The Sigma international conference told pharmacists to raise the bar. Neil Trainis reports from Rio de Janeiro…


To the intoxicating backdrop of sunshine, sand, samba and bossa nova, the UK community pharmacy bandwagon trundled on uneasily.

The Sigma Pharmaceuticals conference had landed in Rio de Janeiro, ‘Cidade Maravilhosa’ to the locals, but the quixotic Brazilian municipality with its mountainous beauty and vibrant colour could not take pharmacists’ minds off sobering issues back home for long.

Funding cuts, hub and spoke dispensing, the Amazonisation of medicines supply, drugs shortages, community pharmacy representation, they all accompanied the Sigma delegation to South America.

“Do not allow NHS England to divide the sector,” exclaimed Pharmacy Voice chair Claire Ward from the stage at the Sheraton hotel. Some at the conference thought pharmacy itself had done a good enough job of that given the National Pharmacy Associations’ split from Pharmacy Voice. Others were having none of it.

“I’ve seen some comments and I think it’s right that I say a few words,” said NPA chairman Ian Strachan. “Some people have said to me ‘haven’t you jeopardised unity at a time when the sector needs it the most?’

“And I’ll say this…the pursuit of unity and a single voice is fine, there’s nothing wrong with that but if the price of that unity is to compromise our ability to defend our interests, this profession will know that if the price I have to pay for that unity is that I have to have one hand tied behind my back while we negotiate, particularly when the threat is on the independents, all of these measures will affect you the most.

“I would rather lobby outside the establishment and influence politicians, civil servants, without that handicap of the illusion of unity sometimes. That’s not to say we won’t strive for it. But to get unity you do need transparency, not cloak and dagger.”

Fighting words indeed. Fin McCaul, recently elected north western regional representative on the PSNC, tried to inject some urgency into proceedings. There was a warning for pharmacists to fulfil their quota of Medicines Use Reviews and do their New Medicine Service consultations with patients.

“You need to be working on outcomes with patients. It’s really tight at the minute and it’s probably going to get tighter,” he said.

“If we are looking at some of the (health) outcomes (at) the Department of Health, it’s pretty shocking. Now we can take some ownership of that problem or we can leave it alone and ignore it. I guarantee if we don’t take ownership of the problem, somebody else will.”

McCaul revealed that just 16% of patients in England prescribed a new medicine take it as intended. About £300 million worth of medicines, he said, are wasted in primary care each year. That presented a huge opportunity for community pharmacy to make its presence felt.

Sigma managing director Bharat Shah, who revealed his company will fund a PhD project at the University of Bath “to create a model of pharmacy in the year 2025,” said he wanted to see a pharmacist on every Clinical Commissioning Group.

What would the GPs make of that one wondered? “We missed a chance by not pushing for it when legislation was passed,” tweeted English Pharmacy Board chair Sandra Gidley. And who was to blame for that? “RPS was weak at the time but I’m not going to mention the two key names!” came her tweeted reply.

An admission by Dr Etheldreda Kong, chair of Brent CCG, that her body has an LPC member on its board although they do not have voting rights hardly alleviated concerns.

Theresa May got in on the act albeit not in person, the Prime Minister gracing the conference with a letter shown to delegates expressing her desire to see a “thriving community pharmacy service” which the government was “committed to achieving.”

Before anyone could settle on feelings of optimism, up popped Alistair Burt, the former minister responsible for pharmacy via video link, who said pharmacy has too many voices which “weakens the base for negotiations.” He warned pharmacy to “sort it out.”

Then came Sigma’s ‘pharmacy champions,’ four pharmacists who had achieved excellence through their dedication to patient care. Take a bow Olutayo Arikawe, Adeyemi Williams, Dushyant Patel and Hatul Shah.

The conference was reminded of a critical date; February 9, 2019. Implementation of the Falsified Medicines Directive which will demand all pharmacists scan the barcodes of medicines. One imagined how FMD and hub and spoke would work. “They do seem rather imcompatible,” mused Gareth Jones the NPA’s public affairs manager

Tess Fenn, president of the Association of Pharmacy Technicians UK, pushed the case for greater recognition of pharmacy technicians and Trevor Gore, director at Maestro Consulting, said pharmacy can help patients “self-monitor” their health.

Tim Nancholas from Kantar Worldpanel revealed healthcare was the fastest growing FMCG (fast-moving consumer goods) category last year. Four million people, he said, purchase a product from a pharmacy each year, 30% buying oral analgesics, 21% cough medicines and 14% topical analgesics.

There was a trip to a favela and Sugarloaf Mountain where James Bond once did battle on a cable car with Jaws. A stroll down the Copacabana in the blazing sunshine might have allowed one to lose themselves. But not for very long.


Pharmacy cuts may be halted and pharmacy could retrieve funding

David Reissner, senior healthcare partner at Charles Russell Speechlys, said a successful legal challenge could compel the government to put its funding cuts on hold and pay pharmacies back money taken as part of its budgetary reduction.
Judicial reviews have been launched by the PSNC and National Pharmacy Association as the pharmacy profession tries to put up a fight against the government’s cuts. The PSNC’s legal action is based on what it regards as the government’s unlawful consultation on its cuts and the NPA’s action revolves around ministers’ failure to properly assess the impact of the cuts.
“If either of the judicial reviews is successful, there will certainly be a need for reconsideration. The judge is then likely to say there is the need for the Secretary of State to go back and take the correct factors into account,” Reissner said.
“In the NPA’s case he may say to the Sectary of State ‘you’ve got to go back and look at things again, taking into account those equality issues and comply with your public sector equality duty.’
“Similarly, if the PSNC’s case is upheld, the likely implications are that the consultation is not valid and therefore there has to be a proper, new consultation with sufficient information. The minimum (length) for a consultation is 12 weeks. That means restarting the consultation process with the PSNC and others being able to respond on the basis of the information they now have from the impact assessment.
“If the impact assessment (is found to be invalid) and relied on an insufficient financial analysis or too small a financial sample, they may have to redo the impact assessment. That will take an even longer process. I think you’re looking at the cuts being put on hold.”
When asked if pharmacy will retrieve money taken as a result of the cuts if the government is forced to restart its consultation, Reissner said: “If the judicial reviews are successful and the minister has to halt the cuts, for example restart the consultation process, yes, I would expect, through some mechanism in the Drug Tariff, there will have to be a restoration of the cuts.
“But over a long period, exactly when would depend on how that works and how long it takes to go through this process.”


Funding cuts place 315 pharmacies in England at high risk of closure
An analysis carried out by IMS identified 315 pharmacies in England, mainly in London, which are at high risk of closure because of the government’s funding cuts.
The study, based on NHS and pharmacy income data, cast a light on the devastating impact the 12% cut to the community pharmacy budget will have on pharmacies.
“We’ve got access to public information through NHS data. We also looked at the PSNC income data,” said Carol Alexandre, director of information offerings at IMS.
“We also looked at our own OTC data because what we were trying to do was establish the profit in pharmacy and then we came up with a model to identify those pharmacies we believe would be at risk.
“We looked at pharmacies where they have a low total gross profit, we looked at the lowest 1,000 pharmacies in England. We looked at those on the highest establishment payments and we looked at clustering, so how close pharmacies are to one another.
“It doesn’t take into account everything, so we know the labour costs, rents and rates, but we believe it’s a robust analysis. We believe there are 315 high-risk pharmacies. That means pharmacies that are at risk of closure.”


I won’t dwell on Pharmacy Voice demise, insists chair
Claire Ward, the chair of Pharmacy Voice, issued a rallying call to community pharmacy not to allow the government to divide it but insisted she would not be drawn on the detail of her organisation’s impending demise following the NPA’s decision to withdraw its support next year.
In front of an audience containing NPA chairman Ian Strachan who watched on with interest, Ward insisted she would not “dwell” on Pharmacy Voice’s disbandment and urged the pharmacy sector, independents and multiples alike, to unite to meet the challenges facing them.
“Pharmacy Voice will cease to operate before the end of this year. I am not going to dwell on that because whether Pharmacy Voice exists as the vehicle to support, represent and deliver change on behalf of community pharmacy, it’s no longer the issue,” she said.
“The question is whether the sector still has an important journey to go on collectively. And if so, how does it find a new mode of transport when the Pharmacy Voice vehicle is left on the side of the road?”
Ward added: “We know there are going to be different hurdles that independent and multiple contractors are going to face. We know it’s a different life, the commercial decisions, the ways of working that are different.
“But please do not let those differences be the reason for the sector not to come together in order to get on this vital journey because the journey is not about individuals. The journey is about the sector.
“And what NHS England is looking for, what the Department of Health is looking for, is a united sector. Do not allow them to cause that division. When we get to that destination, we want every part of the sector and independents to be a prime part of that to be able to benefit from it.
“Whilst Pharmacy Voice will not be that vehicle (for change), the sector will in due course have to decide which one is.”


NPA chairman: pharmacy bodies ignored plea for common agenda
NPA chairman Ian Strachan hit back at claims his organisation’s split from Pharmacy Voice has destroyed pharmacy’s unity at a critical time and revealed he wrote to all of the profession’s bodies two years ago asking them to form a collective agenda only for his request to fall on deaf ears.
Strachan vigorously defend the NPA’s decision to withdraw support from Pharmacy Voice and said only two bodies, who he did not name, responded to his letter after the Sigma conference in India in 2015 which outlined his idea of “a collective work-stream we could call our strategy, our agenda.”
“You need your full cards on the table so we know where we are. You need values and beliefs. You need a work-stream that you can sell,” Strachan said.
“After (the) Sigma (conference) in India in 2015 I wrote to all the bodies, the CCA, the PSNC, all of them, and I asked to come together to find a collective work-stream we could call our strategy, our agenda. I got two responses at the time. Then I wrote again in 2016.
“I have cried out for unity and that common agenda because it always seemed to me to be the thing that was missing. But right now the scale and the scope of the threats to the sector are so fundamental to your future, that there isn’t time to get things wrong. It’s not a personal thing.”
Strachan justified the NPA’s split from Pharmacy Voice by suggesting it was important for the NPA to lobby “outside the establishment” without the element of “cloak and dagger.”
“I’ve seen some comments and I think it’s right that I say a few words. Some people have said to me ‘haven’t you jeopardised unity at a time when the sector needs it the most?’” he said.
“And I’ll say this, the pursuit of unity and a single voice is fine, there’s nothing wrong with that but if the price of that unity is to compromise our ability to defend our interests, this profession will know that if the price I have to pay for that unity is that I have to have one hand tied behind my back while we negotiate, particularly when the threat is on the independents, all of these measures will affect you the most.
“I would rather lobby outside the establishment and influence politicians, civil servants, without that handicap of the illusion of unity sometimes. That’s not to say we won’t strive for it. But to get unity you do need transparency, not cloak and dagger.”


Commissioning will be at local level in future, says PSNC chief
Sue Sharpe, the chief executive of the PSNC, branded the government “stupid” over its cuts to community pharmacy funding then warned the sector not to overlook the local commissioning landscape within an NHS she described as “in crisis.”
Speaking via video link, Sharpe attempted to reassure the Sigma conference that the PSNC, preparing for its judicial review of the government’s funding cuts back in London, would protect community pharmacy “as far as we can” against decisions made by the NHS which she said were “borne of complete ignorance.”
“We know the NHS is in crisis. It’s going to stay that way for a number of years to come. What we are facing was a decision to cut community pharmacy funding,” she said.
Sharpe cautioned community pharmacy not to ignore opportunities at local level because that was where the commissioning of services would be prevalent in future.
“I think the future is much more focused on local commissioning much more than national. At national level the PSNC will do its very, very best to secure service and the best funding delivery and opportunities to make sure that you have a certain level of protection from the (reduction) in funding,” she said.
“Each one of you I think needs to ask yourself the question ‘have I got good relationships with local commissioners? Do they think of you as being reliable in terms of service, in terms of care for patients?”
Sharpe said community pharmacy had an opportunity to develop local services to meet local needs but warned “the next four months of funding is going to be very, very difficult for pharmacists. She also said pharmacists should strive to secure “100% of the quality payments.”


Pharmacy has too many voices – sort it out, says Burt
Alistair Burt, the former minister responsible for community pharmacy, revealed that a lack of clarity over who spoke up for the sector weakened its case during funding negotiations.
Burt, who stood down as health minister last year, said that although he was not personally in the negotiating room during talks with the PSNC, he was informed by his team that “pharmacy has many voices.”
Urging community pharmacy to “sort it out,” Burt told the Sigma conference via video link: “Going back to the negotiations, I wasn’t a personal player in the negotiation room but was represented by a whole departmental team.
“At an early stage, I was made aware that pharmacy has many voices. I formed my own view that the funding structure was not of the best, heavily skewed towards volume and quantity rather than quality and service.
“There had been concerns for some time within pharmacy itself that the funding formula wasn’t right and, in that passive phrase, ‘something had to be done.’
“More than once I said to various groups that although change can come about when new money is injected into a situation, more often change is more likely to be brought about by necessity and efficiencies often developed through a tightening of resource rather than an increase.
“To be honest, I found some agreed with me and this assessment and some agreed more than others did. And I found a number of voices recognising that the funding structure could not remain the same even though the profession was largely united in rejecting the way government was going about things. The negotiation process was not easy and I was aware of frustrations on all sides.”
Burt added: “I think pharmacy has got to be very clear about who speaks for it. I was aware of different voices and although there are many different parts that come together in the pharmacy profession, it doesn’t help the process if ministers become aware of mixed views and it rather weakens the base for negotiations.”