Mike Smith puts the world to rights…

We have to face up to the facts about the NHS – it is abundantly clear that the financial pressures are growing daily. Last month, this column was headed “Between a rock and a hard place”. This time, I want to make a case for facing up to the reality of the situation, and working with the Department of Health and commissioners to address the crisis.

Every day, I read more stories about ambulances turned away from A&E, with emergency departments and GP surgeries unable to cope with increased demand on their services. I have referred to these winter pressures many times over recent months – and they’re not going away.

Along with many others, I have repeatedly made the case that community pharmacy can help the NHS by being the first port of call, without appointment, for treating minor ailments and referring patients to A&E when necessary. But even with the current economic situation facing the NHS, these suggestions seem to be falling on deaf ears. The health secretary, Jeremy Hunt, has made it clear that the “NHS should not continue to subsidise pharmacies that are very close to other pharmacies”. Frankly, this is very difficult to argue against, and key is the second part of his statement – “our reforms are designed to ensure that there is only one local pharmacy that people can access, and that pharmacy is protected”.

The real problems will arise if the changes lead to the loss of the “one local pharmacy”. I say again – community pharmacy support seems to be working in Scotland, so why can’t it in England? Scotland has fewer pharmacies, but they work together and have a Department that is open to new ideas that benefit patients and deliver a cost-effective service.

Following the publication of King’s Fund director of policy Richard Murray’s Community Pharmacy Clinical Services Review document, I was interested to read the Community Pharmacy Forward View: Making it Happen document – an excellent, if somewhat aspirational piece of work. However, I would point out one important phrase from Mr Murray’s paper: “There is little point in developing recommendations unless there is real expectation that they can be implemented in a pragmatic way within the context of current policy…Only by policy makers and practitioners working together will that change be made in a sustainable and robust way that achieves the overall objectives.”

To me, this is the crux of our problem. I fear that there can be little hope of meaningful discussion until the legal processes started by PSNC and NPA have taken their course. In the meantime, we have to be on our guard. Local commissioners are already cutting back funding – recently focusing on glutenfree products and local minor ailment schemes. For many years, my fear has been that, since the devolution of funding to CCGs and local authorities, monies would not be ringfenced for pharmacy services, promotion of public health or, very importantly, social care. I encourage you to be aware of what is happening in your patch and, if necessary, raise awareness of the consequences of such cuts. Don’t forget the power of public opinion on local commissioners and councillors.

On another note, I have given my first lecture of the year to pharmacy students at Portsmouth University on community pharmacy as a career. The 100 or so undergraduates present showed great enthusiasm, with their main concerns still focused around excess of pharmacists, preregistration places and the examination.

I was a little concerned that there is a definite preference among students and tutors for preregistration places in community pharmacy to be with the multiples. We independents need to think about this. We must leave community pharmacy as a fit place to practise for these talented young people. They are the future of our profession.

Mike Smith is chairman of Alliance Healthcare, mike.h.smith@alliance-healthcare.co.uk

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