Treasury hold the purse strings: Simon Dukes

Simon Dukes has announced that the general practice (GP) referrals to community pharmacies through the advanced community pharmacist consultation services (CPCS) will be rolled out across England in the autumn.

The chief executive of the Pharmaceutical Services Negotiating Committee (PSNC) told delegates at the virtually-held Local Pharmaceutical Committee Conference 2020 on Wednesday (September 16) that “success of the service will be built on the success of relationships” between community pharmacies and GPs. He added that the scheme would “build a platform for longer-term relationships between the two professions”.

The GP CPCS scheme is currently being trialled in 11 regions across England. The purpose of the GP CPCS is to reduce the burden on general practices by referring patients needing advice and treatment for certain low acuity conditions from a GP surgery to a community pharmacist.

The conference heard during a session later in the day that there was good evidence to suggest the advice given by community pharmacists, as part of a consultation about symptoms of minor illnesses, have resulted in the same outcome as when a patient visits their family doctor.

Dukes also announced that the new advanced discharge medicines service (DMS) – added to the Community Pharmacy Contractual Framework from July 2020 – will commence from January 2021 and will bring community pharmacy and hospital pharmacy closer.

“We are working with NHS England to have service specification toolkits agreed and sent out to you in the very near future,” he told the conference.

Joint incentive scheme

Speaking of this season’s flu vaccination programme, Dukes said that the service this year will be “more ambitious, more flexible and more unusual than every before”. He added that the number of people wanting to be vaccinated will pose a “huge challenge” which is why community pharmacies will need to work in collaboration with general practices for a better outcome.

Dukes said that a “joint incentive scheme” had been launched to help the collaborative work between GP and community pharmacies and added that contractors would benefit from the flexibility to undertake vaccinations off-site, outside of their pharmacy premises.

He hoped this would “help contractors to absolutely smash last year’s flu vax totals”.

It’s a disgrace

In a blatant dismissal of the government’s reluctance to help the sector financially, Dukes said: “It’s a disgrace that a key part of primary care in England is under threat in the middle of a global health crisis.”

Recognising the personal, financial, and psychological toll of Covid-19 on community pharmacy, he regretted that many contractors were now “contemplating their own survival, whether they can actually remain in business.”

Funding irons in fire

Giving an update on the PSNC’s funding negotiations with the government, Dukes said: “We have two important funding irons in the fire right now. The first is our ongoing discussion with the Department of Health and Social Care on Covid-19 costs, seeking to reconcile that £370 million of bonds against costs. And the second is our bid for additional funding to the contractual framework’s global sum of £2.592 billion pounds.”

He said the PSNC was “pushing for the £370 million of bonds to be fully written off against Covid costs – both costs that contractors have already experienced and those that are yet to come.” He added that the costs did not stop even after the lockdown restrictions gradually being were eased.

“In fact, with schools now returning and an uptick in the R-rate, many contractors are seeing an increase in staff absences, and therefore an increase in their Covid costs for September.

“We need the reassurance that all Covid costs will be fully covered, especially with the shadow of a second wave hanging over us.”

Dukes explained how his negotiating team has put forward a strong bid for additional funding to the global sum agreed on the Community Pharmacy Contractual Framework, a document which “was not written with Covid in mind.”

“The pandemic has changed how patient’s view community pharmacy right now and how community pharmacy now does business,” he said, giving details from the PSNC’s recently released Pharmacy Audit data which showed that over 600,000 consultations were carried out to respond to patients’ symptoms in an average week across all English pharmacies.

During an average week nearly 185,000 consultations were carried out where pharmacies gave patients additional support for a known medical condition, the data revealed.

While some funding was provided for pharmacies for supporting people with ‘self-care’ through the CPCF, it was no longer sufficient to cover the considerable costs of this increasingly important part of pharmacies’ work, according to PSNC.

Additionally, this funding is distributed on a prescription volume related basis, while the audit showed that there was no correlation between prescription volumes and the number of advice consultations that pharmacies were carrying out.

Treasury quibbling

Implying that it would be down to the Treasury to release the money on both fronts as it “holds the purse strings”, Dukes said that PSNC has got “tough negotiations ahead”.

He went on to quote Jackie Doyle-Price, the chair of the All-Party Pharmacy Group, who wrote in a column in The Mirror on September 13: “Our local chemists, some of the quiet heroes of the NHS, are being abandoned to financial ruin through consistent underfunding and the costs of staying open during coronavirus.

Doyle-Price also wrote that the “bean-counting civil servants in the Treasury have been quibbling over an increase in pharmacy funding that represents a minuscule proportion of the NHS budget, but would keep thousands of pharmacies from going to the wall.”

Hancock, Churchill get pharmacy

Dukes, however, praised both health secretary Matt Hancock and under-secretary of state for health Jo Churchill who “genuinely understand the benefits of community pharmacy and do argue, on our behalf, within the government”.

Ending his speech on a positive note, Dukes said: “Suffice to say that an upsurge in Covid-19, coupled with bad a flu and medicine shortages” due to a potential no-deal Brexit could lead to a combination of extremes.

“I know that community pharmacy will stand ready to just get on with it, just as we’ve done with other health challenges down the years and as we have done over the past weeks and months,” added.

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