A meeting with a charity worker friend causes LPC chairman Dilip Joshi to reflect on how pharmacy’s hands are tied when it comes to helping people in need
Tuesday July 4
I meet David Logan, the former director of the local Ace of Clubs charity for homeless and vulnerable people this evening. He has moved to another charity organisation in Westminster, but has become a good friend. He tells me that Westminster has the biggest homeless population and the most number of rough sleepers in the country. It is hard to imagine the stark contrast in an area that is perhaps the most affluent while at the same time having the greatest challenges in health and social care. Substance misuse is prevalent amongst David’s clients and he tells me moving stories of helplessness and despair. Many of those helped by the charity are not registered with a GP and cannot afford to buy medicines. This increases crime – we have noticed a significant increase in shoplifting at our pharmacy – as well as inequalities. A Minor Ailments Scheme (very successful in Scotland) has been spoken of as a service for England but has not materialised. David Mowat, the former pharmacy minister who lost his seat in the general election, changed a suggestion of national funding for this to simply “encouraging” CCGs to commission MASs locally. In the event, many local schemes already in place have been decommissioned (as in Lambeth, part of my LPC’s area) due to pressures on CCG budgets. The promise of promoting self-care has never sounded so hollow.
Thursday July 6
At an NPA Information Technology Steering Group meeting at St Albans today we consider how best to embrace technology to promote a “clinical and digital” future for members. These words currently resonate with policy-makers and community pharmacy needs to step up to the challenge. I believe we can meet both criteria and convince paymasters that, effectively used, we will continue to make a significant and long-term contribution to patient care. Unfortunately, some see community pharmacy as an expensive distribution service. However, you only have to ask those who use community pharmacies what they think; recently, 2.2million patient signatures resoundingly confirmed public support for us. Technology can bring benefits but cannot replace the face-to-face contact valued by patients. An enhanced clinical role through patient contact is achievable and I believe we need to become familiar with using stethoscopes, otoscopes, spirometers and other screening equipment to make the most of the ease and convenience patients have in using community pharmacies.
Tuesday July 11
I am at the new NPA Westminster office opening this evening. The recently acquired facility in Tufton Street is only a small room – not grand by any stretch of the imagination – but it is but well located. MPs and representatives from pharmacy stakeholder organisations have been invited and I meet Jim Dowd, who stepped down as the Member of Parliament for Lewisham West at the last election. Janet Anderson MP is also here. They were both great supporters of our campaign against Office of Fair Trading proposals to remove control of entry in what seems a lifetime ago. The event is well-attended and I realise that, contrary to belief amongst some colleagues, community pharmacy has many friends and supporters that truly value our contribution to society and I am heartened as I leave. Of course, cynics will wonder whether I have been hoodwinked by the soothing words of politicians.
Wednesday July 19
The PSNC announces additional cuts through Category M clawback today, resulting in an average drop of around 17-18p per item on current Drug Tariff prices for the 12-month period beginning in August. An accountancy firm estimates that an average pharmacy in England will lose £42,000 over 12 months as the result of combining the category M clawback with the £15,000 being added to the £27,000 shortfall already expected as a result of the funding cuts. This is sickeningnews that most colleagues will not have anticipated and it is likely, once again, to affect smaller Independents disproportionately. A new contract is long overdue, but will the DH continue this attrition until they realise their objective of reduction in pharmacy numbers?
Tuesday July 25
Today, I attend the final Stop Smoking service redesign group meeting before the drafting of an outline proposal from the provider consortium for presentation to Lambeth local authority commissioners. After a number of previous meetings, we are optimistic that we will have done this by mid-August, as required. Our challenge has been to come up with a service that delivers more than in previous years with a lower budget than last year. Fortunately, data show that pharmacy has delivered a higher percentage of quits than their GP counterparts at service fee levels not reviewed for several years. The largest part of the budget goes towards administration and specialist secondary care provision. We agreed to make savings from this part and use some funds for social marketing. Pharmacy will be involved in several referral pathways, which is encouraging, but, as always, the devil will be in the detail when the outline proposal is further developed.
Saturday July 29
It’s a big birthday for me today. I won’t say which! I truly do not know where the years have gone and am almost surprised at myself that my passion for our profession is undiminished after all this time. I reflect on the time I have been on the LPC, the years on the PSNC and the NPA board and all the changes I have seen. Community pharmacy is no longer the Cinderella branch of the profession with a shopkeeper image. Instead, I believe we are fortunate to be able to witness the impact we have on our patients’ lives through our interventions. I have a sense of fulfilment as I join the family for the evening dinner after having been at work for my usual Saturday morning shift.