Smoking cessation manoeuvres

Before deciding on who should be commissioned to provide smoking cessation services, Lambeth Council has arranged a series of meetings with all possible suppliers. This is just one of the issues LPC chairman Dilip Joshi has had to contend with in another busy month

 

Monday May 8
Lambeth Council has arranged individual meetings with provider stakeholders to discuss stop-smoking commissioning intentions for 2018. Today, we go into bat for community pharmacy and hear that meetings have already taken place or been arranged with GPs, secondary care trusts and specialist addiction services. Following separate meetings, joint meetings will follow with a view to work up a collaborative service between all providers. Whilst this is a positive move, giving existing providers an opportunity to work together, we are told that this will be within a reduced budget, with a lightly veiled threat that, should an agreement not be forthcoming, the service will be put out to tender. Furthermore, the stop smoking service is an experiment for how Lambeth might commission other public health services, so there is a lot at stake for our contractors. Our dilemma is between agreeing to a poorly remunerated service or, potentially, giving up all public health services. Speaking to non-pharmacist colleagues later, they are all in a similar position and agree to try their best to work together to develop a sustainable service.

Tuesday May 9
Sue Sharpe announces her resignation as CEO of the PSNC. Reactions to this news appear to be mixed, depending on who is seen to be at fault over the current poor situation that contractors find themselves in; some blame the DH for wrong-footing the PSNC in negotiations by sending the infamous December 2016 letter (“Community pharmacy in 2016/17 and beyond”) and others seek to lay the blame for pharmacy’s lot at the negotiator’s door. Having been on both sides of the fence – as a PSNC member for over a dozen years as well as a practising contractor – I can say the CEO job at PSNC is one of the hardest in community pharmacy. On the one hand, there are a number of constituents in pharmacy that do not always have the same agenda and, on the other, there is negotiating with a monopoly employer holding the purse strings. I was on PSNC when Sue was recruited – the first nonpharmacist to hold the position – and saw how the organisation was transformed in terms of both personnel and LPC and contractor support. A shining example is the website, used by as many outside of the profession as within, being easy to navigate and having up-to-date information. Even though much in need of revision now, the concept of benefit-sharing introduced in the 2005 contract was ground-breaking and laid the foundations for good working relationships with DH for several years. I believe community pharmacy owes Sue Sharpe a huge debt of gratitude and I, for one, shall miss her being at the helm.

Thursday May 18
The long-awaited judicial review judgment is handed down this morning and the news is disappointing. The DH’s action is not judged to be unlawful and this means the cuts remain in force. On the other hand, the judge is critical of the DH, expressing regret at not being able to “properly quash the decision”. Demonstrating unlawful wbehaviour is of course a very high burden of proof but the judge also regretted a breakdown in relationships between pharmacy bodies and the DH. As a result of the snap election, it is far from certain how (and with whom) future negotiations might be conducted and whether the judge’s comments are likely to temper the tone of the engagement. It is sad the focus is on cuts rather than using the network of community pharmacies to better effect.

Monday May 22
At the NPA Board meetings today, there is focus on member services. Having spent much energy on campaigning against cuts and received many positive comments from members for the NPA showing leadership in representing independents, we agree to carry out member surveys to enable us to tailor support to members’ needs. Specific aims are to deliver the right member services, develop and optimise communications with members and ensure high quality and value that is relevant to all members, irrespective of size. Existing services will be reviewed in response to survey findings, building on core functions to represent, support and protect members.

Wednesday May 24
At Lambeth Borough Prescribing Committee this morning, “promoting self-care” is on the agenda. This is a euphemism for GPs “encouraging” patients to buy items directly rather than obtain them on prescription. I ask whether “encourage” means GPs have an element of discretion. GPs around the table look uncomfortable as, on the one hand, they wish to be decision-makers in matters relating to their patient’s health but, on the other, they have to make a decision on a patient’s ability to pay. There is comfort in numbers and the chair quotes Julie Wood (chief executive of NHS Clinical Commissioners): “This is not about cutting essential services or restricting access for patients to services they need, it is about allowing local clinical leaders to make the best and most efficient use of the money CCGs have available to spend in really challenging circumstances”.

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