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Sigma in Jamaica: Storm clouds and Caribbean sunshine

By Neil Trainis

PUBLISHED: December 2, 2016 | UPDATED: December 5, 2016

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The eighth annual Sigma conference gave pharmacists the chance to debate the government’s swingeing cuts and try to escape the inescapable. Neil Trainis reports from Ocho Rios, Jamaica…

One imagines, ministerial rules aside, it might have been difficult to lure a government figurehead or Department of Health official to the land of Bob Marley and Usain Bolt despite Sigma Pharmaceutical’s ability to attract healthcare luminaries to its international conferences.

After all, storm clouds quickly gathered to the backdrop of Caribbean sunshine. Little surprise given that community pharmacy is making concerted efforts to show it has teeth despite Kirit Patel’s suggestion delivered during this event that for unity and organisation, the British Medical Association should be given 10 out of 10 and pharmacy four.

Perhaps the social care minister Alistair Burt felt more comfortable delivering a recorded message to the conference instead of standing on the stage at the Moon Palace Hotel before an audience of disillusioned, frankly cheesed off pharmacists. As it turned out his message was not one that filled many hearts with hope.

“(There will be) reductions in the amount of NHS funding for community pharmacists in England. However, the sum will remain significant, with £2.63 billion in funding in 2016-17,” he said.

“I want to emphasise that our aim is to secure efficiencies and make savings. It is not our aim to close pharmacies. The average pharmacy receives £220,000 in NHS funding annually.

“In some parts of the country there may be more pharmacies than are necessary to maintain good access.”

No doubt others from the Department of Health and NHS England who sat in that meeting with the PSNC to discuss the ramifications of that dreaded December 17 letter might have said they were too busy to travel to the Jamaican town of Ocho Rios to face the frustrations, the anger, the vitriol of pharmacists who had made the journey.

From the start it was clear this was a conference that was going to be consumed by the government’s controversial efficiency plans for pharmacy.

“The timing of this conference is very important in light of some real challenges and changes posed for pharmacy in the UK,” said Bharat Shah, the managing director of Sigma, as he opened proceedings.

“As you know Sigma is a family business built on strong ties and it is my vision that retail pharmacy in the UK becomes one family.”

Dr Keith Ridge, the chief pharmaceutical officer and a signatory to the December 17 letter, would not have enjoyed the musings of Mike Smith, a non-executive advisor at Alliance Healthcare and not renowned for being a shrinking violet.

“I think we have a real challenge with the Department of Health,” he said. “I don’t actually think Keith Ridge and his colleagues understand what we actually do for our patients because of the desire to close 3,000 (pharmacies which) demonstrates to me a complete lack of strategic thinking and planning about our profession and just how valuable we are to the communities we serve.”

Soon Royal Pharmaceutical Society president Ash Soni was asking Sue Sharpe, who spoke in charactersitically blunt fashion on the cuts via video link from London, if she believed a chunk of the £170 million reduction for 2016-17 will be shouldered by the multiples.

“In terms of multiples’ profit, I think there’s a little bit of kneejerk reaction that if multiples are in this market, we must be paying too much money, which is rubbish,” Sharpe said.

“In terms of the funding for years two and three, I don’t know what is going to be coming but we shouldn’t assume that this is it. We have to recognise that this government is tasked to try and save £22 billion over the five years to 2020-21 and I think it would be overly optimistic to assume the savings they want from pharmacy are those and only those that they have announced in this letter.” She ominously added that “the Treasury is always behind the funding settlements.”

There were brief diversions from funding misery. Ryan Olohan, national industry director at Google Healthcare, revealed there are 420 million online searches each year for pharmacy in the UK, including millions of searches for pharmacy on YouTube.

David Mitchell, a one-time mainstay of Johnson & Johnson and nowadays a healthcare consultant, asked delegates if they had sufficient information to drive OTC sales. The response – 48% said no.

He would go on to reveal that 13 out of 15 leading OTC categories are in growth, the exceptions being smoking cessation and hayfever.

Despite the gloom, the Sigma conference did provide a chance for delegates to unwind. There were Jamaican and Indian-themed dinners, a Pirates of the Caribbean night and the chance to swim with dolphins.

It was the chance for pharmacists to escape from the inescapable. If only for a short while.

Government U-turn on pharmacy cuts? Fat chance
The Sigma conference in Jamaica played host to the ongoing frustrations and concerns of community pharmacists in the UK as they continue to wrestle with fears over their futures in the wake of stringent government funding cuts.
An audience of pharmacists, drug company executives, pharmacy politicians and representative bodies at the Moon Palace resort in the town of Ocho Rios congregated to debate the what-ifs and likelihoods of minister’s plans to slash pharmacy funding by £170 million for 2016-17.
Mike Dent, the chief financial officer at the PSNC exacerbated pharmacists’ concerns when he said there was little chance the government, which has put its plans out to consultation, would perform a U-turn.
Comparing community pharmacy’s situation with that of junior doctors in England whose strikes have so far failed to sway the government, Dent said: “The government is in a really tough mood. Jeremy Hunt (the Health Secretary) hasn’t done a great job keeping the NHS off the front pages of the newspapers but I think this imposition of the contract for hospital doctors is a very clear statement of intent.
“This doesn’t feel like something they are going to back away from easily. If at all. On the one hand you’ve got ‘we want some funding cuts” and on the other ‘we want an investment in a more clinical service.’ I don’t see how they balance.”
Delegates’ concerns were not alleviated by a video message from Alistair Burt, the social care minister, who said the government had proven its support for community pharmacy to play a central role through its Integration Fund, which is designed to aid pharmacy’s integration into the NHS.
Dent responded with a touch of sarcasm: “No doubt you’ll be very relieved that Alistair Burt believes you can make that efficiency without compromising the quality of service that the public has access to.”
What is the point of a ‘defunct’ PSNC, asks pharmacist
The PSNC was inevitably not spared from criticism during the Sigma conference, with one pharmacist questioning the body’s relevance as the government presses ahead with its cuts to pharmacy funding.
Addressing Mike Dent and Sue Sharpe, the chief executive of the PSNC, Amish Patel, who runs Hodgson Pharmacy in Kent, said: “(Look) at the junior doctors where their contract is going to be bulldozed on to them, the same sort of thing seems like it’s happening (to pharmacy). It seems like the funding cut is going to happen. It’s going to be bulldozed on to us.
“No disrespect, but it almost makes the PSNC’s job role defunct. What’s the point of a negotiating body if there is no negotiations going on?”
Sharpe, speaking via video link, responded: “I think that’s unduly pessimistic. If you look at the junior doctors, they have shifted the government quite a bit.
“I don’t think that all we have now we should take as what we’re going to get. What’s being proposed is a bigger threat to community pharmacy than we have ever had before and what we have got to do is rise up and talk about the value of the sector.
“With the alignment and togetherness we’ve got we can really make a difference. Even if your pessimism is well founded, you’ve got to fight.”
Government can’t push BMA around like it does pharmacy
Kirit Patel, the chief executive of Day Lewis, insisted the government has not been able to dictate terms to general practice as easily as it has done so to community pharmacy and accused the pharmacy profession of disunity.
Pulling no punches, Patel said that on a scale of 10 for organisation and unity he would give the British Medical Association 10 and pharmacy four and went on to suggest that getting pharmacists to work in GP surgeries would serve to fracture community pharmacy.
The BMA have vigorously supported junior doctors in their protests against the government over pay and conditions and Patel indicated he wanted to see pharmacy’s leadership bodies react in a similar fashion over its plans for the profession, especially its intention to phase out establishment payments and introduce an Integration Fund.
“The real danger is employing pharmacists in GP practices, how long before we lose MURs, NMS? The doctors could signpost patients straight to the surgery. They don’t signpost patients to us,” he said.
“I just hope all the politicians, all the pharmacy bodies get together and fight to make sure the Integration Fund is kept within pharmacy and we should be able to prescribe pharmacists on hourly, weekly or 10 hours a day, whatever the practice needs.
“Otherwise we’re going to create disunity in our profession because pharmacists working in doctors’ surgeries I have found work very differently and they behave differently. I don’t wish to see our profession be divided.”
He added: “Jeremy Hunt can take on the BMA (British Medical Association). Pharmacy is not united. On a scale of 10, I’d probably give it four. I’d give the BMA 10.”
Patel also urged pharmacists to concentrate on its service agenda despite government cuts to community pharmacy revenue.
“Local enhanced services, private PGDs, travel clinics, health checks, focusing on service income streams is the way. Focusing on service income streams is the future,” he said.
“We need to shape our focus away from dispensing to service income. What is good for the patient is good for the business.”
NPA petition will strike at the ‘heart of government’ 
Ian Strachan, the chairman of the National Pharmacy Association, used the Sigma conference to renew his attack on the government over its controversial plans for community pharmacy and revealed his organisation has intensified its campaign to force a rethink by launching a petition which will strike at the “heart of government and the decision-makers.”
Strachan accused ministers of failing to conduct a proper consultation on its proposals to slash pharmacy revenue by 6%, phase out establishment payments and introduce hub and spoke dispensing and insisted the NPA would crank up its campaign against the measures.
The NPA recently started to engage pharmacy teams to gather evidence of community pharmacy’s value to healthcare, including issuing order campaign cards for staff and patients to send to MPs.
The petition, Strachan said, would take the NPA’s campaign to “a new level” and would be aimed at David Cameron.
“We’re now moving into a new phase of this campaign where we’re going to go for a petition-based approach. That’s different from a parliamentary petition. This is going to be a petition aimed at the Prime Minister,” Strachan said via video link.
“This will be a petition that will mobilise contractors and we’re going to deliver a petition right to the heart of government and the decision-makers.
“If you think we’ve got 10,000 contractors to play with, well do your homework. I think we can really start to have a serious impact now on raising that awareness.
“We’ve really got to escalate this now to a new level, it’s petition-based and we have various mechanisms to download the petitions on the NPA website, we’ve got commitments from wholesalers to distribute these. The campaign is building up nicely and this next phase will be critical.”
We will fight these fundamentally flawed plans
The collective manoeuvre of community pharmacy against the government’s funding cuts gathered pace as Pharmacy Voice became the latest body to intensify its campaign to force ministers into rethinking their plans.
Claire Ward, the chair of Pharmacy Voice, said the organisation had lodged its response to the government’s plans to reduce pharmacy’s funding by £170 million from October as well as its intention to introduce hub and spoke dispensing and click and collect medicines distribution.
In the wake of the NPA’s reaction, Pharmacy Voice produced its own response with five commitments it wants ministers to fulfil, including a reconsideration of the “planned disinvestment” in community pharmacy in 2016-17 and the establishment of a “sustainable long-term settlement.”
Pharmacy Voice also said it wants to see the government “invest in service transformation in the same way as for other parts of the NHS,” forge “meaningful” partnerships with community pharmacy bodies and deliver reforms to other parts of the health system to allow pharmacy to play a central role.
The government put its plans for pharmacy out to consultation but that has held no sway with community pharmacy.
“This consultation process is fundamentally flawed. It is a consultation which is suggesting some really sudden and arbitrary cuts in funding to the sector which is absolutely inconsistent to what the government said I wants to do,” Ward said.
“It said it wants to create a service in pharmacy and in healthcare that is responsive to patient needs and delivers better patient outcomes. But this consultation process and the way they’ve gone about it on what they propose won’t do that. In fact, it will undermine it. We need them to understand that.”
Ward also urged ministers to ensure that the Integration Fund, which starts at £20 million and will have risen to £300 million by the end of its fifth year, is “a fully accessible fund for pharmacy, not across the whole of primary care. It has to be there to help, not just integrate, but also support innovation.”
Bloody awful Labour allow Tories to do what the hell it likes 
Warwick Smith, the director general of the British Generic Manufacturers’ Association, launched a scathing attack on the government, accusing it of risking the development of critical life-saving drugs with its austerity measures.
Community pharmacy will shoulder funding cuts to the tune of £170 million in 2016-17 but, insisting “we’re all in this together,” Smith said the drug manufacturing industry will also suffer.
“It takes eight years to develop a biosimilar. It takes an investment of $350 million to produce a biosimilar medicine. We are talking about the sort of investment periods and investment costs that would have been a blockbuster of 10 years ago,” he said.
“The PPRS (Pharmaceutical Price Regulation Scheme) reduced a rebate. Rebates are awful, dreadful, evil things. What happens now is these branded generics reduce in price from the originator by, on average, 77%.
“And now the government is coming up and saying ‘well we think we might want to take another 15% off you by way of rebate.’ That risks killing off this incredibly important class of medicines that is coming forward. It really does feel like somebody asking for more when we’ve already basically given away the kitchen sink.”
Smith also accused the Labour party of being too weak to hold a first majority Conservative government in nearly 20 years to account.
“Here is a government that has got power for the first time in nearly 20 years and it has a bloody awful opposition that is not holding it to account. So it has realised it can do what the hell it likes and realised it can do what the hell it likes to achieve its austerity programme in the first two years of its term, swap Prime Ministers and look good for the next election.
“And that’s where the Osborne philosophy comes in. Let’s not make any mistake. A lot of the detail of what’s being driven at the moment is coming out of the Treasury, it’s not really coming out of 10 Downing Street.”
Chief pharmaceutical officer does not understand pharmacy
Mike Smith, a non-executive advisor at Alliance Healthcare, raised a few eyebrows during the Sigma conference in Jamaica by insisting Dr Keith Ridge, the chief pharmaceutical officer at NHS England, does not understand what community pharmacists do for their patients.
Identifying what he described as “a lack of public understanding” about how community pharmacists improve the health and wellbeing of their patients, Smith (pictured) said that lack of understanding stretched to the corridors of power at the Department of Health and Dr Ridge, who was a signatory to the December 17 letter to the PSNC outlining the government’s cuts to pharmacy revenue.
“There’s still a lack of public understanding about what we can do. What’s more important is that the Department of Health don’t really understand what we can do. And that’s why we find ourselves in the situation we’re in,” Smith said.
“I think we have a real challenge with the Department of Health. I don’t actually think Keith Ridge and his colleagues understand what we actually do for our patients because of the desire to close 3,000 (pharmacies which) demonstrates to me a complete lack of strategic thinking and planning about our profession and just how valuable we are to the communities we serve.
“I don’t blame the PSNC, Pharmacy Voice and the NPA because I think they’ve been taken along by this. The fact is the DH do not understand how vital we are to the future of our patients in the UK.”
Smith said poor pharmacy PR, which he described as “abysmal,” was to blame for pharmacy’s predicament and the swingeing government cuts facing it in 2016-17.
“Lack of PR. I’m sorry but this is my real bugbear, PR. I think our PR is abysmal. I don’t know who is responsible for it,” he said.
“I was very encouraged to see the NPA’s response to say we’re going to mount a robust campaign to defend our profession. I think that is very necessary at this time.
“We all read the papers, we watch the news on TV, we see the junior doctors, we see the stories about various healthcare issues, very little about pharmacy.
“In can only recall two incidents in recent weeks. One was Fin (McCaul) who was talking about ibuprofen in Australia. We actually had a real life pharmacist on the breakfast couch, that was great.
“The other was Neal Patel who highlighted the dangers of using the illegal slimming drug DNP (Dinitrophenol). We just don’t get our message out.
“One of the things we have to do is step up our PR so we get public opinion on our side and they ensure what we do and they ensure the consequences if we’re not there any more.”
Community pharmacy, notably Pharmacy Voice and the National Pharmacy Association, has expressed its desire to fight the cuts but Smith said he believed that was a lost battle and intimated the key was to limit the damage which could be inflicted by potentially larger cuts after the £170 million in 2016-17.
“I personally think the £170 million is gone despite the consultation process. But we have to challenge and work with the Department of Health,” he said.