LPC chairman and NPA board member Dilip Joshi suggests hypertension gets the flu jab treatment and is bemused by different justification for the decommissioning of MAS

Thursday - November 9

I attend a NHS England (London Region) Community Pharmacy Steering Group today. These meetings between NHS England and London LPCs were set up to provide a single point of contact between NHS England and LPCs. Previously we heard that for local authorities and clinical commissioning groups (CCGs) to work together required legislative changes. Now we learn that pooling budgets and joint decision-making are possible without such changes. This requires “everyone working in a fundamentally different and more joined-up way”, a manager states. A colleague next to me mutters: “Aspirational clap-trap”!

I understand the sentiment as we have been saying this for some time, but it seems self-preservation is uppermost in the various organisations’ minds. Managers state the NHS 111 service is moving from ‘assess-and- refer’ to ‘consult-and-complete’. I wonder whether this is simply semantics, but we are told pharmacists will have a greater role as this develops.

On a positive note, we hear that there is an 11% increase in flu vaccinations in London over last year and the lead commissioner, Kenny Gibson, is extremely positive about pharmacy’s contribution. I issue a challenge to NHS England (London) to do something similar in another disease area. Pharmacy has demonstrated the ability to deliver in the right conditions and if another ‘Kenny’ takes on a lead role, much of the bureaucracy can be cut through. I suggest hypertension as an option to consider.

Friday - November 10

At a Pharmacy London meeting, we hear of GP attempts to undermine pharmacy
flu vaccination. A surgery has put up a poster stating that GP vaccines are better. This differentiation, supposedly based on quality, also delivers greater profits due to larger discounts being offered to GPs than for trivalent vaccines. Public Health England has endorsed the trivalent vaccine for the current season and we resolve to make representations to ensure public confidence in pharmacy vaccines is not compromised.

There is a discussion on decommissioning pharmacy services in London. Interestingly, different justifications are given to support decisions. For example, the minor ailments service (MAS) in Lambeth is decommissioned on the basis that medicines GPs have been asked to tell patients to buy are not available on the NHS through MAS in pharmacies. Hackney, on the other hand, has taken a different approach and commissioned MAS to meet need, as these medicines are not available via GPs!

Saturday - November 11

A British woman faces trial for smuggling painkillers into Egypt. Laura Plummer, from Hull, was arrested after 290 Tramadol capsules were found in her suitcase. Although she claims they were for her Egyptian partner who suffers from chronic back pain, there is a possibility of a lengthy jail sentence because the drug, while legal in the UK, is banned in Egypt. I was not aware of Tramadol being a banned drug in Egypt until this news broke and it highlighted the responsibility we have when advising patients who travel. Whenever large quantities of medicines are prescribed for patients who may be going abroad we should tell them not to remove the labels and to check restricted items before travel. Similarly, some medicines may be more freely available abroad but restricted in the UK. I wonder what part we can play in raising awareness through community pharmacy? 

Monday - November 13

Quality Payment declaration opens today and the LPC office is busy sending out support materials to contractors. In theory, this should be less onerous than the first wave. However, in many cases, the gateway criteria of NHS emails for the pharmacy and NHS Choices declarations were not completed. Our message is clear: it is essential to recover as much as we can, having faced the worst cuts to our remuneration. There is frustration about why contractors do not complete their declarations in time, but having spoken to many in our area, I am convinced the workload and regulatory burden are making it very difficult for contractors to cope with their day-to-day activities in supporting patients as well as remain administratively efficient.

Wednesday - November 15

At a Lambeth Borough Prescribing Committee meeting, I report that many dissatisfied patients are coming into pharmacies asking for paracetamol and other items that GPs no longer prescribe. Unfortunately, GPs have told patients to ‘get’ these medicines from pharmacies without explaining that they would have to pay for them. Having decommissioned the MAS, patients who may have been exempt from payment are having to buy medicines, and express their annoyance to pharmacy staff. It is both difficult and time consuming to explain why the decision has been taken. We are already seeing evidence of an increase in inequalities, a reduction of which is supposedly a key priority for the CCG.