By Ade Williams

On 4 January 2010 my wife became an NHS contractor. My confidence in her ability was never in doubt, and I signed up for the adventure. I must confess, it has been rough. I have, at times, longed for my old life; looked up how Canadian colleagues are faring. Like many, I’ve seen the reverse of the financial security that used to define us. 

It’s often said that we forget too soon or fail to learn lessons. So what if I could go back? What words of advice might have prepared me for the last 10 years? Did anyone see what was coming? Did we really sleepwalk into the massive changes the NHS and pharmacy would go through? I thought the P3 magazine from precisely a decade ago should offer some answers. 

Rallying cry

The editorial was succinct and poignant. A rallying cry that with so much happening – the creation of the GPhC and the professional leadership body, a cost of service enquiry, the transfer of the global sum – pharmacy leaders should seize the initiative and influence NHS commissioners to introduce clinical services into community pharmacies. 

There were lots of takeaways from the exclusive interview with Jonathan Mason – then one of two NHS pharmacy czars. With the recession biting, the need to save costs provided opportunities for groundbreaking changes. But, he warned: ‘’There is little formal evidence that demonstrates how good and useful pharmacy is. Now is the time to record how we make a difference to the health of patients.”

I suspect his mention of quality indicators in pharmacy may not have got much attention back then. Confirming that MURs were probably not valued by other professionals in primary care, he suggested pharmacy’s target chasing approach did us no favours. His stark warning echoes: “I think pharmacy needs to step up and start making a difference”. 

An opinion piece, It is time to cut to the chase, advocated original pack dispensing by exploring benefits like improving adherence and reducing medicines wastage. I was particularly drawn to the Audit Commission report cited in the article. A spoonful of sugar recommended implementing original pack dispensing to improve patient safety. Interestingly, Department of Health proposals that in 2005 suggested pharmacists should be able to round quantities prescribed up or down were rejected by the negotiator as a pharmacist would only be paid for the prescribed quantity, irrespective of the action deemed in best interest of the patient.

P3pharmacy’s current editor, then chief executive of the Company Chemists’ Association, warned: ‘‘Regardless of who wins the general election, one thing is certain: money is going to be tight.” Suggesting that year’s cost of service inquiry would be vital, he went on: “The buzz around the NHS is that a dose of financial pressure will be useful because it will make needed changes inevitable”. QIPP (quality + innovation = productivity + prevention) might not survive as an acronym, but the goals it espoused would shape community pharmacy’s future.

The switch of tamsulosin for benign prostatic hyperplasia, especially the opportunity to deliver men’s health benefits in pharmacy, was universally welcomed, and could be seen as having paved the way for the hugely successful Viagra Connect switch last year.

A business feature about online content could have been written today. “Is your website only fit for the dark ages?” it asked. With many familiar retailers undone by online competition and the NHS’s digital agenda shaping the future, the question today would be: “How grammable is your community pharmacy?” 

Progressive ambitions

Other content highlights the profession’s progressive clinical ambitions in 2010: weight management, smoking cessation, child health and pain management, while regular contributor Mike Smith encouraged us to beat a path to the shadow health secretary’s door. Andrew Lansley’s recent draft manifesto suggested that some radical changes were planned for the NHS if the Conservatives took power in the election ahead: “Let us all make sure community pharmacy is not sidelined.”

From the perspective of 10 years ago, community pharmacy 2020 has elements of Greek tragedy: trouble brought on by collective failings in circumstances out of our control, but foretold. Like Odysseus after the fall of Troy, if we are to survive, we need to listen more, respond quicker and win over our paymasters, whoever they are, with evidence of what we do. 

I’m no Greek philosopher, but I’m dead certain we do not have another 10 years to get it wrong.