By James Tibbs
I have heard very mixed opinions from various stakeholders on the new pharmacy contract, and in my opinion, there are definitely some positives and negatives. I have pulled out the key points that are most relevant to my business and that of my fellow independents.
With my business-hat on, the fact that the Pharmaceutical Services Negotiating Committee (PSNC) have negotiated a five-year contract gives community pharmacy, and indeed my business personally, some much-needed stability. I can now forecast to the future and decide where and when I will invest, in, say for example, new technologies to tie in with the contract’s mention of IT development (incidentally keep your ears to the ground for any pots of money that may come out of this that you can apply for to help you invest in technology… if you think it will benefit your business, patients and ultimately save money for the NHS why should we not be paid for it?! Even as a single pharmacy I am constantly looking for revenue streams to support my business growth).
One of the most exciting parts of the contract is the development of meaningful clinical services in community. At last! Putting my pharmacist hat back on, the current structure of the medicines use reviews (MURs) has not been fit for purpose for many years in my opinion and I welcome the reinvestment of funding into more robust and evidence-based clinical services released from scrapping MURs.
Contractors need to think of this as a short-term loss for a long-term gain. One of the most frustrating things about MURs was the cap at 400 no matter how many patients you see. Many pharmacies could (and indeed did) achieve this in less than a month and it became a target driven exercise rather than a meaningful clinical intervention to prevent ill health.
The new Community Pharmacist Consultation Service (CPCS) is perhaps the best opportunity we have to prove our worth to the NHS. Finally, we are going to be paid for a service we have largely done anyway and for free for a number of years!
I implore my colleagues to not waste the opportunity. The Department of Health and Social Care (DHSC) will be watching us very closely over the next five years. Let’s show them what we can really do! Although it will be a slow start, the real gold nugget will be when GPs can refer to us. Get in touch with your surgeries now, tell them what’s happening in the pharmacy world, and become a more integrated part of their systems. I believe this is our open door into primary care networks and will open many more doors (probably more locally) to gain more commissioned services.
My vision would be you go to your surgery and the receptionist asks: “Would you like an appointment with the nurse practitioner, GP or your community pharmacist? The community pharmacist can see you right away by the way.” Who wouldn’t go for that?!
Hub and spoke
Now for the negative… the inclination that the DHSC wants a more centralised dispensing model is, in my opinion, dangerous for community pharmacy, particularly smaller independent pharmacies.
For example, many of the wholesalers have already set up operations to be able to deliver this service to us and then ultimately skip out the community pharmacy and go straight to the patient’s door, Pharmacy2U-style. This will have a huge impact on our access to patients and ability to deliver these services the Department wants us to.
However, ever the optimist, let’s use the news to prepare ourselves and change our operational model. Start delivering all the services now to all your patients to change patients’ mentality about community pharmacy being a destination for health and wellbeing, rather than just “a place to pick up my tablets from”.
The hint in the contract of a review of the antiquated re-imbursement system is welcome, however, I am still unsure about whether this will be of benefit or hindrance to my business. It could go either way and will be very dependent on the mix of branded and generics in your particular business. The two positives I can see however is the end of dispensing at a loss and, hopefully, branded generics.
James Tibbs is superintendent pharmacist at A.R. Pharmacy in Southampton.
This article also appears in the September issue of Pharmacy Business.