The pharmacy minister David Mowat says of the imposed cuts in England: “I very much hope that we can get that behind us.” What exactly are we to make of this statement at the Sigma conference in Rio? The cuts are in place and pharmacy contractors are facing them every day. There is absolutely no chance of the minister’s weasel words having any meaning whatsoever. He also talks about government and pharmacy working together and producing “what we all want to do, which is a much more clinically focused, services-orientated community pharmacy profession”. It all sounds good, but what is in prospect that is not just hot air? The Murray report, we hear, will be guiding policy. This had a lot to say on future developments (MURs evolving into full medication reviews, integrating pharmacy into local service provision, supporting patients with long-term conditions), but nothing concrete is on the table. The key issue is that contractors, generally, will provide what the government is prepared to pay for and if the services are not paid for, they are not provided. Even when it is prepared to pay, there is no guarantee that something will happen. The DoH backs a national minor ailments service, but is leaving that to commissioners locally, where the medics can act as a brake on pharmacy development.

 

One voice

We learn that a former pharmacy minister, Alistair Burt, is suggesting that pharmacy does not do well in negotiations because it has too many organisations sending out different messages, which minsters fi nd confusing. It needs to sort out a representative organisation, he claims. Well, we have one. It is the Pharmaceutical Services Negotiating Committee. It has been in place for many years. All types of contractor are represented on it. It is the body that the NHS sees across the other side of the negotiating table. So, more meaningless words. The key is making the PSNC more effective. It does not operate in a vacuum and this is where the other representative bodies come in. If they are good at what they do, that should strengthen the PSNC’s arm. There is the RPS, which should be taking a lead in the way that the profession develops. It should be progressing new practice models. It still, on the whole, though, sees pharmacists playing a supportive role rather than being prime movers in their area of expertise, namely, medicines. There is one practice model that has been developed internationally. It is called pharmaceutical care, and it is where pharmacists seek to optimise drug therapy by looking for and resolving drug therapy problems, in consultation with patients and other health professionals, and take responsibility for outcomes. But the RPS has never really got behind it. There is, for the most part, no real follow up when a prescribed medicine is supplied. The profession here has not built a case for it and until the government is convinced of its value, it will not pay for it.

 

No voice

With a former minister saying that there were too many organisations putting their oar in and confusing ministers, the NPA’s decision to pull out of Pharmacy Voice has come in for criticism. But Pharmacy Voice was only speaking for contractors (independents and multiples) in England. The PSNC and the RPS were not part of it. It is all very well people saying that pharmacy needs to speak with one voice, but, if it seeks to do so, distinctive areas like independents may feel that their views are being ignored. I suspect this is why the NPA, which has reverted to its former role as the representative body for independents (making the Independent Pharmacy Federation redundant in the process) wants to speak out for itself once more. What is needed is a means of distilling the various views down to where it really matters: when contractors’ negotiators are sitting across the table from the government’s and deciding who will be paid for what.