Outsider: Spring is here. Will we see a new beginning?

As the seasons change, so does the pharmacy landscape. And with this comes opportunities and risks

It’s April – and if you turn on the radio, or whatever setting on Spotify or Alexa that pretends to be a radio, the music has started to change with the season. ‘Here Comes The Sun’, ‘Beautiful Day’, maybe even some Beach Boys. Look around and there are budding leaves, daffodils and the first signs of nesting birds. A season of change and a sign of things to come.

Looking around in pharmacy, times certainly are a-changin’. Integrated Care Boards (ICBs) are now a real actual thing. The Pharmaceutical Services Negotiating Committee is different, smaller, than last month and has a new name – Community Pharmacy England. Local Pharmaceutical Committees are also different, also smaller and perhaps more streamlined than before. They’re certainly less well funded.

These are not minor, seasonal changes. These are big, structural, organisational changes. And big organisational changes bring with them opportunities and risks.

The re-unification of commissioning from the disparate and dire state that Lansley left it post his 2012 reforms can only be seen as a good thing. Granted, there is not the political will or capacity to fully undo his reforms – ICBs are still made of independent, and often independently minded organisations – but the “Integrated” in their title is purposeful and well intentioned. It should go a long way in most areas to make coherent what has often been vague and piecemeal.

The last piece of the ICB jigsaw to be put in place will be the transfer of the NHS England contract manager roles into the ICBs. As always, human resources processes take time and, unsurprisingly, this is running late. That’s not a huge problem. What might be more of a problem is that NHSE role now being part of the ICB.

Countless are the times a keen CCG wanted to push the boundaries of innovation or cost saving or some other brilliant new idea. To them, these ideas were great (on paper) and saved money. After all, one of the effects of the Lansley reforms was the focus on financial performance it gave CCGs; the fear of being put in special measures was quite a motivator.

Yet to community pharmacy contractors, these ideas often looked like prescription direction, or inappropriate diversion from FP10 prescribing. The role of NHSE in those situations was often crucial in resetting the norms and stabilising those relationships. How the role will function inside an ICB which will still retain all the financial pressures and imperatives of its constituent organisations remains to be seen.

Any organisational change comes with the risk of organisational memory loss. That’s potentially a big problem for community pharmacy, which is dependent on the quality of the relationship it has with its commissioner. Not everyone who worked with pharmacy made the leap to ICB lands. For those that did, they often find themselves in different roles, meaning the relationship they had with community pharmacy gets strained or even broken.

That memory loss manifests itself in different ways. Sometimes it’s about not understanding the capabilities of the other party, perhaps failing to recognise that pharmacy can deliver at scale and on time. Sometimes it’s about missing out on crucial context, like why a service is one national advanced service instead of there being dozens of different local services. Often, it’s just about not having had the time to build trust in each other.

Community Pharmacy England starts its new life pretty much as PSNC left it. There will be fewer people sat around the table, but many are the same people who filled those seats last year, and the year before that, and even 10 or 15 years ago. Looking from the outside in, you could be forgiven for wishing that this organisation does go through a bout of memory loss. It won’t. 

The same internal factions will be at play. The tension between vertically integrated multinationals who make money every-which-way, and the pharmacies striving after margin at the point of supply. While the committee size is reduced, the ratios remain pretty much the same, although judging by the rate some multiples are off-loading branches, it won’t be long before either AIMp or the independents feel rightly disenfranchised by the CCA’s 40 per cent voting block.

The real question is how well this new committee can invest the huge budget increase it has arrived at as an end point of the Wright Review. And can they achieve a bigger return on investment for contractors than if they had left that money in the hands of those from whom they have taken it – the LPCs who are having to rebuild relationships with new Integrated Commissioning Boards? Beats me.

Outsider is a community pharmacist