Déjà vu all over again

A woman walks into a pharmacy. No, not the beginning of a joke... although maybe a bad one...

Mrs Outsider, the good-lady-teacher- her-indoors, was heading off to work one morning in June when she remembered that her local pharmacy of choice had sent a text message the previous night stating her repeat prescription was ready to collect. Quickly changing direction, she dutifully arrived at the pharmacy to collect the little paper bag of joy.

After presenting herself at the counter and the prescription being retrieved, the pharmacist offered her a blood pressure check. “I’m sorry, I’m running late for work. I’m already stressed and I know it will be high...” came Mrs O’s rejoinder. The pharmacist must have been persuasive because several minutes later, she was informed that indeed, her blood pressure was high.

At this point in her account, I let out a little chuckle, for it reminded me of my time ticking off five-bar gates on the whiteboard in the dispensary for this-or- that target. The pressure to get the patient into the consultation room no matter what. The emails from management with the best phrases to guilt trip patients into just spending a little more of their day with you (for that extra £28). “When do you go back to get the ambulatory monitor fitted?” I enquired.

Yet instead of booking this particular patient in for an ambulatory meter, the pharmacist instead referred Mrs O back to her own GP. To be clear, this was not due to the readings being so high that an urgent referral was needed – although as the readings were never given to Mrs O, who knows? No, this was due to some unexplained capacity constraint or lack of effort.

This doesn’t appear to be a one off. Community Pharmacy England spent June in “intensive negotiations” with the Government and NHS England, but its interlocutors may not have been impressed by the referral rate from the Hypertension Case-finding Service into ambulatory monitoring. The rate for the six months from October to March was a lowly 6.2 per cent.

Digging into the NHS BSA figures for particular businesses, there are some striking findings. Some pharmacies appear to have delivered thousands of checks and converted hardly any patients to the ABPM stream of the service; others have conversion rates of around 20 per cent.

Of course, these are top line findings, and there could be perfectly reasonable explanations for extremes in performance; perhaps some have marketed the service particularly effectively and are attracting lots of ‘worried well’ patients.

But I’m mindful that pharmacy has form with payment targets. There was egregious behaviour in the MUR days that led not only to the demise of the service, but to much individual pain along the way. In addition to the pharmacists that were dragged through Fitness to Practice hearings, the many suffered also. “Post-payment verification” wasn’t a thing before that time, but it is increasingly common practice now – and it could be hitting the Hypertension Case-finding Service any day now.

In news of other things that were once great and are now in demise – LloydsPharmacy. There has been speculation in these pages (and others) recently about the fate of the multiple as it axed its Sainsbury’s stores and was seemingly carving up many of its group operations into smaller entities. Why? We could only speculate.

The last couple of weeks have seen a change of pace. Notifications of change of ownerships have been flooding out of NHS England, but not, for the most part, of sales to known operators, or plucky locums wanting to chance their hand. This time, it appears that a large chunk of the remaining estate is being hived off, one by one, into individual holding companies named LP North or LP SD followed by a number – a process that has been going on since November last year, as P3pharmacy reported in May, but which LPCs are only now being officially notified of.

Most of these companies still appear to be ultimately owned by LloydsPharmacy’s parent company Aurelius for now, although as P3pharmacy went to press, a handful of LP North entities had been acquired by new owners, according to Companies House records. 

The fate of the rest, and of the LloydsPharmacy estate as a whole (not to mention the staff and patients) remains to be seen. Aurelius may be looking to shift the lot, but could there be a stubborn few left on its hands because no buyers are available? 

Finally, what about Mrs O’s blood pressure, I hear you ask? When her GP called her in to re-do the work already done by the pharmacy, it was perfectly normal. White coat syndrome indeed.

Outsider is a community pharmacist