NHS England has agreed to maintain a £2.8 billion community pharmacy budget for the coming year, plus fund a national community pharmacy-based flu service. Carolyn Scott asks PSNC’s Sue Sharpe for her thoughts on what’s been achieved, and what’s still to be done.

P3 spoke to PSNC’s chief executive Sue Sharpe on the day of the announcement of England’s settlement for 2015/16 – the once-a-year deal, which this time comes in the midst of rounds of hard-hitting changes in the NHS driven by a newly empowered and cash conscious Conservative government. She tells us more about the settlement achieved this time around.

It’s great news, in particular, that a national community pharmacy flu vaccination service has been given the green light, says Mrs Sharpe, and it recognises the progress that locally commissioned flu schemes have been making over the past couple of years. ‘This was a long time coming,’ she says, but as well as giving the NHS a new means of reaching WHO targets for vaccination, the new advanced service gives pharmacy a new opportunity to show what it can do, working closely with general practice. ‘It gives a powerful signal to the general public that pharmacies are providing to the public an important clinical service. I hope that this will do a lot to reinforce in the public’s mind that pharmacies are places offering professional services.’

Mrs Sharpe is also very pleased that PSNC has maintained the £2.8 billion for community pharmacy this year, and that concerns about additional costs being borne by pharmacies as a result of the roll out of EPS will be the subject of a joint study between PSNC and NHS England.

‘Of course, funding is tight for pharmacies and will continue to be tight. We’ve been able to protect the funding levels at £2.8 billion even though the NHS demanded efficiencies across the whole NHS of a minimum of four per cent. So pharmacy remains stable, but of course pharmacies are running lean operations and the pressures of additional costs can’t be just absorbed,’ she says.

Still on the table?

But what about the plans that were progressing for a national minor ailments scheme, which appear to have been knocked back? What happened to the idea, which PSNC alluded to in a statement only a few months ago, for a funded minor ailments service?

‘The area that we are most disappointed in is, as we confirmed in May, that we were hoping to agree a minor ailments advice service. And we have been unable to do so.’ Funding was being discussed for a pharmacist-based service that would offer patients a higher level of clinical advice compared to the product supply based services that are currently locally commissioned, largely delivered by medicines counter assistants. This would offer patients the choice of a more comparable service to that available from their GP.

‘We made a lot of progress, but then at the eleventh hour were hit by the confusion between these two types of service. So, very sadly, the NHS will go for another year with wasted expense for [common conditions] appointments, at a time when general practice is buckling under the strain.’

She feels that the two types of service and the different costs involved to offer them and the remuneration that would be required, became confused with decision-makers. ‘What we have now is a world apart from the service that the NHS really needs, using the advice of the pharmacist to relieve pressures on GPs from people whose symptoms can be managed by advice alone or a simple medication, and the costs for this are significantly different.’

These costs have to account for the pharmacist time, the need to record the data at the right time, to liaise with the patient’s GP, and to ensure that pharmacists are ‘protected against pressure to do an imperfect job’, she says. ‘We believe that pharmacies do an immense amount to help manage demand in local GP practices and walk in centres. But this can’t be on an underfunded service.’

PSNC will continue to make the case for a national pharmacist-led service, she stresses, and believes that existing local minor ailments services still also have a place. ‘I expect those local supply based schemes to continue. The impact on demands for GP appointments, if they were to be abandoned, would be catastrophic.’

Is community pharmacy being involved enough as part of the solution for a stressed NHS? Mrs Sharpe is very clear about what she thinks: not by a mile. ‘I think Jeremy Hunt and Simon Stevens are far too focused on old traditional sources of care. Jeremy Hunt, when asked about pharmacy, always says ‘yes, pharmacists can do more’ and gives examples of good practice, but both he and Simon Stevens never truly get behind pharmacy.

‘I think they are looking in the wrong direction, and are possibly just a little weak, and reluctant to tackle the pockets of old-style GP resistance to any change or weakening of their monopoly. I must say, that as a taxpayer, that drives me nuts.’

Does pharmacy as a whole need to take a stronger stance on the case for minor ailments? ‘Yes. I believe that we need to analyse a bit more this time around and see just what the prejudices are that we need to confront. Once we’ve done that, I think we need to ask very clearly why the taxpayer is not getting best value.’

Flu fantastic

The new national community pharmacy flu immunisation service is ‘a great move forward,’ she says. ‘If you go back 10 or 15 years, this would be an un-thought of development for pharmacies. Many pharmacists are now doing something that they never expected to be part of their clinical practice. What we need to do as a sector is to use flu jabs and the other advanced services to demonstrate our professionalism and credibility.’

There’s already been a great start, she says, with many locally commissioned flu services in place last season and the majority of pharmacies have pharmacists trained up to deliver it. But, with the new deal this winter, community pharmacy needs to get behind flu as much as possible.

Mrs Sharpe fears that anyone choosing to stand on the side-lines could ‘damage the credibility of the whole sector.’ As always, the potential for future services could rely on the delivery of this one, she suggests. ‘Unless pharmacy shows that it will respond to opportunities then we can’t be surprised if people are reluctant to give us further opportunities,’ she warns. ‘Every community pharmacy has to do its bit, to show that the NHS can rely on us to deliver services that it commissions.’

With the summer months rapidly drawing to a close, she acknowledges that the announcement has come rather close to winter. ‘We really did push hard to get an earlier announcement, but the combination of the election and the new ministerial team thwarted that.’ There is going to be a potential problem with access to vaccines because it’s very late in the year, she says, but adds that any progress will mean a lot: ‘It’s a long-term service. We can get ourselves in a good position this year, for even fuller delivery next year.’

What next?

Negotiations for next year’s settlement will begin when NHS England indicates to PSNC that they are ready to sit around the table. Policy and politics inevitably get in the way of this, causing delays, but there is a hope that the timings of pharmacy negotiations can gradually become more closely aligned with those for general practice. ‘We hope that we will move speedily this time. Our settlement for this year is slightly earlier than previously, although the GP negotiations were concluded before Christmas last year…’

When NHS England does indicate they are ready, there is plenty to discuss, she says. ‘We have got some interesting work and developments on services that pharmacy can provide for people with long term conditions: identification and management, and I would expect that we would have discussions for those in the mandate for negotiations for next year. I do also believe that there is an important case to be made for the urgent supply of routine medication through pharmacies and for using the advice of pharmacists to reduce unnecessary GP appointments.’

In conclusion, what are her overall feelings about the PSNC announcement? It’s certainly positive, she says. ‘I think it is a move forward and I hope it will be received well. Clearly, I’m balancing this [the flu service] against the frustration that we didn’t get the other [minor ailments service]. But it’s absolutely another step in the right direction.’