This is a summary of a letter sent by Hemant Patel (pictured), secretary of North-East London LPC, to local contractors during November

Is your value as a pharmacist going up or down? In financial terms, what needs to happen to retain and add value to your work? In terms of respect, why is it some pharmacists’ value is considered greater than others?

Critically, with big changes in health and social care taking place, what action do you need to take to retain and add value to the future system? GP leaders have realised that their workload is unmanageable and they have to work with local pharmacies.

To be relevant to the commissioners of future services, you will need greater self-awareness, new skills and frameworks that reflect your increased responsibilities.

The LPC is discussing new services with commissioners, including pharmacy-based prescribing for local populations. So, let us consider some changes that will impact on you.¹Â How you fare will depend on how prepared you are to meet them:

• There are not enough GPs to meet demand, so commissioners need to develop prescribing skills in pharmacists and nurses. But there are not enough nurses either. There are increasing numbers of young and clinically competent pharmacists, however. Pharmacy owners will have a range of talented, skilled and willing pharmacists available to provide prescribing services. Commissioners will not allow an opt-out for pharmacists. Patient interest will dominate.^2,3
• Dispensing fees are predicted to go down, when taking volume increase and inflation into account, threatening income. With robotic dispensing and an increased role for technicians, is it unlikely that pharmacists will be paid a greater fee for dispensing when cheaper models are available. 3,500 pharmacies are expected to close.⁴
• Technicians’ role will be enhanced even further.⁵
• Automation and robotics will mean cheaper dispensing costs. Pharmacies will be given access to patient records. Access to summary care records will be followed by read/write access.⁶
• GP surgery numbers are expected to fall and be replaced with fewer but larger centres, containing multidisciplinary teams of health and social care workers. In parallel, the government has said it will allow centralised dispensing to create a hub-and-spoke system. Effectively, we are on the way to a pharmacy without dispensary model.^7,8 So, what service will your pharmacy provide?
• There will be a 365-day, 24-hour, NHS service. Have you considered how this will impact on your ability to respond? What if your neighbouring pharmacy responds first? Other than dispensing, what needs to happen to make the proposal viable?
• Pharmacists in surgeries will be providing some services. We believe they will largely be medicines-related, but could include a broader range.⁹
• Pharmacy regulations will be relaxed to improve ‘efficiency and costs-effectiveness’ and new players like Amazon could enter the market.^10,11
• The economy and tax revenues to fund public services are not predicted to improve before 2020.¹²
• The number of elderly and people with long-term conditions is predicted to increase, especially people with obesity, diabetes, hypertension, mental health and respiratory diseases.¹³

The situation presented here is not an opinion. It is a fact-based analysis.

Apathy, arrogance, ignorance, lack of urgency and hope for the status quo will not create a secure future for you. Courage to embrace changes, commitment to develop a new mindset and skills, a sense of urgency, deeper understanding of the changes and speed at which changes take place, will help you not only manage change but also create a place in the future system to guarantee you and your family a more secure future.

You might want to start by referring to the NHS plans described on the NHS website, which have started to be implemented.¹⁴

History and evidence has shown that the fittest in any species have the best chances of survival. What does fitness to survive mean? What are you doing to improve your fitness?