LPC chairman Dilip Joshi begins his month helping contractors jump the many and various hurdles needed to qualify for extra payments
Monday April 3
It is the beginning of the month and Quality Payments are uppermost in community pharmacists’ minds. Local pharmaceutical committee support events begin in earnest, with HLP and leadership training, LPC guides for meeting QP requirements and achieving the basic four gateway criteria. These are: offering at least one advanced service (MUR, NMS, flu vaccinations or registered for NHS Urgent Medicine Supply Advanced Service [NUMSAS]); having an up-to-date NHS Choices entry; ability for staff at the pharmacy to send and receive NHS mail and, demonstrate ongoing utilisation of the Electronic Prescription Service. Of these, obtaining a pharmacy NHS mail account and editing rights for NHS Choices have been the most difficult, as demand has overwhelmed NHS support resources. The PSNC negotiates concessions, with application for an NHS mail account by 1 February 2017 deemed acceptable evidence, and an extension for NHS Choices update. Engulfed in bureaucracy, meeting requirements for most contractors is more on their mind than any improvement in quality. An unsympathetic GP practice manager says: “Welcome to the real world; we have been doing Quality and Outcomes Framework (QOF) submissions for years and patient care has not improved. We’ve become very good at filling forms instead”. Having set a precedent, my fear is how much extra work contractors will have to do under the banner of Quality Payments in future.
Saturday April 8
I wonder how many pharmacists have not done any MURs at all. Today, a colleague comes to the pharmacy, after we close, for assistance with meeting his QP requirements. He has left everything late and will not be able to meet criteria for the 28 April review point. I am more than a little surprised that he has not done any MURs. I know many that do not complete their quota of 400 each year but no-one that has not done any at all. Ironically, both the pharmacist and his premises are accredited. He realises the cuts will force him to reconsider and we run through a dummy MUR. Often, service provision is a confidence issue, as was the case with me when I carried out my first NHS Health Check. I had undergone training but did not see my first patient for three weeks and had to phone a friend for advice. In my experience, services commissioned without proper support tend to fall away in quality, as regular provision is necessary to keep skills at a consistent level. The contractor leaves with a promise of completing his first 10 MURs over the next two weeks.
Saturday April 15
I dread working on Easter Saturday or any Saturday in a bank holiday weekend, as many surgeries are closed and, like colleagues all over the country, we end up picking up the pieces for the NHS. The number of people that run out of medicines is extraordinary. I wonder how many patients would contact emergency out-of-hours services or visit A&E if a pharmacy was not there to help. We have several requests for prescription medicines from our regular patients, as well as from those who usually go elsewhere. Of course, there is additional work in making a supply subsequently redeemed against a prescription the surgery has ready but is not open for it to be collected. Unfortunately, it is a widely held belief that pharmacy is there just for dealing with such matters and, grateful though most patients are, we feel we are taken for granted. Additionally, with Lambeth decommissioning the minor ailments service, I am sure a proportion of people will end up using emergency services, which are far more costly to the NHS (and less convenient to patients) than commissioning pharmacy providers.
Thursday April 20
I meet four enthusiastic contractors this evening who “want to roll their sleeves up and really get to grips with commissioners”. They are understandably disappointed with decommissioning decisions that affect their pharmacies and ask to meet LPC officers to suggest we be more robust with commissioners. These are young contractors, and I feel we can harness their energy; however, there needs to be a degree of political awareness. We discuss the limited scope of sanctions available to us and I explain that lack of unity has historically been problematic. For example, there would be fair remuneration for patient delivery services if we did not provide them free, fearing that others would if we did not. The meeting concludes cordially and I resolve to reach out to such contractors, who continue to be the lifeblood of our profession at grassroots level.
Monday April 24
I am attending the first day of the two-day NPA board meeting. We welcome Councillor Frances Leonard, the 473rd Mayor of St Albans, who is a pharmacist who qualified at the School of Pharmacy, University of London. She is dressed in her mayoral finery and explains that her role for the year is apolitical. She has not been to the NPA before and we take the opportunity to show her around, confident that she will act as an advocate for pharmacy when her year is completed. The mace-bearer that accompanies her gives us a history of the artefact, informing us that it is older than the mace at the House of Commons. While its purpose is ceremonial, it has been used as a weapon to defend a past mayor! Frances offers the cloak for one of us to try and we promptly volunteer the vice chair of the NPA, Nitin Sodha.