LPC chairman Dilip Joshi believes that the cutting back of the succesful Minor Ailments Service in his area if combined with a ban on the prescribing of OTCs will add to the pressure on A&Es

Friday 3 March  
Today, I receive a decommissioning letter from Lambeth CCG for the Minor Ailments Service (MAS). The LPC was consulted on MAS and asked to be involved in a selection process in order to partly retain the service in the “most deprived” areas. We refused on grounds of governance and our fundamental disagreement with decommissioning a service that has become a victim of its own success. The MAS is well-liked by patients and GPs, as those exempt from prescription charges can access medicines from a restricted formulary without going to their GP or having to pay. There is another consultation going on seeking to discourage GPs from prescribing medicines that can be purchased over the counter. The combined effect would mean that those who were time-rich and cashpoor would be likely to turn up at A&E more frequently or avoid treatment altogether. In another letter, Emis Health (formerly Proscript) states that the IMS data rebate is to end on 1 June 2017. It justifies its decision by saying government legislation and the Freedom of Infomation Act has resulted in the “value of pharmacy data being eroded to disappearing point”. This small rebate partially offsets significant sums charged by PMR suppliers for maintenance. The attitude of one of the most widely used pharmacy system suppliers taken over by a GP systems supplier does not bode well for the future.

Thursday 9 March 
At a Pharmacy London meeting today, we receive a presentation from an NHS expert on electronic repeat dispensing. There is apparently an issue with GPs confusing electronic repeat dispensing (allowing prescribing for up to 12 months) with forward-dating of prescriptions. We are asked how we could help GPs do their jobs better as it might be in our interest to receive these prescriptions. The expert is silent on the question of why a prescription is only deemed to be dispensed when collected by the patient. Contractors are financially disadvantaged when they order stock, often specifically for a prescription, and it is not collected by the patient. This important issue has not been resolved satisfactorily and routinely involves us in financial loss. We raise another one-sided issue of prescriptions levies being assumed to have been collected unless declarations of exemption are recorded – this is particularly problematic for electronic prescriptions, as further checks before submission cannot easily be made.

Thursday 16 March
I attend an unusual Lambeth Integrated Pharmacy Services (LIPS) meeting today where a commissioner I have known for years proposes a pragmatic approach. She starts by saying that for years she worked to guidelines, assessment grids and the like, but now is a firm believer in a common sense. The aim of the project is to make best use of medicines by reviewing elderly patients on multiple medications, recommending reduction where necessary – in short, to support such patients and reduce frequency of hospital admissions. She states that outcomes will be the only measure. She asks us to identify patients we feel could benefit. I welcome such a refreshing approach. I am hopeful it will truly benefit patients and that this commissioner takes on more roles with community pharmacy.

Wednesday 22 March
At an NHS England meeting at Skipton House today, I hear complaints on communications around market entry and learn this is also the responsibility of our friends at Capita. I ask if NHS England has made any representations to Capita for compensation. We are advised that, this being a PSNC matter, LPCs should collectively take this up. But I got the feeling that NHS England would not oppose any such representations. We also hear recruitment of pharmacists to work in GP surgeries in London is taking place, with a target of 85 pharmacists per year for the next three years. I realise this is following a national initiative but again mention the importance of integrating their work with community pharmacy.

Thursday 23 March 
A contractor formally writes to the LPC to complain about being decommissioned from the Minor Ailments Service. Why had we “allowed” the CCG to do this? We explain how the decision was made and everything we did to resist it. In our area, we have hitherto been fortunate in avoiding large scale decommissioning. We have achieved this through arguments supported by data on our value. In addition, we have continued to provide services in spite of fees not being reviewed for four years. It comes as a shock to the LPC and contractors alike that our loyalty is no longer sufficient to avoid decommissioning. I reflect on whether all the groundwork in establishing the value of community pharmacy in the hope that rewards would improve has turned out to be a waste of time.

Thursday 30 March
Two days of NPA board meetings start, with the highlight being a memorial and tribute dinner organised at Apothecaries Hall to recognise a giant of the pharmacy world: the late Kirit Patel. The Patel family, as well as senior Day Lewis staff members, are present. Past board members who served during Kirit’s time in office also attend. There are moving speeches from Hiten Patel, a board member, and from Kirit’s pharmacist son Jay. It is an enjoyable evening, not too sombre, just as Kirit would have liked.

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