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Adventure of the second letter

By Outsider

It seems like only yesterday we welcomed the four-and-a-half year contract settlement, but yet another joint letter from PSNC, NHSE/I and the DHSC has dropped on the proverbial doormat of pharmacy. The question is, will joy spring forth or will its contents merely dampen our spirits?

 Unfortunately, however closely you scrutinise the 24 paragraphs, you won’t find a straightforward answer within them. Instead, you need to read it like a Sherlock Holmes short story, and then, like all good mysteries, the answers will be revealed, with a twist at the end. 

Firstly, there’s not a lot of detail. All parties openly admit that they’re announcing that the broad principles are agreed and the detail will follow. What this means in practice is that some of the key milestones of the contract appear to get pushed back in time. 

The much vaunted hospital discharge referral service (or TCAM, transfer of care around medicines) will launch in July as the slightly clunky sounding NHS Discharge Medicines Service. This will need to align with the medication review work carried out by primary care networks, says the letter. Despite recent attempts to kill PCNs by the BMA, they remain, with the medics receiving financial sweeteners to keep playing nicely. Exist they might, but function? Very few of them will, and certainly not from day one. Most PCNs will need to recruit for and actually deliver the structured medication reviews before we see how this alignment works.

CPCS referrals from NHS 111 Online will arrive in June, with referrals from GP surgeries following in the second half of the year. Both of these measures should (and will need to) significantly increase the activity level and associated funding delivered by this service. What doesn’t get delayed is the further reduction and restriction of the MUR service to 100, with the hospital discharge target group ceasing when the NHS Discharge Medicines Service commences.

You need to read it like a Sherlock Holmes short story, and then, like all good mysteries, the answers will be revealed

Secondly, as the letter concludes, this is a transitional period, and many of the changes are to fix things that have been broken, some for quite a time. The use of the Pharmacy Integration Fund to pilot service innovation in public health can only be a tacit admission that hiving off public health commissioning to local authorities was not Andrew Lansley’s brightest idea.  

There’s no public data on the CPCS yet, but as that and the other services grow, the transitional payments will have to transition into something else. What? We don’t know, but it won’t be establishment payments or payment for dispensing. Other changes see us finally get electronic FP34 submission (hooray!) and PQS becoming more focussed, with only one declaration point.

My third and final takeaway from the announcements is that actually, where we have it, detail really matters. The chaos of the final Sue Sharpe years let some things slip under the carpet and moulder, but no longer. Expect to see revised regulations soon, making the following mandatory: HLP, NHSmail access, SCR access, keeping DoS updated, keeping NHS website profile updated, EPS, safeguarding and more. Also being fixed is the mockery that is the out of pocket expenses clause in the Drug Tariff. On the ‘still too hard’ list remains fixing the Pharmacy Access Scheme to properly reflect pharmacies needing additional support.

In one sense, this shows the determination of all parties to see this framework deliver where the 2005 contract didn’t. Incentivising to raise standards and then baking them into the core was how the last contract was supposed to function, but it stagnated. We always knew that pharmacies that didn’t adapt would sell or close, with the lack of the consultation room expected to be the principal driver of change. Fifteen years on, it may finally come to pass.

The final detail gives the real truth about the relationship community pharmacy is in with its paymasters. Alongside a desire to increase protections in pharmaceutical needs assessments for pharmacies that consolidate (welcome if done correctly), the regulations will soon include a requirement to notify NHSE/I should a pharmacy enter administration. A perfectly sensible requirement in principle, but one that has never been there before. Why add it now? 

As Sherlock Holmes would say, I think you’ll find the answer is elementary.

 Outsider is a community pharmacist




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