Remuneration cuts both national and local feature in another busy month for LPC chair Dilip Joshi

Wednesday November 2

I am at the LPC Conference at the Congress Centre in London today and am surprised the health minister, David Mowat, attends and is robust in announcing that cuts will go ahead in the face of a lukewarm reception from delegates. He states an intention to move community pharmacy into a future shaped around services largely commissioned locally, admitting that this will be easier to bring about in some areas than others.

Sue Sharpe speaks of betrayal by the DH’s disregard of the value of community pharmacy and dismissal of concerns of patients who rely on the care provided by community pharmacy teams. Delegates convey a strong message that LPCs across the country have no confidence in NHS England’s ability to engage with the sector and unanimously support a motion stating that there is insufficient expertise on community pharmacy within NHS England.

Monday November 7
Raj Aggarwal, honorary consul for India in Wales, has invited me to a Diwali celebration event at the Millennium Centre in Cardiff. It is attended by various dignitaries, including Carwyn Jones, First Minister of Wales. I sometimes envy the close relationships pharmacy has in the devolved countries and how their politicians seem to look at healthcare differently. For instance, Scotland has had a national minor ailments service for several years while we, in England, have patchy local schemes commissioned only in certain areas. Similarly, the cuts affecting English contractors will not affect our Welsh colleagues.

Looking further back, the OFT recommendation to remove restrictions for pharmacy openings were rejected by both Scotland and Wales, whereas, in England, we had the disastrous ‘balanced package
of measures’ that led to the opening of 100-hour pharmacies and arguably put us in the mess we are in today. How ironic that the very measures taken to ostensibly improve access have led the government to make cuts with the aim of bringing about the closures of 3,000 pharmacies.

Friday November 11
This evening, I am at a public meeting on pharmacy cuts in Carshalton, Surrey. It has been organised by Tom Brake, MP for Carshalton and Wallington. Tom was one of the few Lib Dem MPs re-elected at the general election and, from the turnout, it is clear he is a good constituency MP. He is also a real friend to community pharmacy, making strong representations in the House of Commons. The sole topic for this evening’s meeting is to discuss the impact of pharmacy cuts on patients and the public. I arrive early and take the opportunity to chat to several attendees, who are clearly upset with the government’s position.

One even said to me that, if I were a politician, he would vote for me. I try my best to take this as a compliment! Tom hosts the meeting and my fellow speakers are Simon Wales, deputy leader of Sutton Council, Reena Barai, local pharmacist, and Dr Brendan Hudson, chair of Sutton CCG. I set out the national context and global impact the cuts will have on pharmacy services and Reena speaks of local examples where pharmacists go the extra mile, for example, making free deliveries to housebound patients.

Both the non-pharmacist speakers are supportive of community pharmacy, with the councillor voicing concerns about large organisations, the threat of unplanned closures, and privatisation of NHS services. The CCG chair, a local GP, speaks highly of the contribution community pharmacists make and about collaborative working. Much of the time is allocated to Q&As and the vociferous audience’s mood borders on anger with the nonsensical cuts and calls for more investment in community pharmacy.

Monday November 28
NPA board meetings today and tomorrow are focusing on the action to take in both resisting cuts and providing support for members. We discuss close cooperation with PSNC to explore legal redress against the DH’s imposition and agree that the impact analysis of proposals appeared to be inadequate and not made available for consultation in advance. On a more practical front, support for members to claim quality payments will require considerable work and the NPA team will need to prepare appropriate resources to reduce the impact of cuts, at least to some extent.

Wednesday November 30
I am at a Lambeth Borough Prescribing Committee meeting today in which most agenda items could have come under a heading of ‘cuts’. Gluten-free foods are the first target. NICE guidance on inequalities
is mentioned by one member to defend their being prescribed. This is countered by another member pointing out that diabetes foods are not available on the NHS. Decision deferred.

Next on the list is availability of antimalarials and travel vaccines on prescription. These items are not generally available on the basis that holiday and travel expenses are normally covered by the traveller. When this was tried in the past, many visitors to West Africa simply didn’t take precautions and it became more costly to treat those contracting malaria than to make antimalarials available on prescription.The policy is to be reviewed.

Some pharmacies providing minor ailment services are to be decommissioned, with the aim of maintaining geographic coverage through a reduced number of providers. The Lambeth scheme has gone well but
has resulted in an overspend and has become a victim of its own success. The usual arguments about more pressure on GPs and A&E are sympathetically received but there is no money. Greenwich is in a worse state, we hear, with GPs being asked to encourage patients to buy medicines OTC.

GP representatives on the committee say that this is unlikely to succeed and will heighten inequalities. This has been one of the more disheartening meetings this month and I believe it is a snapshot of what must be happening elsewhere in the country and, to my mind, shows the unsustainability of the government’s healthcare model.