Over the past couple of months, I must have heard half a dozen times that the coronavirus has had a transformative effect on decision-making in the NHS. When people have to make decisions because of an existential threat – surprise, surprise – they can. Across the land, as telephone triage lines started ringing and perspex screens went up, arcane procurement processes, committee jobsworths and financial pedants were either locked in a filing cabinet or told to get a life.
The NHS has come to like the experience and the freedom of devolved decision making. General practices have been transformed, and the shape shifting they have undergone looks like becoming permanent. Even long-standing programmes like electronic repeat dispensing have suddenly taken on a new lease of life, after years in the ‘too difficult’ (or ‘can’t be bothered’) box.
Against the backdrop of a primary care keen to cement the energy of liberation that comes from decisions being taken because they have to be, Professor David Wright has proposed the biggest transformation in pharmacy representation in England for years. Since the negotiating body was carved out of the National Pharmaceutical Association, as it then was, in the late ’60s in fact. You can read more about his proposals and the intial reactions to them here.
We all know what’s most likely to happen, of course. After a period of introspection (I’m putting it mildly), I predict prevarication and debate about the minutest of details and imagined scenarios. We can do detail to death, you know we can.
As a junior civil servant with £1m to spend on the first waste medicine collections for community pharmacy, I spent an afternoon with a senior RPSGB official dealing with some of the most fantastical ‘what ifs’ imaginable. Bye the bye, the meeting was needed because the Minister for Health, the late Brian Mawhinney, announced the funding at a British Pharmaceutical Conference, only for the Society’s then president, in the next speech, to play out the whataboutery in public. I swear Dr Mawhinney never thought positively about pharmacy again. But I digress.
Responding to (and implementing) Professor Wright’s sensible recommendations, as I wrote on the day of their launch, will need bold, altruistic, imaginative and ambitious leadership. Of course, turkeys never vote for Christmas, but community pharmacists (and it seems, some members of PSNC) told the review team they’d been eating turkey in the deals the committee had been negotiating, for years. Could things be any worse than the last three?
Primary care in the NHS has taken some bold and imaginative decisions over the last few months. Primary care leaders, pleased with the results, want to be ambitious and keep the change going. If community pharmacy wants to join the party, it needs to say so, and it will need a transformed leadership and negotiating machinery to work out how and why. Primary care won’t wait, especially for something it doesn’t know wants to join in. We need to get a move on.
See also Outsider's view