The National Pharmacy Association's annual conference in Westminster gave pharmacists plenty of food for thought around issues such as service commissioning, funding, premises inspections and its future in the NHS. Not to mention the chance to air their views. Pharmacy Business reports from the conference….
GPhC to create review mechanism allowing challenges to inspection ratings
Community pharmacists across the UK unhappy with the rating their pharmacy has received from General Pharmaceutical Council inspectors will soon have the opportunity to challenge it through a review mechanism, the regulator's chief executive Duncan Rudkin has revealed.
Addressing the National Pharmacy Association conference in London yesterday, Rudkin said he understood that inspectors' evaluations of pharmacies would always carry an element of subjectivity and as a result their judgments ran the risk of being inconsistent across the board.
Reports have suggested the majority of pharmacies that have undergone an inspection have been given a satisfactory rating while controversy has swirled around the excellent rating, with many pharmacists unhappy that the criteria for achieving it has not been clearly defined by the GPhC. The regulator has said it is not obliged to provide a checklist of criteria need to attain excellent status.
Rudkin attempted to allay pharmacists' concerns over the rating system by revealing that the GPhC is working on a review system which will allow pharmacists to challenge decision's they are unhappy with.
"Because judgment always have an element of subjectivity within them there is risk management in place within the GPhC to manage the risk of idiosyncratic judgments being reached by inspectors on the basis of very different views they might have," he said.
"We know, we always know, that issues about consistency (which) were actually an issue in the past, to a certain extent are bound to be an issue as we work through. Theoretically there's a real risk around consistency in a judgment-based system.
"So we are putting in place measures to manage that risk. There is a decisions framework. It's not an individual judgment out of thin air. There is quality control within the organistion which is designed to make sure different inspectors inspecting different sorts of pharmacies across the whole of Great Britain are actually applying their judgment in a consistent way. That's certainly what we're aiming to achieve. 
"And one of the things that we're working on now as part of the ongoing reworking prototype is designing a review mechanism because we recognise there will be situations, there have already been some, where people are not happy with the evaluation that we did.
"We are designing within the system a mechanism for review so that somebody who has received a report which they feel objectively and factually does not actually back up the judgment that we've reached, then there will be a mechanism for challenging that and getting a second opinion on that."
A review mechanism is sure to trigger an overwhelming number of challenges from pharmacists across the UK and the GPhC is running the risk of being swamped with a huge volume of cases to re-examine. 
Nevertheless, Rudkin was adamant that a review mechanism was the right way forward to prove to GPhC registrants that the regulator is accountable for the decisions it reaches. 
"If we want to be accountable, as I've said we do for how we operate the system, we need to provide a mechanism to hold ourselves accountable against our standards, against our quality control," he said. 
Claire Ward, the chief executive of the Independent Pharmacy Federation, told Pharmacy Business: "This may be a prototype phase and everyone understands it is a move away from the checklist approach. But contractors still need some idea of the type of things they need to do in order to move from good to excellent. 
"The feedback from our members indicates there remains inconsistency in the inspections ratings at every level."
NHS Health Checks should be scaled-up in pharmacy, claims Professor Fenton 
Professor Kevin Fenton, the director of health and wellbeing at Public Health England, told the National Pharmacy Association conference that the government-appointed body is rejuvenating the NHS Health Checks programme and is keen to see community pharmacists increase their involvement in it.
Health Checks have come in for criticism of late, notably from Dr Clare Gerada, chair of the Royal College of GPs, who last year accused the government of offering health checks to millions of people over 40 "against good evidence." 
Danish researchers from the Nordic Cochrane Centre also levelled criticism at the programme by claiming Health Checks did not reduce deaths.
Professor Fenton said Public Health England was intent on rejuvenating NHS Health Checks and insisted that the programme should be increased within community pharmacy.
"(An) element of managing long-term conditions is the Health Checks programme and many of you in the room I'm sure are involved in delivering Health Checks but I would argue that we are nowhere near scaling up this programme in pharmacies as we have the potential to," he said.
"A key part of the collaboration I would like to see is how can we do more faster in thinking about the Health Checks programme.
"Health Checks target seven causes of premature death. I believe it's an opportunity to tackling vascular disease in England. We have really energised the programme in Public Health England as it's moved to us in the last year. 
"A key element of Public Health England's management of NHS Health Checks is opening up and diversifying the providers in the Health Check programme so that you as independents should feel confident in going to your local authority and say 'we want to be able to take part in the delivery of this programme.'"
Professor Fenton said pharmacy has a 'clear role' to play in the detection and management of long-term conditions.
"At Public Health England we believe that good health outcomes rely on more than where hospitals are distributed or the distribution of medicines. If we are serious about addressing healthy lifestyles then we need to address the wider determinants of health," he said. 
"A key part of that is managing long-term conditions and I know many of you in this room are involved in thinking about leveraging the assets you have in your independent pharmacies about what we can do differently with long-term conditions. 
"Uncontrolled high blood pressure is the second leading cause of disability in England. We know about 30% of adults in England have hypertension. There are about five million adults currently undiagnosed or under-diagnosed and treated in England today.
"Public Health England is focusing on a range of these long-term conditions. A key element of what we're hoping to do is to stimulate and support activity and processing thinking of prevention, detection management and this I believe there's a clear role for pharmacy as well."
Pharmacy's Call to Action was 'most successful' says NHS England official
Alison Hemsworth, the national senior programme manager for community pharmacy at NHS England, told the National Pharmacy Association conference that pharmacy's Call to Action consultation was "the most successful" initiative of its type carried by her organisation.
The three-month Call to Action consultation, which involved a variety of health professions including pharmacy, general practice, nursing, dentistry and midwives, was designed to generate debate at local level with NHS England area teams to examine how the healthcare professions can support better health outcomes for patients.
Pharmacy leaders spent large amounts of time hammering home the importance of community pharmacy participation in the consultation and those efforts appear to have paid dividends. Hemsworth described the impact made by pharmacy's Call to Action as "massive." 
"I thought you'd be very happy to know that the pharmacy Call to Action was actually the most successful Call to Action NHS England has completed to date," she said. "We had 859 responses and a further 81 formal responses. That's massive.
"Because it's so massive it allows us to take an awful long time to put into place but we are nearly there now and we do expect that independent evaluation to be with us by early July. We did listen."
Community pharmacy is holding out hope that the Call to Action consultation will result in a new contractual framework and on the issue of access to patient care records, Hemsworth said: "We've done some very early work looking at the summary care record. We're starting to put in place plans to see how access to summary care records in community pharmacy will work."
Pharmacists vent frustration over lack of support
The General Pharmaceutical Council and the National Pharmacy Association came under attack during a conference yesterday from pharmacists who accused the two organisations of failing to respect or support the independent sector.
The NPA's conference in Westminster, billed as Independent Pharmacies Rising to the Challenge, drew pharmacists from across the country and was attended by guest speakers Duncan Rudkin, chief executive of the GPhC, Kevin Fenton, national director of health and wellbeing at Public Health England and Alison Hemsworth, senior programme manager at NHS England.
The event gave NPA members the chance to air their opinions, with one pharmacist accusing the GPhC of treating pharmacists like "donkeys" and another claiming the NPA had failed to educate the public about the "unique selling point" of independent pharmacy. 
"You have spoken about what you want us to do for you. None of you have said 'we will help you do this.' Even the GPs really come out strong against us," the first pharmacist said.
"'I see 50 to 70 people a day. I tell them what to do. But then I can't make a record of that. There is just so much to do. None of you tell us how we are going to help us. The doctors don't help me. The doctors don't help us. 
"It is hell trying to get through to doctors. What are you going to do about that? If I need a doctor, within two minutes he has to answer me and not two days. Will you do anything to help us? Or do you just expect to treat us like a donkey? 
"I've been a pharmacist for 40 years, I've seen lots of changes. The GPhC's recent changes…they said they want the fees from us three months in advance and if you don't give it to us we're going to beat you up.
"What am I? A donkey? You don't show us any respect. You do not respect pharmacists. Thankfully I'm at the end of my career. I've told my children none of you are becoming pharmacists. Respect us, help us, listen us. Including the NPA.
"We have had nothing but kicking and kicking and kicking. You know what? I'm fed up. Help us, respect us. And that goes particularly for GPhC and for the NPA. I've spoken to NPA and you told me 'no, no, no, we are working for you.' You are not. You are just a talking shop. Looking at the pricing, there are so many problems. None of you listen to us."
Rudkin responded by telling the pharmacist that while he respected he had a view, he was "wrong."
"I'm not sure there was a question. But what I would say is that I just think you're wrong. I respect your view, I respect your right to have that view. I have a different view.
"I was in an independent community pharmacy about 10 days ago where I was bowled over by the passion and enthusiasm I saw, the willingness to work with colleagues across the whole health system and even the regulator who has a small but important part to play. I respect you, I respect your view but I think it's a wrong one."
Another pharmacist asked what the NPA is doing to raise public awareness about the "unique selling point" of independent pharmacy. 
"There is a concern that this sector is moving towards big branded multiples like Boots because they have invested a lot in the brand," he said. 
"They have invested a lot in a system that independent pharmacy can afford a hub and spoke way of distribution.
"They can therefore maximise innovation, they can maximise service and they can train people to specialise in (an) area. There is a growing demand for care for the old age. That market is growing.
"At the moment I don't see anything that the NPA is doing to to actually educate the public of the brand independent. I think it should be done. There is this idea that brand is powerful and that shallow marketing is quite successful now.
"I would like to see the NPA educate the public that brand independent can actually differentiate itself from the big multiples."
Michael Holden, the NPA chief executive, defended his organisation by saying it was producing "an enormous amount of positive support for the independent sector both from a promotion support and representation (viewpoint)."
Passion and innovation is the hallmark of an excellent pharmacy, NPA official claims
Leyla Hannbeck, the head of information at the National Pharmacy Association, told the organisation's members at their annual conference in London that passion and innovation can lead to an excellent rating from General Pharmaceutical Council inspections.
The regulator's new inspection regime has come in for staunch criticism primarily because of the uncertainty around what it takes to achieve an excellent rating. She revealed that none of her organisation's members to date have achieved an excellent rating from the GPhC.
"Excellent pharmacy is the tricky bit but unfortunately we haven't had any reports of an excellent pharmacy. We've heard about what happened with the pharmacy (owned by Jignesh Patel) that was given excellent and reduced to good," she said.
"(Pharmacists) want to know more about excellent. The GPhC keep saying that it's about being innovative, going the extra mile, that not only do you achieve those standards but you go over and beyond and demonstrate fantastic patient care.
"How do you show fantastic patient care and how do you show that you're innovative? It's about going the extra mile and identifying for example in your local population, in your local community, what is it that you can do that no other pharmacy is doing to ensure that you demonstrate that you've gone that extra mile.
"Is it to set up a clinic, to manage diabetes issues in your local community? That's one bit of it. Another bit of it is to ensure that not only you as a pharmacist but the whole team demonstrate that passion that we need to showcase as healthcare individuals for patient care."
Hannbeck said there were two strands to achieving an excellent rating; having everybody in the pharmacy team showing passion and being "on-board" and demonstrating innovation. 
She added: "Doctors can be as loud as possible but we pharmacists don't shout about what we're doing."
The NPA found that the management of medicines and medical devices was the most common standard not met by pharmacists following a GPhC inspection.

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