Dilip Joshi, Lambeth, Southwark and Lewisham LPC chairman, meets the Shadow Health Minister and takes a trip to the US but can’t resist having a few pharmacy engagements, despite the fact that he is supposed to be on holiday

Thursday, October 8

I administer my first flu vaccination of the season. Every year there are frantic exchanges between commissioners and Pharmacy London about patient group directions, training and reporting requirements and eligible vaccinations. As last year, flu and pneumonia are approved, but shingles and pertussis are still not included. It seems the objections raised by GPs last year have not been overcome and, equally likely, commissioners ran out of time once again. At the eleventh hour, it is announced that PSNC has negotiated flu vaccination as a national advanced service starting this season. Whilst this is to be commended – as it puts colleagues across the country on an even footing and improves patient access – in London it has complicated matters. Success in London in recent years provided PSNC with the necessary evidence to make its case; however, London contractors had to ensure criteria for both London-wide and the national service were met, leading to considerable extra work for LPC offices across the Capital.

Thursday, October 15

Together with my LPC CEO, I am making my way to Portcullis House in Westminster for a meeting with Heidi Alexander, Shadow Secretary of State for Health, and MP for Lewisham East. We had invited her to a local event that she couldn’t attend, but she suggested we meet her at her parliamentary office. Our pitch covers both a big-picture role that community pharmacy can play as well as several local examples of excellence, such as the success in Vitamin D distribution and EHC – community pharmacy achieved an unprecedented 35 per cent distribution of Vitamin D and provides more EHC to clients than all other agencies combined. Heidi is interested in our ideas to utilise pharmacy more comprehensively and expresses anger at the present government’s “savage cuts” masquerading as efficiency savings and shares her fear of privatising the NHS by the back door. We tell her of a presentation to MPs that we are organising with Kate Hoey MP and she asks us to keep her abreast of developments.

I am welcomed by academics at a lunch at the University of California in San Francisco

 

Saturday, October 17

I occasionally read a column in Private Eye written by Dr Phil Hammond under the title ‘Medicine Balls’. In today’s edition (number 1343) he writes: “In the first year of (NHS chief executive Simon) Stevens’s ‘five-year forward view’, no efficiency savings have been made at all. Indeed, the NHS deficit will soar to over £2 billion, leaving the NHS to somehow make £24 billion worth of savings over four years.” Hammond goes on to say that performance of the NHS has nosedived; waiting times are up across the board, some CCGs are rationing NICE-approved services illegally, and every day 100,000 people aren’t able to see a GP when they want to. I reflect on the cyclical nature of NHS changes and wonder where we go next. Is Heidi’s fear of privatisation real? There is an argument that, with an ageing population and increasing demand, there will never be enough money for the NHS. Equally, we may have reached (gone beyond?) savings that can be achieved through efficiency without impacting on quality of services. It seems that morale in the NHS is at an all-time low, with both providers and administrators. I reflect on whether the NHS has become so unwieldy that meaningful change has become impossibly difficult and that we must carry on as best as we can.

Tuesday, October 20

I am on a family vacation for a couple of weeks visiting the US. We fly into New York and then to San Francisco to drive down the beautiful Pacific Highway. Unable to resist an element of a busman’s holiday, I have a pre-arranged meeting at the University of California, San Francisco (UCSF) today. KCL, where I’m a visiting lecturer, and UCSF have an affiliation. I am welcomed like a VIP with an excellent lunch. They are keen to learn about the development of community pharmacy in the UK and ask about the prescribing roles of pharmacists, increase in professional responsibility and autonomous decision-making. We agree that better access to patient records is essential for more integrated care. With all its faults, the NHS still appears to be the envy of the world – much time is needed to manage insurance payments associated with patient-care in the US. Following lunch, I am given a tour of a nearby Walgreens branch that is working with UCSF. A new initiative is being trialed known as ‘Meds-to-Beds’, in which discharge medication is communicated to the pharmacy a few hours in advance and the pharmacy delivers directly to the patient in hospital so they leave with medication dispensed by Walgreens rather than the hospital. They look to follow this up with a phone call similar to our NMS service. Of course, there is a commercial angle, with patients being required to sign up with Walgreens. They say this is only temporary, but I wonder if it turns out that way.

Monday, October 26

I visit a branch of CVS Pharmacy in Los Angeles. I am particularly interested in their program (ScriptSync) for co-prescribed medicines. CVS Pharmacy is the second largest pharmacy chain, after Walgreens, in the US. ScriptSync aligns prescription treatment days by working with patients and prescribers to address inequivalence in amounts. Where needed, a prescription for a balancing amount is requested by the pharmacy initially and subsequent repeats are managed by the pharmacy or online. Patients can view their prescription information, add or remove prescriptions from their ScriptSync order, and confirm or change their ScriptSync pickup date. I think of the ad hoc ways in which we presently manage inequivalence and resolve to consider a better method when I return.