Turning point

It may come as a shock to you that grumpy old Outsider isn’t the biggest Christmas fan, but I grudgingly appreciate the traditions and the trimmings.

What I do like about the holiday season though, is that feeling of change; it’s crammed full of points of inflection. It starts a few days before… You know the days are getting longer and the dark nights are shortening; glancing at the calendar, there are no more pages to turn.

Then there’s that moment, some time between Christmas Day and New Year, when you go from being content and satiated to recognising that you’ve over-eaten and are surrounded by more leftovers than you know what to do with. This is followed by a feeling of renewal and relief when you go to the fridge and – finally – there are no remnants of turkey or stuffing, and all is normal once more.

Looking back on the last year, it is easy to be distracted by the big news stories within and around community pharmacy. After two years where politics and the world seemed centred on the pandemic, 2022 was definitely playing catch up. Five education secretaries, four chancellors, three prime ministers, two PSNC chief executives and one invasion of Ukraine…the resulting global and very real energy and inflation crisis looks like it may last as long as the pandemic.

When PSNC and the Government announced the final details of the contract settlement in 2019, it seemed that both parties were hurrying to close the lid on the five-year framework for good. Everything announced at the beginning, if not delivered, had at least been piloted and a tick put against it. It was all neatly packaged and wrapped up, regardless of the increasing financial pressures and uncertainty when looking out into the real world of community pharmacy.  

If we are to look forward then, what are the leftovers of the five-year contract and what do they tell us about what the new year may bring?  

There are pharmacies going into 2023 who haven’t paid their wholesaler bill or their energy bill, or both. There are also pharmacies who are riding a wave of increased patient loyalty and commensurate financial stability built on a platform of services, vaccination and great patient care. 

There will be national multiples who aggressively reduce their estate and regional multiples equally aggressively adding to their own. It will never have been as easy or as daunting to buy an NHS pharmacy as it will be this year.

The planned and deliberate expansion in services differentiates this five-year contract from any other time in modern community pharmacy. The breadth and depth of new services added to the prominence pharmacy now plays in vaccination post-pandemic is transformational and will be essential to the sustainability of any future community pharmacy model. 

Then there is the funding – or lack of it. The plaintive cries in the media begging for more money. It isn’t just about the money though – it’s the whole way pharmacy looks at how it operates and makes, or fails to make, money. If it is true that the pandemic has given way to a new political and world order, it has also cast light and dark on the capabilities of pharmacies to manage their businesses and deal with change. 

It is clear that the financial envelope of £2.592 billion is not sustainable. It’s also important to remember that we very much negotiated our way into that position over decades, a feat that will take some undoing. 

The hubris of relying on our ability to buy tablets cheaper than list price and pocket the difference has come back to haunt us like a particularly spiteful ghost of Christmas past. The message the ghost of Christmas future brings is that there is no point in appearing on breakfast TV petitioning for more money in isolation. Those new services are great, but they’ll go the same way as MURs if pharmacy can’t demonstrate positive outcomes with quality, longitudinal research studies.

As for the negotiators who brought us that five-year deal, what can be said of PSNC that hasn’t already been said?

One thing the finality of the five-year framework has ensured is that any future negotiating team will be wary of trapping itself into a multi-year framework again, no matter how neatly it is packaged. There is the prospect though that once it is finished with the death throes of the Wright Review and birthing the bastard love child that is the Transforming Pharmacy Representation Programme, PSNC should be in a better position to do its actual job. It will at least have an extra £1.5 million to do it with!

2023 will be a great year for many pharmacies up and down the country. It will be a disaster for others. For the sector as a whole, it needs to be a point of inflection.

Outsider is a community pharmacist.