The Big Interview: Mandeep Mudhar
By Neil Trainis
PUBLISHED: July 14, 2017 | UPDATED: July 14, 2017
There are genuine fears community pharmacies will be forced to close despite pharmacy’s continued fight against the measures says Mandeep Mudhar. Numark’s director of marketing talks to Neil Trainis…
“Saying it’s a waste of time is harsh,” Mandeep Mudhar says assertively as he weighs up whether an appeal by the PSNC and National Pharmacy Association was worth pursuing given it seems the funding cuts are surely inescapable.
There is much to occupy the minds of those with an interest in community pharmacy in these difficult, daunting, exciting days which will make or break community pharmacy. Numark’s director of marketing is keen to offer his opinions.
“I think it’s almost inevitable that the funding cuts are going to happen but the law allows you to go through an appeal process,” he says to the backdrop of gentle chatter from guests in the bar of a London hotel.
“Now will this be overturned? Difficult to see that because of what the judge said which was ‘yep, there might have been issues with the process but in the overall scheme of things it was a justifiable action. So it’s hard to see how the actual funding cuts are going to be reversed.
“If, however, they are, the big question is going to be are pharmacies going to be recompensed for all of the hurt they’ve had over the last few months? But I think it’s right that an appeal has gone ahead but I think we have to accept that the inevitable is coming down the line.
“It has been the right thing to do because we have to challenge the way this was done in pharmacy because if we accept that this is ok and justifiable, then is it ok in future for the negotiating body to be completely bypassed in all future funding arrangements. If the appeal creates as much noise as possible about the process I think it’s a good thing. But I’m not sure the decision is going to be reversed.”
Numark have been in the news lately. Its managing director John D’Arcy said some of his members had been hit harder than the 12% cut in revenue predicted by the PSNC. Harder even than the 20% reduction claimed by others. It is impossible to imagine a community pharmacy, with all its overheads and struggles to get services commissioned, bearing the brunt of a 20% drop in revenue.
“It’s tough, it really is,” Mandeep says providing an insight into the hardship being endured by community pharmacists across England as the government sets about threatening their very existence with swingeing cuts, £320 million over two years.
“We’ve been hearing from our members that the actual FP34, the actual cheque coming in, in some cases we’ve had members saying to us the actual amount that they’re being paid is less than the amount they’ve got to pay the wholesaler. So they’re having to pay the wholesaler bills out of money they have put aside from previously out of their own savings.
“Others have said because of other administrative errors that they’ve had either through some of the EPS (electronic prescription service) submissions not going through properly, they’ve had a further hit on top of that, so not only the 20% because of the funding cut but other issues linked to either submission of prescriptions or the way the quality payments have been taking place. They’ve had a further…more than a disappointment shall we say in terms of the actual amount of money coming in.
“However, pharmacists are resilient. There have been times when they’ve been hit quite hard one month but they know it’ll be adjusted the following month. I think they’re all hoping this readjustment will happen at the end of this month but it’s difficult. It really is difficult.”
The appeal, which is not expected to be heard for months, might bring a halt to the government’s pharmacy efficiency measures but Mandeep is asked if any Numark pharmacies have told him personally that the cuts will force them to close.
“I haven’t yet. No-one has. From all of the members that I’ve met or spoken to no-one has said ‘right, I’m shutting shop.’ I really think it’s going to have to be really desperate measures for someone…if you’ve invested all of your life and all of your livelihood in building your business, and let’s face it, for many that is their pension, that is their retirement pot, perhaps their children’s future, it’s really going to be difficult to close the doors on that pharmacy.
“I think what you’ll find is many will make adjustments in their pharmacy and cope as they have before. Maybe the size of the adjustment they have to make is a lot more than they’ve ever had to do before and our concern is inevitably that will lead to staff cuts, efficiencies, reducing your overheads.
“And there’s only so much you can of that as well. And so our advice to our members is don’t do that knee-jerk reaction. You might want to immediately cut your overheads down but you still have a volume of prescriptions you have to dispense, you still have advice to give, you still have services to provide. But it’s difficult to give advice to a member on that when the reality is there just isn’t enough cashflow about to play with.”
Mandeep is asked if he fears the cuts will force Numark members to close.
“I think there is still that fear because if that readjustment isn’t made for example and the 20% remains close to 20%, and when the funding cuts were first announced there was a ‘will there be, won’t there be 3,000 pharmacies and all that’ and largely around the bigger cities, the inner-city areas, where it was deemed there was maybe too many pharmacies, then there may be a definite risk there.
“We have not picked that up from any members yet, we’ve not heard from anyone at the moment who’s said ‘I’m going to shut my pharmacy down’ or ‘if this carries on for another three months I’m not going to be here.’ I think people are still in that period of making lots of adjustments.
“The harsh reality is if you’ve made all those adjustments and in three months’ time, four months’ time it’s still not enough, then what do you do? If a member then comes to us and says ‘I am absolutely at the end of my tether,’ that’ll probably be the first conversation we’ll be having with them about shutting their pharmacy but that hasn’t happened.”
He reveals that of 3,400 Numark members, 378 had qualified for pharmacy access scheme payments (PhAS). It seems NHS England has little interest in saving community pharmacies which offer health and, in many instances, social care to vulnerable people.
“If you at the criteria that was used for the pharmacy access payment, in its letter of the law, I think many more pharmacists probably qualify for that or should have qualified for it. I think a lot more pharmacists thought they would qualify for that payment.
“Our argument right from the outset has been ‘you’ve had the funding cuts element in terms of how the cuts have been applied but then you’ve had this bit, the pharmacy access scheme, in which effectively all of pharmacy have been taken a pot of money away from and only some have been entitled to get it back from the criteria.’
“So our argument from a Numark perspective is they need to relook at the criteria. Is the criteria too stringent because there were pharmacies previously that were qualifying for the essential small pharmacy scheme and now some of those pharmacies are not any more. So has the criteria become too rigid? Is it too narrow? Does it need to be revised?”
Mandeep is asked if Numark has approached NHS England with this.
“We haven’t because our role from a Numark perspective is to support our members, help them make their argument through their negotiating body.”
But surely approaching NHS England would be supporting Numark members?
“We do it through, for example, yourself, through our PR, though our comms to our members, we would share with them what we see from and hear from other members and we would make representation through the representative bodies.
“We would raise our concerns be it with the PSNC, be it with… the one thing Numark has never been is a representative body. We have to be really clear, we are a membership organisation, we have a voice there but it would be wrong for us to become another body out there representing…we represent our members but to start negotiating with the Department of Health for example and NHS England.
“We channel any concerns from our members either through the LPC, PSNC or through the NPA.”
Community pharmacy’s destiny, to some extent, is in its own hands. The profession has been cautioned to form relationships with local GP surgeries and ensure they are tapping into the patient summary care record (SCR).
According to NHS Digital 50% of community pharmacies are using the SCR although Dr Jill Loader at NHS England last year claimed the average record viewing per pharmacy was just 0.3 a week. Mandeep is asked if Numark members are viewing the SCR. He reveals some Numark members have encountered resistance from GPs.
“From everything we hear from members, access to summary care records and the EPS connectivity is getting better. Some of it perhaps slower. The challenge we have is that a lot of this is dependent on the GP in a particular region allowing you access.
“It’s difficult to put a national picture in terms of how well or not the access to summary care records is because you find anomalies going on. But the direction of travel has been established. If there is a GP who is being particularly difficult then it needs to be raised with the CCG.
“I wouldn’t say (I’m) 100% (confident Numark members have got SCRs) sorted because where they’re being given access to summary care records by prescribers or where the CCG has pushed that agenda quite strongly, then yes, they’re sorted.
“There are still pockets where GPs are being resistant because that machine has to be switched on by the GP in the first instance to allow that access. We are encouraging our members to have a collegiate conversion with the GP because this is no longer about us muscling into your territory. This is about us working together for both of our survivals.”
One wonders why some GPs are resistant to community pharmacies having access to the SCR. After all, that electronic collaboration is designed to improve patient care.
“Resistance…but to the extent GPs are not aware of why they’re being asked to do this. Some of our members have made us aware that their GPs are not even aware about giving access to summary care records,” Mandeep offers.
These are challenging times for community pharmacy.
• Joined Numark as director of marketing in 2015.
• Worked in variety of senior marketing-related roles for major pharmacy organisations including AAH, Alliance Healthcare and Co-operative Pharmacy.
• Has experience in academia and is practising community pharmacist.
• As head of business development at Co-op Pharmacy he created a new structure to support acquisition of new clinical services and contracts.