As PSNC prepares to rebrand as Community Pharmacy England, chief executive Janet Morrison tells Arthur Walsh why this presents a useful opportunity to reset and regroup
The Pharmaceutical Services Negotiating Committee (PSNC) is no more; long live Community Pharmacy England. At an unconfirmed date – likely to be soon after this issue of P3pharmacy lands in pharmacies – the negotiator will emerge rebranded, dropping its old name in favour of something a little less unwieldy.
“I always thought it sounded like a committee that meets on Friday afternoons at the bowls club,” chief executive Janet Morrison tells me, sounding relieved at the name change. “When I speak to parliamentarians and the media and say I’m Janet Morrison from the Pharmaceutical Services Negotiating Committee... by that point they’ve all fallen asleep.”
“I think it’s a positive move,” she says. “It gives us more impact and authority externally, and more fairly reflects what we do. We don’t just negotiate – we are there to represent the interests of the whole sector and advocate for its future.” What can Janet tell us about the rebrand – will they be keeping the traditional PSNC purple?
“I’m not going to comment on colours,” she says firmly. “It’s modern and fresh, and it’s got an impact, but it still needs to put across the fact that we’re a professional organisation.”
There was a collaborative process, she says, with contractors, LPCs and other pharmacy bodies all consulted. “It started from the question, who should we be? Who does the sector want us to be?” She lists a few of the key organisational values that were identified: assertive, knowledgeable, transparent, open minded.
“We’re starting with a blank page,” she says. “We’ve had elections and are kicking off with our new committee. Some people have been there before, some are new, but we’ll treat it as a new committee for Community Pharmacy England.”
Were any stakeholders concerned about losing the familiar PSNC brand? “Not really,” she replies, arguing that the new identity will be clearer and more effective. She adds: “A lot of people have a lot of opinions about PSNC, not all of which are flattering.”
She’s not wrong there. The five-year contractual framework, which in April entered its final year, was hardly met with open arms when PSNC’s then-CEO Simon Dukes announced the agreement in 2019. After all, it baked the 2016 funding cuts in over a longer period. To contractors’ dismay, it has become apparent over the years that nothing – not Covid, not spiralling inflation – will get in the way of the Treasury’s laser-like focus on the fixed annual £2.592bn global sum.
As the recent Pharmacy Pressures survey revealed, the strain has become unbearable for many. Just seven per cent of contractors say their business is profitable, with unreimbursed medicines costs, wage increases and rising utility costs all eating away at precious little margin.
All this raises the prospect of more pharmacy closures. There have been grim stories about LloydsPharmacy this year – could this be repeated across the sector? “Everyone is really struggling,” Janet replies, adding that while the big chains have been closing and consolidating branches for some time, this has ramped up in the last six months. “If it’s a family-owned business, they’re just going to cling on for as long as possible to stay open,” she says.
“You might not see hundreds of closures straight off, but I think we’re headed that way if we don’t get a further injection of money. We know people have got cash flow issues; we’ve heard of people having to rely on overdraft facilities. That’s no way to run a business, is it?”
So, how will Community Pharmacy England succeed where PSNC arguably failed? What are the big-ticket items on its agenda?
Janet says she has been delivering a clear message to policymakers: “If you carry on down this road, the sector will be decimated, with all the chaos that brings. If you choose a more positive path and make an investment in the sector, we could be doing so much more.”
She says that some time ago, the CPE team identified a Pharmacy First minor ailments scheme as “the best solution for the sector – the most realistic and feasible... it’s the nearest thing to funding what pharmacies are currently doing and enabling them to have core costs and staffing capacity”.
“In the conversations we’ve been having, not just with the Department [of Health and Social Care], but with those that influence it and more widely, all the indicators are that ministers like the idea of Pharmacy First. It’s a question of whether in these difficult economic times they can find the money for it.” A previous pitch for the service was rebuffed by the DHSC and NHS England (NHSE).
NHSE’s primary care recovery plan – still unpublished at the time of going to press – would be an ideal vehicle for announcing Pharmacy First, she says: “We’re optimistic about the potential for the recovery plan to have some things for us, but we don’t know to what extent.”
If we do get Pharmacy First, is that the end of the Community Pharmacist Consultation Service? “That is a good question – I don’t know what happens to the CPCS,” Janet says. When she took on the chief executive position in February 2022, her view was that the CPCS “doesn’t make sense... it seems like the most inefficient way [to run things]”.
Other elements of the new negotiating strategy are still to be determined as it sees through a vision project that seeks to unite the sector behind shared goals and present clear ambitions to the Government. As part of this work, in the coming months, the King’s Fund and Nuffield Trust will publish an interim report presenting a number of strategic options, partly informed by a sector-wide consultation exercise that kicked off last November.
“What we’ve asked them to do is come back with some challenging questions and propositions,” Janet says. “I think a lot of us are very ambitious for the sector and there are a lot of shared views on that; what I wanted them to do was rattle the cage a bit about what does the Government want, but also how would we need to change?
“We can’t rest on our laurels... if we want a wider role, there are going to be some challenges about how we can meet patients’ expectations and enable them to use pharmacies in an effective way that meets their needs.”
She says the benefit of partnering with the two organisations is that “they’ve got a lot of inside track and influence... they understand the thinking and decision making that’s going on [in the DHSC and NHSE]”.
Once their report is published, “we will need to do a piece of work ourselves and ask what community pharmacy’s strategy should be”. This involves deciding “what kind of service proposition we could be arguing for that is deliverable,” she says, adding that consideration must also be given to how services are incentivised through funding mechanisms: “At the moment, the crushing reality is that there’s a concertina effect whereby any part of the contract in which we’ve ‘over-earned’ must be paid up by the end of Year 5 – it puts severe pressure on funding.
“All that thinking has to be done before we get into the negotiating room; by then, Treasury has already set its terms.”
The rebrand and the work on a new strategy are two strands of the Transforming Pharmacy Representation Programme (TAPR), which follows on from the 21 recommendations of the Wright Review Steering Group that were accepted by contractors after a vote last year.
There are “about seven work streams” in the TAPR programme, including supporting LPCs to reform and merge, should they wish to (her team expects there to be 48 LPCs from April 2024, down from 69 prior to the Wright Review), a stepped-up influencing and campaigning strategy and an internal governance shake-up that has seen the negotiating committee reduce in size.
Is it difficult to balance the needs, ambitions and competing voices of different-sized businesses? “We’re rather good in pharmacy at having differences of opinion, and sometimes I wonder if that’s helpful when we’re trying to influence Government at such a critical time,” Janet says. “But overall, I think people are pretty much on the same page about the future; not many are saying we can just stick to dispensing and everything will be fine.”
And if the CCA estate reduces in size as drastically as some are predicting, should that be reflected in the number of seats its member companies have on the committee? “I don’t think it’s going to be quite as dramatic and revolutionary as people think, but we do need to be representative and to put in place a review mechanism. We need to see how things shake down in terms of closures."
Our conversation takes place four days after NHSE’s announcement of an imminent launch date for the Pharmacy Contraception Service – an advanced service that Janet and her team had warned policymakers would be impossible for pharmacies to deliver within a fixed funding envelope.
On the face of it, this seemed like a blatant display of power – an impression perhaps supported by the DHSC’s earlier decision to jack up the discount deduction rate so the NHS could balance its books, a move CPE did not consent to. Do these impositions signify a dire worsening of the relationship between CPE and its interlocutors?
Janet offers some context: “I wrote to the minister on 13 March and basically told him, ‘Unless there is an urgent injection of new money, you can’t afford Year 5, you can’t afford the contraception service or the Pharmacy Quality Scheme and you can’t afford the extension of existing services.’
“What we heard back was that the minister still wanted the contraception service, so they were going to go for a soft launch of Tier 1 of the service at least. They decided not to make a big hullabaloo about it because we weren’t going to be promoting it.
“That will be the case with anything further – if they decide to roll out [services] without any more money, we’ll be saying you can’t afford it – you’ve cut our funding by 30 per cent in real terms.”
Talks are often challenging, she says. “When we’re in negotiations, it’s with both the Department and NHSE, but they are different organisations.
“If I’m totally honest, sometimes we’re frustrated with the Department [of Health and Social Care], and sometimes it’s with NHSE. With the DHSC, the tricky conversations are about the overall funding envelope and the expectations of what can be done by the sector.
“With NHSE, you can talk to them until you’re blue in the face about the lack of capacity in pharmacy, the staffing problems caused by their scheme [the recruitment of pharmacists into primary care networks], and then their comms come out telling the public to go to pharmacies. That causes us a lot of irritation.”
Some contractors have said they will not deliver the contraception service and have advised colleagues to act similarly. Is that Community Pharmacy England’s position? “We say, think really hard about it,” Janet says. “These are not essential services, so contractors have the choice not to do them – and that’s not easy.
“I totally understand that if you’re a contractor, you’re effectively in competition with other pharmacies, and they might have an advantage if they do provide a given service.
“The problem is, the more money they might earn on that, the higher the chance it could be taken away from somewhere else. People would be extremely unhappy if the single activity fee per prescription went down, but that could be a consequence if we sign up for too many services within this funding envelope."
I’m curious to learn more about the relationship with NHSE, in particular. Janet’s virtual address to this year’s Sigma conference was big on Pharmacy First and workforce challenges. The next day, chief pharmacist David Webb gave a presentation that did not mention Pharmacy First once – and effectively argued that when it comes to staffing, the onus is all on employers to offer “attractive careers”. Did she find this a bit tone deaf?
Janet says she didn’t hear Webb’s talk and can’t comment on his remarks in any detail; on workforce, she says that despite scepticism “from the other side” about the existence of staffing shortages caused by NHSE’s recruitment policies, “we have made some progress”. She also says she has worked hard at “building wider relationships” higher up in NHSE and the Government, and at forging alliances with other primary care providers.
'Every pharmacy is different'
Janet is conscious that in highlighting the pressures in community pharmacy, she is “not necessarily painting the most beautiful picture” to those considering it as a career: “It’s a bit of a dilemma for us”. Nonetheless, she says that amidst the gloom, her regular visits to pharmacies can leave her feeling optimistic.
On a recent visit to a Manchester pharmacy, she met pre-reg pharmacists and observed “the satisfaction out of those much more personal relationships with patients than you might get in a GP surgery reviewing scripts”.
“Every pharmacy is different,” she says. “I love going to see them and understanding what they do – a lot of them are incredibly enterprising.” She also points to social attitude surveys that show the public views the sector warmly. “For example, the feedback on Pharmacy First Scotland shows there is a lot of trust in pharmacies and pharmacists in being able to give that advice.”
There is a personal element too. “I’m a carer for my 93-year-old father and during the lockdowns, I took him to the local pharmacy for his vaccinations – they were an absolutely vital lifeline, I woke up to how vital they were in keeping him alive. I thought, why isn’t more being done through pharmacies so the GPs can deal with higher levels of patient need?
“It made me realise pharmacies have sort of been taken for granted by everyone – I hope we are changing that now.”