Dr Keith Ridge appears to have lost patience with contractors and their representatives, says Terry Maguire…
Keith Ridge looked bored and disinterested, uncomfortable even, as he listened to the new Welsh chief pharmaceutical officer Andrew Evans gave a positive forward-looking speech, his first, to the Royal Pharmaceutical Society conference in Birmingham.
Keith, I assume, has heard it all before but now knew; the proof was in the pudding, the devil in the detail and the distance between vision and reality exponentially larger than he thought when he took up post as chief pharmaceutical officer for England.
Judging by his frown it had been a difficult 12 months since the last conference. Much water under the bridge and when the Welsh rookie had finished and it was Keith’s turn to speak he acknowledged this; the concern, the fear, the worry, the turmoil that English contractors were going through as they manage and steer their businesses through painful financial cuts and struggle to survive.
Keith genuinely felt it. It would be better if he did not have to make the cuts and where they are community pharmacy’s contribution to relief of national austerity it seems he has lost patience with contractors and their representatives.
Attempts to transform the national community pharmacy service have been slow and difficult and Keith seemed less sure now 12 years in post that it is doable.
Everyone agreed with so many things; community pharmacy had a huge role to play in the NHS, pharmacy is an under-utilised resource, there is a need for change. And yet to do this there is a need to radically change the funding model for community pharmacy, something negotiating bodies across the four devolved regions vehemently oppose.
Ash Soni, the RPS president, offered up a number of challenges to the four CPOs before they made their speeches. In essence Ash is calling for professional autonomy in day-to-day practice; to prescribe new medicines and de-prescribing medicines that aren’t working or are causing harm and “to work to the top of our license.”
Who disagrees? But with no clear plans to alter professional regulation, the current NHS structures and medicines legislation that would allow this to happen, these remain mere aspirations. When is the NHS going to pay me not to dispense a medicine and incentivise me to do so? Then we will be getting somewhere.
Rosemarie Parr, CPO for Scotland, told us in her speech that she has a strong commitment to pharmaceutical care as outlined by Hepler and Strand back in 1990. She is right to keep this focus but I am not seeing service developments in Scotland achieving this through the community pharmacy network.
Why is the GP not just making the diagnosis and allowing the pharmacist get on with prescribing, asked Mark Koziol?
The reason is simple. This is the elephant in all the rooms that have hosted these discussions over the years. The big grey pachyderm that is always lurking in the corner of every conference is that community pharmacy contractors make money from the medicines they supply and they cannot be trusted to take charge of pharmaceutical care. This is why the main focus of investment in all UK regions is in GP practice pharmacists.
And perhaps that is right and we need to stop exhausting ourselves with talk of the great transformation of community pharmacy that I first heard about at my first British pharmaceutical conference back in 1979 and have been committed to for over 35 years.
Perhaps we need to read between the lines and let the multiples get on with their hub and spoke developments and when they are in place shrink the number of contracts, first by half and then, when robotics and IT are able, by half as much again.
About 25% of the current network numbers supplies the nation’s medicine needs with huge efficiencies while the challenge of pharmaceutical care is handed over to a new breed of employee pharmacists within GP practices where integrated services are more guaranteed.
Perhaps at next year’s conference in Glasgow the CPOs might tell us the real truth.
Terry Maguire is a community pharmacist based in Northern Ireland. With more than 30 years’ experience, he has spearheaded the development of services across the UK.