BIG INTERVIEW: There’s more that unites than divides us, says new chief executive of PSNC

Pharmacy’s new negotiator-in-chief wants community pharmacy to be recognised as a credible, forward-looking and solutions-focused partner in an integrated primary care. Janet Morrison spoke with Priyankur Mandav…

Just a few weeks after Janet Morrison joined the Pharmaceutical Services Negotiating Committee as its new chief executive, she saw the results of PSNC’s ‘Pressures Survey’ which highlighted the scale of the workforce challenge that the sector was facing.

More than 90 per cent of pharmacy owners said they were experiencing staff shortages (which included delivery drivers, counter staff and pharmacy technicians – not just pharmacists), while 23 per cent reported that they were forced to close their shops temporarily due to the same issue.

“This is very concerning, and perhaps even more concerning is the fact that we know these problems are not easy to solve,” said Morrison .

“Workforce issues are affecting all parts of the NHS, and for community pharmacy there are a number of factors at play, including the increased recruitment of pharmacists to NHS roles, the effects of the pandemic, Brexit, and wider economic factors.

“These issues cannot be addressed by the sector alone, but I have been pleased to see us trying to do so with the government and the NHS via the Community Pharmacy Workforce Development Group: that collaborative approach will be key to finding solutions.”

Morrison has worked in policy and government relations, both in the public and voluntary sector. A lot of what she has done in her career has involved influencing negotiations and strategy with government as well as transforming, influencing and moving organisations on. Most recently, she worked in the health and social care areas, principally with older people, but also with people having long-term conditions and those on rehabilitation.

“Coming from a patient perspective, I’ve always thought about how can community pharmacy deliver healthcare support and advice to people at the closest and most neighbourly level?”

She was pleased at how public awareness about community pharmacy rose substantially during Covid. “It was incredibly powerful and impressive – the entire sector demonstrated its potential, accessibility and willingness to support more people. That’s really valuable and the message is clear: if community pharmacy is funded in the right way, there is a lot more it can do. I want to be able to help the sector as best I can.

“Better integration of community pharmacy and its services within the wider health and care system is an important goal and one that PSNC and the LPCs need to continue working together on. NHS England has been clear that the community pharmacy contractual framework (CPCF) will continue to be negotiated nationally with PSNC, but delegated commissioning and assurance of CPCF and local commissioning will all happen at the level of the emerging integrated care systems (ICSs), which will be particularly important players for community pharmacy.

“It is vital that the sector is fully engaged with them: this is why we have been working with the other healthcare professions across parliament to press for more formal recognition of community pharmacy in these local systems.

“We have also been in contact with Claire Fuller about the importance of community pharmacy and we are looking forward to seeing her report on integration at a local level.”

Unity in diversity

Asked how she would be dealing with division and infighting within pharmacy and the associated mixed, and often conflicting, messages that keep pouring in from various interest groups within the sector, she quipped: “We’re here to negotiate on behalf of the whole sector.”

Community pharmacy has historically suffered from fragmentation and a lack of coherent voice, but Morrison said she leads an organisation that’s made up of contractors from all different size and scope of businesses, who would take a view that’s representative of the whole sector, not just one individual group.

“Of course, a sector like this with that amount of diversity and scale and scope is going to have different opinions and viewpoints. But people are really honest and open about that. Everyone I’ve spoken to has admitted to some of the tensions and the challenges, but everyone has said there’s more that unites us than divides us.

“So, from my perspective, I’ve got to make sure that I can hear all of those voices.”

One contractor has impressed Morrison on a personal level by looking after her 93-year old father’s health and care needs – reaching out to him for his vaccines and boosters whilst ensuring all his other medical requirements are met.

But “the most united thing that I’ve heard” since arriving is that everyone is facing really significant funding and capacity pressures. Some of it might be burnout from Covid but a lot of it is actually from a long-term situation with a very difficult funding settlement.

“Going ahead as a sector, we’re in negotiations now with the government and the NHS over the four-year deal, and therefore, we’ve got to look outward and onwards in terms of saying what our vision for community pharmacy is so that when we are looking at the next deal, we’ve actually bought a view about where we should be going, what our strategy should be, and what a healthy and expanding community pharmacy sector looks like.

“We need to really focus on what our goals are, and I think there will be much more that we agree on than we disagree on.”

The sector has long been encouraged to embrace more clinical services yet when the opportunity came during the national roll-out of Covid-19 vaccination programme, only a handful (just over 10 per cent) of community pharmacies in England were commissioned by NHS England to deliver the service. While the Covid vaccine clinic contract did save some struggling pharmacies, many among those who were not selected are now suffering financially as the cost of living continues to rise.

“There was a bit of a missed opportunity in terms of more of community pharmacies being commissioned to provide vaccination services for Covid,” she said.

But rather than mulling over what could have been, Morrison would like to focus on how pharmacists can add distinctive value to services that would potentially move out of GP surgeries and into community pharmacy in a post-pandemic world.

“Our negotiations with DHSC and NHSE&I on the arrangements for Year 4 of the current deal are continuing and there is much to discuss given PSNC’s very serious concerns around the difficult and unpredictable economic situation, and wider pharmacy pressures, including workforce and the increasing volume of advice that pharmacies are giving to patients on a walk-in basis. Our negotiating team is working hard to make progress on these critical issues and we will update contractors as soon as we can.”

Medicine shortages

Longstanding supply chain issues – made worse by Brexit and the pandemic – have contributed to drug shortages, which inevitably leads to pharmacists spending more time in sourcing products, discussing alternatives with prescribers and counselling patients.

Shortages can also have an impact on key pharmacy relationships as they can increase conflict between the patient and the pharmacist as well as between the pharmacist and the prescriber. In recent times, there have been reports of rising levels of abuse from patients who are frustrated at not being able to access their medication.

“Pharmacies have always done a brilliant job of ensuring that patients can access the medicines they need, while also saving the NHS billions of pounds on medicines spend. But this is getting ever harder: two thirds of pharmacy teams we have surveyed say they are having to deal with supply issues on a daily basis, and keeping up with this is simply not sustainable alongside all the other critical work going on in pharmacies. It was also very disappointing to hear that more than 75 per cent of pharmacies have been subjected to patient aggression linked to medicines supply issues.”

Shortage of APIs was cited as a reason given by suppliers when they were unable to supply orders of certain medicines. A case in the point is an acute shortage of some HRT products, which are used by about a million women in the UK to treat symptoms of menopause. In the past five years, prescription volume of some HRT products has more than doubled in England.

Morrison said PSNC is pleased to see the government ramping up efforts to support pharmacy teams to obtain and supply HRT medicines for their patients in recent weeks including issuing a suite of new SSPs.

“But while the SSPs are a welcome step, familiarising themselves with them and implementing them does not help to ease the time and capacity pressures that all community pharmacy teams are having to grapple with at the moment. We are continuing to highlight these issues to the government and to work closely with the DHSC’s medicines supply resilience team to help them to manage the situation.

“Community pharmacy teams need to know that they can access the medicines their patients need, and they need to be properly compensated for the additional workload involved in managing issues that are well beyond their control.”

Opportunity to start afresh

On how her team was preparing the groundwork for the next round of negotiations, Morrison said it was “a clear opportunity to start afresh” after years of flat funding, which in real terms is actually a cut year on year.

“As we look ahead to what comes after that deal ends in April 2024, I want to bring the sector more strongly together, uniting behind a shared vision for the future and engaging with the government and the NHS on our shared aspirations as partners in integrated primary care. We need that vision so that as a sector we are seen as credible, forward-looking and solutions-focused: that has to be our goal.

“We also need to invest considerably more in data and analytics to support our case – whether that is looking at patient polling, or economic analysis, or cost and value estimations, or more regular audits and data-gathering from within the sector. Much of this already goes on at PSNC, but we are very constrained by resources and capacity, and need to find the resources to upscale this work.

“Once we have that shared vision, and regular collation of data, we also then need to use all of this to influence in a more coordinated and effective way. That will include our work to influence parliamentarians, of course, but we will also need to think more broadly and to do more in the national media, and more with think-tanks, charities and other influential groups.

“For me, that strategic influencing is some of the most important work ahead for PSNC: by the time we enter negotiations it is too late to influence the most senior stakeholders – ministers and their advisors – so that work all needs to happen over the next year to 18 months.

“This is our challenge, as recognised recently by the Review Steering Group, and it is this critical work that we will be spending any additional monies that come to PSNC in the future on.

On the recommendations made by the RSG to provide better value for the levy-paying contractor, she said: “I personally am very much hoping for a ‘yes’ vote on the RSG’s proposals and am looking forward to bringing about positive change at PSNC in the event of a vote in favour of the proposals.

“The things the RSG talk about seem to me to be eminently sensible: strengthening governance, getting better outcomes for contractors, ensuring local and national organisations are closer together, and allowing contractors to see clearly how their levy is being spent and what outcomes they are getting for it.

“These all seem to be things that any modern and forward-looking sector should want to do, and I believe they would help to make us more credible in the eyes of the government and the NHS.”