By Rob Darracott

When we met up three or four weeks ago, Simon Dukes told me he thought the reaction and the coverage of the five-year deal and contractual framework in England had been fair. After weekly Sunday roadshows since the end of August he will now have a good sense of just how contractors are feeling about five years’ worth of flat funding against a background of rising costs. Especially if Outsider’s view this month reflects the sentiments of others. 

The upsides: the five-year deal does provide a degree of certainty, even if it’s not quite what contractors wanted, and not what some of them badly need at the moment. I think Mr Dukes is right. The Community Pharmacist Consultation Service is potentially a gateway to more. And, judging from the appearance of a member of the GPs’ negotiating team on a platform at this week’s LPC Conference, our local colleagues might not all be approaching the development of new community pharmacy services as increased competition for them. 

The downsides: there’s a few more here, of course. The assumption that a sector that has had year-on-year efficiency gains dialled into contract settlements for years, can just continue to absorb the cost pressures in the UK high street. The switch to a more clinically oriented service, with cost penalties for not moving, is going to be very difficult for some. The absence of a lot of the detail. Inevitable in many respects, but given that we know how much pharmacists love detail, I shudder to think what this might look like. As one individual at the LPC Conference said, pointedly: “in pharmacy, we often let the perfect get in the way of the good”. (I’d say good enough). The distractions of local organisational change that could provide the means to plug some of the income gap, if we only knew what integrated services were and had the means to get properly involved. 

The realists, and I’m including Outsider in this, know that the real task over the next 18 months is to land the CPCS properly, because there is an opportunity in there somewhere. It’s not the economy, stupid, it’s delivery. The relative failures of 2005 and 2011 are lessons to be learned. Deliver the CPCS, and you showcase what community pharmacy can do directly to its commissioners, initially NHS111 and GPs. As well as grateful patients no longer being passed from pillar to post. You don’t know what you don’t know, and it’s always been the case that without an automatic seat around most decision-making tables in the NHS, people make assumptions about community pharmacy which are often wrong. 

Delivery requires a plan, and contractors are going to need support. Some will need a lot, some not so much, but at the same time they’re expected to not only start working with their colleagues over the road, they’re supposed to be engaging as one with their local primary care network, whatever that is. Mr Dukes’ assessment that the collective resources of PSNC and LPCs are about to be stretched like never before is spot on. He’s absolutely right to put that in play by launching an independent review of contractor support, and wanting to do it quickly. 

And he’s right to start with identifying the tasks that need to be done. Pharmacy is great at designing organisations by starting with the size of the board table – how many provider company sets of articles of association have we had now? Form should follow function, as any fule kno, and it’s the functions that are critical for community pharmacy in delivering on its new contractual framework over the next five years.