy, the GP, the A&E and other local providers. The services should also work out how to work together in hours and out of hours.

All community pharmacies in a locality should be involved. They all should work towards healthy living pharmacy status and should all provide access to NHS Choices to their local community. They should all offer a range of health and wellbeing services and should link together to provide inter-pharmacy referrals.

All community pharmacies should provide minor ailment / common condition / pharmacy first services in which they provide an increasing range of services based on advice and treatment. The contract should be set with targets that support closer working between all providers to make sure that each element delivers on their commitment and all providers benefit when targets are met.

There are no excuses – we have to get primary care right – we have to firstly support people to access appropriate information and advice in a wide range of settings and when they touch the primary care provider, they have to get the best care in the most appropriate setting.

NICE and the NHS constitution – failing guidance

I often write guidance. I often read guidance. But sometimes I’m shocked on the waste of NHS money to provide guidance that is neither required or palatably to the reader. Today is that day!

So the CCG has written guidance – ‘on the cost-effective use’ of medicines approved by NICE within TAGs. 14 pages with flow diagrams sent for consultation throughout the area and updated and reviewed several times. Must have cost tens of thousands of pounds to produce a guideline that the NHS has been expressly told not to produce.

NICE is the organisation that judges whether a medicine is cost-effective. The NHS should introduce all NICE recommended medicines ‘without further assessment’. Put the guidance in your formulary within 3 months and publish on-line. Make the money available to ‘fund and resource’ the implementation of the guidance within three months. Do not introduce ‘barriers’ to uptake and ensure existing barriers are overcome. Monitor uptake in line with the NICE costing template. Surely this is simple enough.

But obviously not. CCGs and CSUs continue to commission further reviews of NICE TAGs at considerable expense. They make recommendations that are clearly not in line with the NICE TAG and does not contain NICE wording. It is shocking that they can also make false claims and cherry pick data. They think that they can get away by saying at the end – ultimately it is the choice of the clinician and the patient – followed in bolt type with – we recommend xxxx over the NICE recommended medicines. So it is the responsibility of the clinician to do the right thing and it will be the clinician in the dock if something goes wrong.

They fail to reference the NHS constitution which talks about patient’s rights to access NICE approved medicines if the clinician and the patient agree it is the right choice for them. But they go right ahead and suggest that clinicians should only offer a single medicine.

The guidelines clearly state that I the patient appear to be well controlled on their existing treatment then the clinician ‘must not consider’ a NICE recommended treatment even though it may be clinically advantageous to the patient  or the patient asks about it. That hardly sounds in line with the spirit of openness, transparency and the NHS Constitution.

There are other phrases that I just find insulting and condescending. Whoever uses the phrase ‘wilful non-compliance’ these days – what are they suggesting? Also ‘genuine needle phobia’, suggesting that some needle phobia is not genuine enough. And ‘genuine allergy’ – so what is the definition here. Oh and you need to have a ‘disability that causes difficulty in communication’ – so another judgement on an appropriate level of provable disability. What is the point of inserting the words wilful and genuine in these sentences?

Yes I know –patients will feign non-compliance, needle phobia, allergy and disability just to get access to an appropriate NICE recommended medicine in line with their legal rights under the NHS constitution. Why can’t they just ask?

What I can’t understand are the people who have been involved in the process – Consultants, GPs, Pharmacists, Commissioners, Managers and Patients. Not one of them have stood up and said ‘we should not be doing this’ or ‘don’t you think it is a little insulting to patients’ or shouldn’t we be supporting NICE and the NHS Constitution’. Even just shouldn’t we be open and transparent and explain why we are doing this to our population.

You should be ashamed of this guidance!

And NHS England should get off their butts and stamp it out.

Let’s support NICE and the NHS constitution and let’s trust well informed clinicians to do the right thing. Now there is a radical suggestion.

Dispensing on the Titanic

Today the RPS funded Commission launched it future models of care document and the RPS ENB gave its strongest commitment to support the interests of pharmacists. I have to say that David gave a closing speech that was delivered with sincerity, believing the commitment that he was making. I know he will really try.

I loved Judith’s quip that pharmacy has had more ‘visions’ than in the Old Testament, her view that the window of opportunity was now, the naming of the document ‘Now or Never’ and her plea to ‘just do it’.

It was Stephen Dorrell MP that asked the audience – ‘which group of healthcare professionals see more people each week than all the rest put together’. Really – even I hadn’t used this statistic before – something to be think about with pride.

I was chatting to Nick Kaye – he is always an inspiration – a clear ‘can do’ pharmacist, but it is undoubtedly the time for all the profession to do.

There were, however, some things that were not said. Dispensing is dying, the contract is a disaster and the government, DH, NHS England, Uncle Tom Cobley and all agree. I reflect that dispensing has changed. The need for pharmaceutical compounding skills is gone – we no longer make much and measuring out water to make up an antibiotic mixture is as complex as it gets. Let’s be honest – we put labels on original containers. The clever and important bit is the patient interface before and after the dispensing.

Keith is clearly right. There is now a clear and growing view that the dispensing element is not considered good value for money. Community Pharmacy has saved millions of pounds for the NHS through good procurement, but it is not enough. The government feels that big business will bring in automation and additional discounts through purchasing power which would be reflected in increases in the National Average Discount Rate and money will come rolling back into the coffers. I am not sure that I agree with them, but that is hardly likely to matter – it is an iceberg coming our way. They might even consider putting dispensing out to tender when the electronic transfer of prescriptions is routine. And the vultures are circling.

It’s like dispensing on the Titanic. It is sinking and we are still playing. Bright new pharmacists are drowning under the pressures and are not realising their aspirations. So Captain Smith is saying it’s Now or Never – just do it! Now that is a strange coincidence isn’t it!

Where Keith is wrong is saying that there are 3,000 too many pharmacies and we should go back to earlier days. This is assuming that pharmacies are only there to dispense. Pharmacists are much more than dispensing. Pharmacy technicians are much more than dispensing. Pharmacies and the whole team are much more than dispensing.

We actually have a strong and vibrant network of pharmacies. The old rivals of multiples and independents are working together, led by visionary pharmacists. There is a real opportunity to link up groups of pharmacies with groups / federations of GP practices and look to solve local community issues. All primary care contracts are a disaster – we must show NHS England how we can work together so they can align the contracts to facilitate progress. Heaven knows, they can’t do it on their own – we have to show them the way – lead by example.

Let’s look at people who want pharmacists and pharmacy owners to step up and solve the problems:

  • Jeremy Hunt needs to solve the A&E crisis. He has thrown some cash at it, but he knows that he has to manage demand. Only community pharmacy can change the flow of patients to A&E and prevent the swamping of General Practice. Common condition services with proper access to medicines and technology support is the answer. Don’t complain about 100 hour pharmacies, they are the solution to out of hours care
  • Professor Kevin Fenton said that he would like to see 5 new services (public health based – non-transmissible disease related) in community pharmacy within the next 5 years. Too slow Kevin – people are dying – let’s do it quicker
  • Sexually transmitted diseases, safe sex advice, emergency hormonal contraception, contraception, services for women and children – where else, but in the community pharmacy – local, discrete and effective.
  • Duncan Selby looked disappointed hearing that there were so few healthy living pharmacies – I think he hoped I would say 5,000 – if you want more just ask
  • Jane Cummins pledged further action to protect patient safety. With 1,700,000 serious prescribing errors each year, the failings of care homes – surely she will turn to pharmacists to help.
  • Dr Mike Berwick says we are not doing enough for the 15m people in England with long term conditions. If there are real problem in medicines selection and adherence – think pharmacist – just saying. Even Paul Dinkin in monitor said that skill mix was the answer
  • Patient organisations, such as Diabetes UK who spoke at the launch today all say that their members value the advice and support that community pharmacists offer – pharmacists change lives – tell your MP.
  • National Voices talk about supported self-care. Who is better positioned to help you with this agenda?

I can’t wait for the community pharmacist and the pharmacy technician to remove the chains that keep them in the dispensary.

So national frameworks, area implementation and local flexibility is the answer. If we remove the problem, perhaps everyone will see community pharmacy as the solution.


Pharmacy and Pharmacists

I constantly remind people that the two are different. The Pharmacist is the health professional and the Pharmacy is their place of work. The Pharmacy owner holds the independent contractor status with NHS England and the Pharmacist is employed to deliver all elements of that contract along with a team of suitably trained technicians, dispensers, counter assistants and in some Pharmacies Health Trainers.

The Pharmacy and the Pharmacist are both regulated by The General Pharmaceutical Council separately. So why do we make the mistake of thinking about them together and managing them as a single entity? I don’t know – it is history.

We must be brave and think about the future. We must try to give some separation between the two to allow the NHS and the Local Authority to commission exactly what they want. We need to set Pharmacits free and allow them to develop the services that the NHS wants and people need. This might require a new way of thinking.

We should allow the separation of dispensing from other clinical services.

Dispensing includes the receipt of a prescription, checking for accuracy and suitability, dispensing, advice and continued support. It should include a management element which supports patient registration, shared information and a mechanism by which the pharmacist can intervene when people don’t collect prescriptions. Introduce  feedback mechanism to support better prescribing and a safety thermometer to support safer dispensing.

All pharmacists can supervise the dispensing process and offer basic advice to patients on their basic healthcare needs. These must be provided in a Pharmacy.

Clinical services may include public health commissioned services such as EHC and stop smoking, sexual health and contraception, weight reduction and general signposting. It also includes management of common conditions, out of hours and other long term conditions management.

The delivery of clinical services might require additional training and accreditation, perhaps the use of PGDs or independent prescribing and disease management qualifications. I have also suggested an intermediary prescribing status (independent community pharmacy prescriber (limited list).

Although clinical services can be delivered in the Pharmacy, they don’t have to be. They can be delivered in walk in centres, GP practices or out of hours premises. That is the point – a clinical pharmacist can deliver these services anywhere.

Perhaps the new community pharmacy contract should reflect this in some way. Perhaps we should have the main dispensing contract with the Pharmacy owner and the clinical contracts held jointly or even independently. It is important to know that the clinical contract is being delivered by a specialist pharmacist.

Specialist pharmacist chambers perhaps?

Responsibility for A&E workload

I write this blog after listening to an MP talk about their experience in A&E. I hope that what was said was hiding a deep understanding and a calculation of the problems and the solutions – but I fear not!

“A&E was very busy” – yes we know that.

“The A&E staff work very hard” – yes we know that as well – absolute heroes – I wouldn’t want to do it and it would seem that newly qualified doctors are less sure as well.

“We must provide more funding to A&E” – and hang it all on achieving 75% immunisation to flu – That does it for me! What a waste of time and effort if this is all they can say!

So let me introduce you to some of the real issues and let us look at who is responsible for solving them. It is no longer tenable to run a Health Service with such a focus on A&E without both understanding the problems and making headway to the solutions.

As a rule of thumb you can split the A&E attendances into three broad categories:

  • Common conditions
  • Medico/social collapse
  • Accidents

So let us look at these three groups as to what you might want to do:

Common conditions: A&E has becomes the single known and reliable treatment point for common conditions which present relatively acutely. This is a job for NHS England and the CCG working together to create other reliable access points. They only become reliable when members of the public know about them, trust them and are happy to use them – so a lot to do here.

The solution is a merging of NHS111, community pharmacy and GP out of hours services to create an integrated solution. This single service needs to be co-created with the public and fully integrated so they are able to advise and treat the majority of patients without referral to A&E. We will need to sort out NHS111 dispositions, engage community pharmacy, giving them better access to medicines and link with GP out of hours through teleconsultations. All three should be able to book patients into dedicated slots within the patient’s GP practice.

Medico/social collapse: Why is A&E the hospital front door for known patients who develop predictable medical or social problems? The government has pledged more money for health and social care to work together and some do. The management of the elderly and people with long term conditions must be the responsibility of a multidisciplinary team within primary care. They should predict problems and respond quickly with suitable support to manage patients within the community. If the patient requires admission to a hospital then this should be arranged directly with the hospital consultant or to a community run unit.

Last week I was asking why a GP co-operative looking after 80,000 people was not able to employ a consultant care of the elderly physician. The automatic response was we can’t. That is not good enough. Care of the elderly and those with long term conditions require the practices and the local authority grouping together to sort out their problems and manage their patients without the “bundling into an ambulance” scenario.

Accidents: well that is clearly the responsibility of the local authority and the emergency services. A large “shoutout” to the fire service who continue to work very hard to reduce the number of house and workplace fires. The police force also works tirelessly to reduce crime and antisocial behaviour. The local authority work hard to reduce the number of accidents in the home and I have seen falls services that really do some great work. There is great effort to reduce accidents on the roads.

And then let me turn this on its head. It is the responsibility of the community to make it safe for the people living there. People need to get together and work closer with all of the organisations that ‘deliver safety’ to ensure that they engage, work together and deliver what is needed. I say this because I have seen the work of community 2 community programs and I have stared in wonder and admiration when they present their results. If some of the most “troubled” communities can turn themselves around then we all can with the right support and willingness.

So the next time an MP or a civil servant goes into A&E ask the people why they are there and what could be provided or done to make it less likely that they would attend A&E.

A&E should only be for the accidents and emergencies that we could not have reasonably prevented or managed in a more appropriate service. Let’s cure the demand not feed the beast.

The death of independent contractor status

I was both surprised and pleased that Clare Gerada, Chair of the RCGP was brave enough to call for a re-evaluation of the current independent contractor status model. She was right to do so and her profession would be wise to listen and think about it before jumping to say no.

I was a mere child when I locumed for a community pharmacy owned by Alan Lloyd. He owned a couple, but at that time most community pharmacies were owned and run by individuals. Pharmacy was a ‘good business’ and Alan Lloyd moved from a single pharmacy in Polesworth to own over 900 when Celesio acquired the largest pharmaceutical wholesaler in the UK and the Lloyds pharmacy group over a couple of years and are now own over 1,600 pharmacies in the UK. Even so they are dwarfed by Alliance Boots who own over 3,000 pharmacies around the world and revenue at about a quarter of the NHS.

I say all this because ‘good business’ can so easily become ‘big business’. The world for GPs is changing. General Practice has always been ‘good business’. It is becoming harder to attract new partners who either wish to join a practice or have the funds to do so. ‘Big business’ is slowly creeping in and soon you will face some of the same issues that community pharmacy face.

For community pharmacy, most of the front line pharmacists are salaried employees. Approximately two thirds are in large organisations with at least 6 pharmacies and with a pre-defined career structure in place. There are only an estimated 5% of pharmacies which are owner managed.

The problems with this position are too many to mention in a single blog, but here are a few:

  • The contract negotiation power lies within the owners and not the pharmacists
  • The voice is fragmented and diluted with several ‘representative’ bodies
  • Business has a shareholder requirement for profit which chases revenue and reduces overheads. Pharmacists are overheads and feel the effects of increasing workload and reducing rates.
  • Co-operation between independents is impressive, but it can be difficult to encourage multiples to operate independently to suite local needs and in co-operation with neighbours
  • Multiples have the capacity to run their own health campaigns
  • Career structure encourages movement between pharmacies and does not incentivise retention in a single pharmacy

So let’s listen to Clare. I want community pharmacies and GP practices with both stability and close working relationships. I want to see the same GPs and the same pharmacists, working together and sharing expertise and running more local services in association with social care and the rest of the local authority. How can we solve the problems that our communities face if we cannot work together as a community?

I say well done Clare! I know the model that I want to see and I am not sure that the independent contractor status facilitates that move. The GP contract is archaic, based on a poorly defined capitation, but you do still retain mostly independent practices. The community pharmacy contract is archaic, derived to reduce the drugs bill and most of the pharmacies are within private limited companies. Wouldn’t it be nice to see us move together under a new contract that respects the GP and the Pharmacist as individuals, but encourages us to work together in groups serving communities?

It is not about scrapping the independent contractor status, but about moving it to something a little more modern and appropriate for the day and the current problems. Over to you Maureen?

Announcement: open season for pharmacists

I am pleased to announce that pharmacists have been officially removed from the endangered species (shortage occupation) list. After several years of difficulty there appears to be plenty of us about. What good news. The employers are pleased because they have choice in the market place which will undoubtedly push up quality and push down price.

This is good news for general practice which currently offers 57,000,000 appointments every year to patients who could be satisfactorily managed by a pharmacist at approximately at less than half the cost of a salaried/locum GP. It is also enables practices to target the medicines section of the CQC registration and seek to reduce the 1,700,000 serious prescribing errors each year. Skill mix is important in managing polypharmacy and patients with long term conditions. The Pharmaceutical Care Awards 2013 was given to a group of independent prescribing pharmacists who managed to bring under control 58% of patients who failed to meet target with consultations with the GP and practice nurse. The CCG might even support you financially if you link it to medicines optimisation and reducing waste.

It is good news for out of hours service providers where about a third of all appointments are offered to people who could have been managed by a pharmacist.

And it is great news for NHS England  and public health in Local Authorities which might want to expand community pharmacy provision of services. There is plenty more to do around immunisation, stop smoking and ‘Pharmacy First’. And we have hardly scratched the surface of other public health related services.

And all at a time when GPs and practice nurses are in short supply.

So you had better go out and bag yourself a pharmacist before they are all gone!

What do I mean by that – well NHS Employers are currently consulting on the issue. Rather than seeing this as an opportunity for everyone in the NHS – they may well recommend reducing University places. If this happens the supply will dry up in a couple of years and you will have lost your chance.

Carpe diem