By Outsider

Well done. Bloody well done. The only thing I can do right now is congratulate you on getting through nearly two years of chaos. It’s a pity pharmacy was not sitting pretty at the beginning of 2020 with margin and capacity to spare. But there is no point in looking back in anger (don’t worry, this won’t be a musical piece).

Looking forward then, I don’t think it’s unreasonable to say that the next three to six months will be crucial to what the next five years of community pharmacy in England will bring, and, due to the residual effects of the Medicines Act and the Barnett Formula, the rest of the UK. 

PSNC drifts on the sea of NHS politics, rudderless, amidst increasingly treacherous currents. The national negotiator has had more than five months to recruit a new leader and there is no sight of dry land. Instead, it appears to have spent that time fighting amongst itself in a representation review process that has dragged on so long it has depleted both the imperative and engagement needed to be successful.

Why is it taking so long? It’s clear that any implementation of the Wright Review has the potential to fundamentally change the structure and relationships of PSNC with the sector and the system, and therefore the role of any incoming chief executive. It cannot be a surprise that after Simon Dukes chose to leave early, it seems no-one has willingly thrown themselves into the proverbial frying pan, just in case it turns to flames.

Yet these next few months will be crucial in determining how community pharmacy navigates itself out of the pandemic. As soon as any level of normality is restored [again], there will be a significant list of jobs to be done. 

Set aside for a moment the constant demands of the Committee to seek financial redress for harms they feel unfairly dealt to them over the last few years and there is the fact that the implementation of the five-year contractual settlement is behind schedule. Some services that should have been implemented are late, while others that have been implemented aren’t necessarily having the impact needed to close the gap in the financial model left by the retirement of Medicines Use Reviews and the Establishment Payment. I sound like a broken record, but this is a material threat to a substantial amount (10 per cent) of remuneration.

it seems no-one has willingly thrown themselves into the proverbial frying pan, just in case it turns to flames

Next year will see the resurgence of commissioner pressure for a cheaper dispensing service. The hub and spoke consultation will return and it’s quite possible the sector’s inability to handle its workforce pressures could lead to remote supervision rearing its ugly head again. 

All this will require strong leadership from national bodies – let’s hope we have it. All of these issues are important, but they risk becoming a distraction from the core things the NHS – especially integrated care systems – need from community pharmacy. There will be no more money for dispensing, so the new services in the five-year contractual framework need to land, and land well.  

The secretary of state for health has already hinted that he likes Scotland’s Pharmacy First approach, so it should not take much negotiation to mould the Community Pharmacy Consultation Service into one that isn’t dependent on input or output referrals to work.

The Discharge Medicines Service continues to offer the secondary care sector huge potential in increased outcomes and decreased costs. It needs local leadership to get it over the line, though. The other services being piloted and recent innovations in the OTC sexual health market present another opportunity for community pharmacy to redefine its offer.

The progression of these elements and others to come over the next few years will shape community pharmacy for the next generation or more. Success is dependent on the leadership of the profession, both locally and nationally. And the shape and style of that leadership is similarly dependent on the outcome of the review and a new chief executive of PSNC.

Nearly two years into a pandemic, everyone in the sector (and the country) is knackered, fed up with national politics and feeling a little let down by all those who are supposed to stand up for them. I know you’re tired, but these next few months are the time to pay attention and react to things that happen locally and nationally.  

It will soon be April, and the start of the penultimate year of the current five-year deal. The sector will turn in on itself as it seeks to elect the local and national representatives that will oversee the new contract negotiations. 

If me, you – all of us – don’t know by then who and what we want to be, then by the time we do, it may be too late.

Outsider is a community pharmacist