By Outsider

Elon Musk is buying pharmacy for $44 billion. Sorry, I mis-spoke. Elon Musk is buying Twitter, including the very enjoyable subsection that is pharmacy Twitter, where earnest conversations can be had about who is using the pointiest stick to poke the bear. Woe betide anyone who does not recognise that my stick is the pointiest and my bear the fiercest.

 What deep and meaningful topics have graced the pharmacy Twittersphere recently? Well, you can’t move on it for people photographing themselves looking pensive in front of plate glass windows, or gurning next to a politician. Then there’s the recurring series of hilariously funny spats the same people keep having about the future (or not) of the Royal Pharmaceutical Society. 

However, the nadir of pharmacy Twitter for me recently was the ever so serious thread on pharmacists not taking rest breaks. This is not news, but it says more about the sector than it does about social media. Echo chambers are called that for a reason. 

In the last 15 years, the sector has been consulted on the substantive revision of the Human Medicines Regulations (2012), the 2012 NHS reforms, the 2012 and 2013 Pharmaceutical Services Regulations and the 2019 contractual framework – not to mention numerous regulatory amendments in between. 

Every time has been an opportunity to resolve the discrepancy between safe working hours and NHS contractual hours. Yet every time, the sector has demurred. Over the same period, general practice has achieved guaranteed protected learning time, defined clinical sessions and achieved generous payments for extended and out of hours provisions.

It can be no surprise that our sector heads into another set of negotiations ill-equipped, under-funded and with no realistic prospect of securing substantive change in the status quo. And that status quo is looking pretty grim right now.

Since the infamous Department of Health/NHS England Christmas card in 2015, contractual funding for pharmacy has dropped in real terms by 23 per cent.  In the same time, the national minimum wage has risen by 46 per cent.  No-one hailed the five-year contractual settlement as a massive success, but it did promise stability and both sides lauded a mechanism to adjust funding if capacity in the system changed.

Every pharmacy owner will have witnessed their own version of this capacity change as their annual bills and contracts ticked up in line with the Consumer Price Index last month. But not the pharmacy contract. If inflation were recognised just in the period of this contract, the value would now be £2.74 billion, equating to approximately £13,000 extra per pharmacy.

If challenged, the Government would no doubt respond by falling back on its proposals for hub and spoke as a means to drive dispensing efficiencies and save contractors money. In reality, the Government’s best estimate is that it would benefit less than 10 per cent of contractors over the first eight years. The consultation runs until 8 June, and it’s important you read it and respond to it.

If only 10 per cent of contractors will benefit from hub and spoke, here are some significant things Government could do, and quickly, to make a real impact on dispensing efficiency:

Patient pack dispensing. It’s been promised for decades but the closest we got was the special container provisions which had to be massively curtailed when someone noticed it was not legal under the EU Medicines Directive. Having now left the EU, perhaps we can catch up with the EU – there is now nothing to stop the standardising of pack sizes and finally introducing patient pack dispensing

Fixing the discount scale and bringing back NCSO. Reduced wholesaler models and direct to pharmacy schemes have distorted the conceit of the clawback on wholesaler discount. It’s bad enough that pharmacies are having to deal with genuine supply issues, but risking being scalped by having to trust in a future price concession is obscene. The level of electronic submission of claims means this should be easy to fix

Generic substitution. Real substitution, not flaky Severe Shortage Protocols or some other half-hearted measure. It’s time pharmacists practice at their limit and are trusted to supply what is needed and available, without having to chase prescribers for petty amendments.

Any one of these would make a significant increase, immediately, in pharmacy efficiency and sustainability.  All three would make much more of an impact than any hub and spoke. In the meantime, a lot will be made of the outcome of the Wright Review. The more savvy observer will recognise that at this point, the review is just another symptom of the disease.

Outsider is a community pharmacist