Speaking at a conference in London on Sunday, Chief Executive of the Pharmaceutical Services Negotiating Committee (PSNC), Simon Dukes, said that one of the greatest strengths of independent pharmacists was their access to 1.6 million visitors every day. He added that in his capacity as a negotiator he was pushing for a multi-year deal for the pharmacy sector.

The PSNC chief was a addressing a 240-strong conference audience at the Hilton hotel in Heathrow. The seminar was organized by Sigma Pharmaceuticals – its first in the country to accommodate independent pharmacists who are unable to attend the annual conferences held abroad. Sigma Pharmaceuticals is one of the UK’s largest independent wholesalers, servicing over 3,000 pharmacies. The business was started by Bharat Shah and his family from a single pharmacy shop in Watford in 1982.

Here are some excerpts from Dukes’ speech entitled ‘Community Pharmacy in 2019’:

One year in pharmacy

“I spend a lot of time rebuilding relationship, especially with government, and building good relationships with the heads of the other pharmacy representative groups. I’ve continued to try and improve the value PSNC provides to you [community pharmacists], to LPCs [local pharmaceutical committee].

“You can’t help but spend any time at the centre without getting some very clear impressions, and those impressions are about the fact that actually a lot of people are very downbeat and downcast and also that the financial pressures and the cashflow issues are having a real significant impact. Yet despite that, patients are insulated often from those aspects simply because of the professionalism and the patient-focused nature of your profession and of community pharmacy more generally.

“What I also get is a very sensible optimism, the fact that people have on a whole range of Long-Term Plan, they can see there are streaks of light for the future. But clearly there are some big challenges for us.”

PSNC pushing for a multi-year deal

“What I didn’t think when I took this job in May 2018 was that it would be 11 months before I actually sat down to start negotiating the next Contractual Framework… We started earlier this month [April]. I have a good and experienced negotiating team made up of members of the independent sector, of multiples, and independent multiples as well. Those people are all experienced negotiators and I have my own team, executive team, of course. It’s a tripartite negotiation with the Department of Health and NHS England. And as you know, if you read any of the comments made last year, I am pushing strongly for a multi-year deal for us. Because I know if we have a multi-year deal, you can make your investment decisions based on certainty as opposed to the uncertainty and ambiguity we face currently.”

Challenges in the negotiations

“But there are some significant challenges in our negotiations. We live and work effectively in a monopsony. There is only one principal buyer – NHS England – and we had a breakdown in the relationships with that principal buyer over the years.

“We don’t have a unified voice. We have a number of different pharmacy groups and that relationship that I have and we have together is absolutely vital. I do believe that it is good that it’s been working well but we are, nonetheless, a number of voices as opposed to one.

“But PSNC represents everyone in the sector – all of you in this room, all independents, we represent multiples, we represent independent multiples, we represent online pharmacies and DSPs (distance selling pharmacies), and that is enormously important when it comes to putting across our collective and joint views together.

“Because there is a need for transformation, not complete transformation, but certainly different areas within our current business models. And we have to accept that that is the case and that for some people will be more difficult than others. And we must also accept that from an NHS England perspective there is no appetite to challenge the role of GPs as being at the core of Primary Care. We have to accept that, and we have to work with that.

What does Government want?

“Unsurprisingly they want value for money. Don’t we all? They are very clear in saying that there is no more money for doing the same thing. But what they do want, and you can see this from the Long-Term Plan, you can see this from the GP contract, that the three areas they want us to focus on – urgent care, prevention and patient safety.

“On urgent care, we have seen successful pilot of the digital minor illness referral scheme and it is no secret that NHS England is keen for that to be rolled out nationally – a minor ailment service effectively for the nation.

“Prevention, they want us to focus on prevention. We are uniquely placed, 1.6 million people visiting a pharmacy every single day. We have the volume and have the scale to make those interventions on prevention, and of course, medicine safety is your core skill. And they have got this all integrated in a primary care network at the local level. Thirty to 50 thousand people in each one.”

Outlook for contractors

“How is it going to work? We need to have a greater understanding of how primary care networks will work and the environment. Not only do we need to have a greater understanding of how it will work, but NHS needs to have a greater understanding of the way we operate too.

“I think often there is sometimes a lack of understanding about the fact that we are 11,600 different businesses – buying, selling, employing, competing, and that isn’t always understood.

“We need to free up capacity in order to undertake some of the services that I mentioned earlier. And that is going to be challenging for us, given our funding model and the volumes we deal with in dispensing on a daily basis.

“We need to look at new ways to deliver those services and we need to ensure that our local engagement is better than it has been before. Lots of why around those things or how is that going to happen, what do you need to do differently, what do you need to start doing on the ground.

“And in the past, I always felt that perhaps the PSNC is very good at the macroeconomic, big picture stuff. But actually not particularly, it’s always going to give you the advice and guidance you need to get the ball rolling to do it. We are making a start in that process.”

(Simon gave a sneak preview to the conference audience into an animation PSNC launched on Tuesday, 30 April 2019.)

PSNC’s Roles

“We will continue to do what we need to do in terms of negotiating the new contract, the contractual framework, and that is the bulk of our role.

“Not only that but also, of course, negotiating on a monthly basis in terms of concession pricing, and also looking for a quicker, more effective ways to deliver those concessions. I have a pricing and audit centre within the heart of PSNC and despite the rising percentages of electronic prescriptions, we are still finding through our dip sampling of prescriptions, many instances where contractors are not being paid for everything. We save millions of pounds for contractors every year through that process. But we need to look at the ways of having that streamlined and making them more efficient and effective – and we are doing that as well.

“Strategic influencing is a big part of what we will continue to be doing, making sure that not only we are talking to the relevant people in politics, our own healthcare sector generally, but also trying to make sure that the influencing that we need in order for the outcomes from that animation to work, that animation which was directed towards contractors and to all LPCs.

Culture change for patient

“In order to make that work properly there is a culture change that is needed for the patient as well. The patient has got to accept that when they phone up NHS 111, or they contact their GP, that the response is going to be: ‘Yes, not the doctor will see you, but the pharmacist will see you’. And not only that, but ‘the pharmacist will be able to deal with and sort out whatever ailment it is that you are facing’. That is something we need to work collaboratively with the NHS on and together as a sector. And I look forward to PSNC playing its role in that.

Supporting LPCs

“We need to support them wider than we do currently, and we are already making an impact on that. We have a new team within LPC providing support now, or soon, negotiation support because clearly a lot of this will be local PCN-focused service delivery as well as support in the way that we have done previously with regulations and briefing webinars.

“I believe that in the past PSNC and LPCs have had a rather attritional relationship. I regard LPCs and PSNC’s as a relationship of equals. We will be doing more and more together in order to help you get into the right frame to work with PCNs.

“Collaboration and unified voice is vital for us, not just while and during negotiation period currently but in a wider sense. Working with the other pharmacy representative bodies and the bodies representing medics and other healthcare providers is essential.”

Collective priorities for 2019 

“So what about the priorities for the rest of this year? We started in January last year and we will continue to rebuild those relationships with the government. They are bearing fruit, but it’s a long haul. There are, of course, trust issues between us, given our history.

“Collaboration, as I said, with the representative groups and also with those groups outside pharmacy representatives and other stakeholders again will be important. But this is a collective priority also for all of us. Primary care networks, with general practices at its heart, £4.5b flowing through general practice in order to fund and finance primary care network, we need to make sure that we are integral to that. Yes, there will be new ways of working. We will help you to do that.

“But we need to negotiate an outcome that is going to benefit all the community pharmacy, not particular groups. And as I have said we need to promote the pharmacy services not just within out sector but of course to patients and we need government support to do that too.”

Promoting pharmacy services

“It is I still think one of the most understated sectors in healthcare. We need to do more to make sure that we are showing, demonstrating not only that they can pay us but more widely the value that community pharmacy brings. Because I do believe that community pharmacy has a bright future.

“Utilising those clinical skills, the instant access to healthcare without an appointment and the scale that 1.6 million people every day, the scale and that exposure to the public – they are our unique selling points. And those are the ones I will do my utmost to ensure are reflected I the next Contractual Framework.”

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