Contract: seize the opportunities
It may not be a popular sentiment, but I think PSNC has done well to get a five year deal out of Government. The deal itself is far from perfect, but as someone who bears the scars of the 2015/16 cuts consultation, I wasn’t sure we would ever see a deal like this.
Back in those dark days, the direction was clear – they liked pharmacists, but they hadn’t got a clue what, if anything, they wanted from pharmacy. To an extent we now have more of a clue what they want from pharmacy, but there is so much detail which still needs to be worked out, that it remains to be seen if this will be our salvation.
As a human being I don’t like surprises, and as a contractor I like them even less, because they are inevitably bad news. In a normal cycle PSNC would generally not have a fully negotiated deal in place until part way through the year. This means that we are often six months or more into the year before we know what we are going to be paid.
It is impossible to plan with so little forewarning, especially when Cat M would come and rip the rug out from under you. The good news is that now we now know what our funding looks like for the next five years. The bad news is it looks like less than you were getting in 2014/15 when we last had a funding increase.
But there is a benefit in knowing where you’re at though, as you can start to plan ahead; the difficulty is that until we know exactly how some of the elements in the new contract are going to work it is very difficult to pinpoint how individual contractors will be affected.
Even with the five year deal, medicines margin remains as unpredictable as ever, with £15m per month being added to the Drug Tariff from August onwards to make up for a shortfall in margin. For me, margin has to go, because it is really volatile and unpredictable, plus we need to be seen as healthcare professionals not medicines traders.
We need to be seen as healthcare professionals not medicines traders
Removing the two key drivers in our contract: prescription volume and medicines margin would help to change the mindset in and towards community pharmacy. Chasing pieces of paper for ever-decreasing returns only leads to an ultimate and inevitable point of collapse. Our focus will have to change as the incentives in the contract change towards quality and clinical indicators.
The new Community Pharmacist Consultation Service is a really important investment for the future. If we get it right and begin to divert significant amounts of activity away from general practice, the NHS will become reliant on us for the delivery of clinical services. Get them on the hook and we can begin to flex our muscles in the future. But if this service fails to deliver, we could be in deep trouble. I urge everyone to get behind it and make it work, even if it is another NUMSAS-shaped pig with lipstick.
To make all of this work, the NHS wants us to embrace technology, suggesting we are too slow to adopt innovative solutions such as hub and spoke in order to drive the costs of dispensing down. Let’s be clear, there is no evidence that hub and spoke can drive costs down, but PSNC has agreed to begin a dialogue to try and make it work for “all parts of the sector”.
Keep an open mind
As someone who has done more work on this subject than virtually anyone in the independent sector, I think it is important that we approach this with an open mind, but are prepared to ask the difficult questions. Last time Government only wanted to do the bare minimum to enable the legal change, but if they genuinely want to create a “level playing field”, I for one will offer them any assistance I can.
The other piece of good news buried in the announcement is a commitment from Government to try and do away with branded generics. This will be massively welcomed by contractors who have suffered from CCGs gaming the system.
There will be winners and losers from this new contract. It is really important that we try and seize the opportunities, lest others point to our failures as evidence that community pharmacy can’t deliver. I know we can and will prove the doubters wrong.