Mike Smith puts the world to rights…

Civil rights leader Mahatma Gandhi’s quote “the future depends on what you do today” really seems to apply to the position we find community pharmacy in at this challenging time. Recently, I have spent some time visiting pharmacists to discuss the impact of the cuts on their business.

From this, it is clear there is more going on than the double whammy of the cuts and Category M, both of which are really hitting cash flow. Added to that are other pressures including the increase in the minimum wage and, in some cases, astonishing increases in business rates. I also learnt that CCGs are withdrawing funding for pharmacy services, including PGDs on fusidic acid for impetigo, trimethoprim for UTI, smoking cessation and nystatin for yeast infections. The removal of funding for the emergency supply of medicines is strange, as we still await the finalisation of the new scheme.

I have also heard reports that pharmacists are not receiving referrals from NHS 111 – despite the announcement that this would be encouraged.

All of these problems are a direct result of the decentralisation of payment from national to regional funds. Community pharmacy alone is not affected by these changes. We read almost daily of increased pressure on budgets for health and social care, affecting many of our patients.

I said in this column many years ago that the transition from payment for volume to payment for services will be fraught with danger, and this has clearly proved to be the case. All of these issues come together to cause a ‘perfect storm’, which will inevitably increase pressure on already stretched surgeries and overcrowded A&E departments.

It is clear that the Department of Health is focusing its investment in GP surgeries, rather than community pharmacy. Health minister David Mowat has outlined plans to close 7,500 surgeries and replace them with 1,500 super hubs. He said “we are finding that things are working better with GP practices being put into hubs of 35,000 to 40,000 people. They can employ pharmacists and physios and do more things on scale”.

Dr Richard Vautrey, deputy chairman of the BMA GP committee, has said about general practice: “The connections that local GPs have with their patients is one of the things that patients value most highly. We break that at our peril”. Such statements apply equally to pharmacy.

The Department of Health will not appreciate the value and social function of community pharmacy until they lose it. Funding has already been promised to move pharmacists into existing GP surgeries, signalling that community pharmacy does not figure very highly in the Department’s thinking – which is hardly surprising in the face of the two judicial reviews hanging over our relationship.

I have recently returned from the excellent European Pharmacist’s Forum, funded in part by Alliance Healthcare, and it is clear the UK is not alone in our challenges. Many countries are seeing increased expenditure through the hospital sector, as more expensive molecules are distributed through this route, at the expense of community pharmacy. In Spain, 973 pharmacies are on the verge of bankruptcy and in Italy they have too many graduates – it is predicted that there could be 20,000 unemployed pharmacists by 2020.

In contrast, in Switzerland a sample of 1,000 patients illustrates that 250 people are healthy, 250 see a physician and the remaining 500 are triaged in a pharmacy, receiving treatment without further referral. It’s taken 10 years for them to achieve this position – so we need to start now.

And, back to Mr Gandhi – what do we need to do now? We need to sell our vision for success to a much wider audience, and we must demonstrate how we can make our patient’s lives healthier, happier and better. As business people, we know all about selling things. Now we must sell the most important thing of all – ourselves.


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