Provider model potential
By Aneet Kapoor, Chair, Greater Manchester LPC
The past two years have been exceptionally challenging for community pharmacies, but if we play our cards right, we could play a major role in local service planning and the primary care networks (PCNs) that will serve populations of 30,000-50,000 people.
It’s a chance to demonstrate community pharmacy’s value when it comes to urgent care, long-term condition management, and people’s health and wellbeing. But it’s essential that we have the right structures and systems in place to support this.
In Greater Manchester, where devolution got the ball rolling in this direction in 2016, we quickly realised the importance of having an effective community pharmacy provider company. Commissioners were clear that some forums had to be restricted to providers – professional representative committees (including LPCs) would be gated out of those discussions. Their preference was to commission services from a single entity (for example, a lead provider) that would be responsible for delivering the agreed outcomes – this was well outside the LPCs’ role.
We set up our provider company CHL jointly with Bolton LPC, but the model constitution and articles of association we used proved less than ideal. Firstly, for various reasons, some pharmacy chains found it difficult to join. Secondly, managing a company with a large number of members is burdensome. And thirdly, while a provider company is designed to tender and deliver services, LPCs may themselves develop services for the benefit of all contractors.
Our need for new articles that provide a level playing field with GP federations and the Local Optical Committee Support Unit (LOCSU, optometry’s provider company model) structures has become even more urgent with our proposals for a new commissioning model for community pharmacy in Greater Manchester, which was covered in P3pharmacy last October. There’s a huge appetite among commissioners to manage locally-commissioned pharmacy services through a single contract with CHL, which would then ensure its pharmacy members delivered the agreed outcomes.
So we’ve worked with solicitors and the Pharmaceutical Services Negotiating Committee to develop a new model for provider companies, which includes all local pharmacies as members, but with governance in place to highlight the separation between LPC and provider company. CHL aims to go live with the new model in April.
The key elements are:
- New articles of association which enable people to sit as ‘observers’ without directors’ responsibilities, in addition to having full CHL directors representing the LPCs and the members.
- CHL will initially have two LPC members – Greater Manchester and Bolton – and the ability to expand to other areas, and a small number of contractor members from designated areas. All community pharmacy contractors will be able to become affiliate members of CHL without accepting individual liability.
- The LPCs will use contractor funds to scope out new services, confident that we are using their funds to benefit all contractors equitably and in line with their legal duties.
Equally importantly, creating a unified and equitable provider company for all Greater Manchester pharmacies establishes a legal framework for collaboration between contractors. This is crucial – community pharmacies need a strong and united voice in local commissioning if we’re to maximise wins for our sector from the NHS Long Term Plan and PCNs.
When times are tough financially it’s tempting to retreat inwards, see other pharmacies as competitive threats, and stop collaboration and information-sharing. That’s absolutely the wrong approach right now. The new NHS landscape is all about collaboration and pooling skills and resources to work as one for our patients. We will be much stronger if we all work together in our local areas.
It’s worth mentioning of course that the new structure still permits competition and any relevant conflicts of interest will need to be declared, as appropriate.
Our provider company is key to ensuring community pharmacy thrives in Greater Manchester. The new model constitution and articles of association that we’ve developed overcome the obstacles and disincentives we’ve encountered along the way. We believe it’s a model that could prove successful for all community pharmacy provider companies in England. We see a future where fewer, but larger, provider companies could support many LPCs to deliver local services and tenders in a competitive and value-for-money way.