Six and a half weeks

By Outsider

Brian Clough lasted 44 days as manager at Leeds United in summer 1974. He was appointed by a board that was fractious and divided. The preceding years at Elland Road had been glory filled, but then manager Don Revie was lured away to lead the national side, who after their 1966 World Cup victory had crashed out to West Germany in the quarter finals in 1970 and didn’t even qualify in ’74.

The humiliation of failing to even make the competition they had won eight years previously led to soul searching in the dusty corridors of power that was the Football Association. As it was back then, the FA today is a committee of local representatives who meet periodically to administer the game in England. Their day-to-day responsibilities are strictly part-time, posting fixture lists to local non-league teams and occasionally officiating at an annual dinner. Their role in recruiting the manager of the national team is an order of magnitude apart.

Don Revie was a strong-willed Yorkshireman from Middlesbrough (note to the editor: Yorkshire was bigger back then). Sometimes thoughtful, sometimes pugnacious but clear about his views, he lasted three years as England manager. His replacement at Leeds United, Brian Clough, was also a strong-willed, pugnacious Yorkshireman from Middlesbrough. There is fantastic archive footage of Austin Mitchell interviewing both men on ITV’s Calendar, just after Clough’s defenestration.

"Prime Ministers come and go... but five-year contractual frameworks, especially if written and signed off more than two governments ago, stay"

The interview starts with introducing Clough as having been sacked after his own team passed a vote of no confidence that led the board to fire him less than seven weeks after appointing him. What follows is 25 minutes of bruised and battered egos engaging in what can only be described as passive (and sometime not so passive) aggressive verbal warfare. It is TV you cannot take your eyes off.

The last seven weeks has been like a fever dream in the politics and social zeitgeist of the United Kingdom. It is now being said that the adults are back in charge – something that will have to be seen to be believed. If that is true though, then the folks at PSNC Towers had better start paying attention quickly.

Prime Ministers come and go (this now appears to be a thing), but five-year contractual frameworks, especially if written and signed off more than two governments ago, stay. And because the politicians who backed them aren’t there any more, there’s no one to champion them, apart from the apparatchiks in Quarry House and Victoria Street. The real terms effect of this for pharmacy can be seen laid bare in the lacklustre settlement for years four and five.

Any new settlement would be due to commence in 2024, less than 18 months from now. Yet the road there will not be smooth. National bodies are still genuflecting and navel gazing after being forced to recognise their own failings. 

PSNC has commissioned strategic, branding and lobbying reviews. Does this mean it will be able to sensibly invest the extra £1.5 million in funding it receives from contractors in 2024? Possibly. But it’s likely that government machinery will be in full general election mode. If negotiations aren’t paused for purdah, they’ll stall because of the reflexive need of any government to offer tax cuts rather than spending commitments.

It’s therefore not inconceivable that any serious government commitment to a new contract model won’t happen until 2025 or 2026. That leaves the sector with two real and tangible problems – funding and prescribing. 

If there is no material uplift of the £2.58 billion settlement figure in that time period, contractors will have absorbed in the last 10 years a real term funding cut of some 40 per cent.

The second problem is the sunny uplands of independent prescribing. It seems obvious that any future contract needs to leverage pharmacist prescribing. The sector is running head-long towards those verdant pastures. But there is a lack of capacity in the pipeline to sign off all these new prescribers and there is still no payment or service model, nor any prescribing or capitation budget to fund a community pharmacy prescribing model. 

It also goes without saying – though a former PSNC Negotiating Team member has done – that a volume-based payment model and community pharmacist prescribing seem incompatible with good governance. Those green fields could well be hiding a cliff edge.

Lastly, good news. It turns out I didn’t need to learn how to spell the name of the previous secretary of state after all, but I hear their attitudes to antimicrobial resistance and public health were acutely grave...

Outsider is a community pharmacist