Firstly – are you OK? I hope so. It feels pretty strange sitting here actually delivering a nationally commissioned Pharmacy First Service

How has it gone for you? Do you keep getting adults self-referring for otitis media because the national advertising doesn’t say it’s only for little ones? Or are you the lucky one that got the local GP referring folks hoping they can rock up for earwax removal?

Did you get that recurrent sinusitis patient referred to you so as to save a GP appointment, only for them to moan about getting “fobbed off” with a nasal spray they knew wouldn’t work? Then, of course, the practice complained to NHS England that they had to use a valuable appointment slot to see them, so why is the pharmacy still getting paid?

One month into the service, two months after the service pathways were published, three and a half months after agreeing to the service and nine months after knowing it was coming, Pharmacy First is still not actually in place.

The IT platform is basic at best and barely functional at worst. Seamlessly updating the patient record at General Practice is something pharmacy has been trying to achieve for years and is perfectly possible. It was promised – guaranteed, as a sweetener – as part of this service. Its repeated delay is starting to make our primary care colleagues question whether it will ever arrive. As if they need any more cause…

Do I exaggerate? Perhaps, but I think not. For when the complaints come, they are never balanced by the tens of thousands of content and satisfied patients. Nor the equivalent in saved appointment time.

This is, of course, to be expected. It was predictable and was predicted. Behind the scenes, Local Pharmaceutical Committees, sorry – Community Pharmacy Locals – try to allay the storm. Calm the waters. Smooth the way. (Note to the Editor – Community Pharmacy Locals sounds like a small chain of convenience stores. Perhaps they have bought some of the LloydsPharmacy stores on the cheap?)

Where was I? Oh yes – LPCs, sorry CPLs, are busy fighting the corner of pharmacy as yet another national pharmacy service lands with bits missing, or late, or broken. LPCs are the ones that endure the inevitable mudslinging and help understand where things are going wrong, and where they are working.

They are the ones that hold the hands of those that are taking over 30 minutes to deliver a Pharmacy First consultation, and provide additional coaching and support to fix that. Then, in six months time, when all the new registrants arrive, they will re-deliver training to make sure it doesn’t happen again.

They are also the ones currently reading through a myriad of information about the detailed reporting NHS England will be using to ensure the Primary Care Access Recovery Plan is delivering the – er, recovery – it should be. And what will be delivering the Primary Care Access Recovery Plan, I hear you ask? Pharmacy First, obviously.

Yes, NHS England has set up a detailed set of metrics to ensure that the £645 million will deliver the outcomes they want. This is great news for the dissatisfied locums and ex-multiple employees who grew weary of performance targets and management rhetoric and have taken the plunge and invested in their own newly minted, slightly used, community pharmacies.

Performance management information that NHS England will be using to determine the success of their £645m investment include:

- Pharmacies registering to provide the service

- Pharmacies delivering consultations

- Number of consultations

- Number of consultations per 100,000 population.

The list goes on. You’ll feel right at home.

Community Pharmacy Locals (really?) are just part of the representative function. Community pharmacies pay their levy to them and they pay Community Pharmacy England to do the national bit on behalf of everyone. Community Pharmacy England is recruiting for two places on its new governance board from the local network. This is a much-reduced expression of representation than the board of LPC Chairs conceived in the original Wright Review. It feels especially limited considering the significant diminishing of the CCA block after the rationalisations in its estate.

On a final note, I want to mention Supervision. A government consultation on Supervision is underway at the moment. What does it mean to supervise a pharmacy or a pharmacy process? For decades, it has meant looking over someone’s shoulder or squiggling initials in a box. It has never and should never have meant that. In fact, it has never been defined in legislation. Very soon it might be, so let’s focus on getting it right and look outside of pharmacy to understand what works elsewhere and what can work in pharmacy.

Supervision is the long overdue younger sibling to Responsible, who has had a difficult childhood. Let’s not make the same mistakes with Supervision.

Outsider is a community pharmacy commentator