The securing of agreement for the setting up of a provider company for commissioned services was the highlight of the month for LPC chairman Dilip Joshi

Monday, November 9

I am attending a Lambeth Borough Prescribing Committee meeting this afternoon. Included in our duties are the agreeing, setting and monitoring of GP targets. We also review appeals of those who did not meet targets and for whom penalties are usually financial. Many pharmacists believe that, as CCGs are GP-led, they would look after GP interests. However, today, tensions are clearly seen between this committee and the LMC. The unrest amongst GPs is clear, with workload and “unsustainable cuts” cited as compounding other reasons for missing targets. Surprisingly, I find myself sympathetic to their cause. I realise pharmacist colleagues might find it difficult to envisage poor beleaguered GPs when we have our own problems but I begin to see tough measures across all healthcare providers and believe this is risking a demotivated workforce and longer-term damage for primary care.

Tuesday, November 10

I have a follow-up meeting with a locum consultant psychiatrist who previously came to the pharmacy to correct a prescribing error for a CD prescription. She has been put forward by her team to explore joint working for better patient care. Issues we discuss include disconnection between secondary care, GPs and pharmacists. She refers to research showing the biggest reason for failure in all medical care is lack of adherence, and says this is even greater for mental health patients. We agree that communications are vital: GPs and pharmacists need effective discharge information about patients seen in hospital/special care centres so that GPs can monitor and prescribe and pharmacists can reinforce messages and monitor adherence. There is also a need for feedback to complete the information loop.

Tuesday, November 17

I have a meeting with Lambeth Public Health this morning and discover there has been a reshuffle of managers in spite of previous undertakings. The proportion of contractors paid fully for public health services is just over 50 per cent. The rest are still waiting for full payment. The reason, I am told, is that an RBS portal used for payments had not issued correct numbers; this has resulted in payments to some contractors not being made for six months. I ask the managers how they might feel about a six-month delay in the payment of their salaries.

Lambeth, Southwark and Lewisham LPC’s AGM

Thursday, November 19

At this evening’s LPC meeting we put final touches to the provider arm for commissioned services – we still have not named it – and the meeting sponsor is a company with a new mental health drug willing to support training for pharmacists. I consider how well this might fit with discussions I had with the consultant psychiatrist and asked the office to set up a multidisciplinary group to explore this further.

Monday, November 23

I start a busy two days with NPA meetings and the NPA’s Triennial Dinner at the Apothecaries’ Hall in London, where I meet many of the great and good both from the pharmacy world and outside and catch up with many old friends, some of whom even say they read this column! Disappointingly, Alistair Burt, the Minister of State for Community and Social Care, pulls out due to “parliamentary business”. The highlight is our chairman’s speech, with a rousing call to independents to trumpet the good work we do every day: “Be proud; be bold”.

Tuesday, November 24

I am chairing a special general meeting of Lambeth, Southwark and Lewisham contractors in Stockwell, South London, this evening. Steve Lutener, director of regulation and support at the PSNC, has kindly agreed to attend. We need to change our constitution to enable the LPC to loan funds to our proposed provider company. Steve presents a company limited by guarantee model, recommended by PSNC, that we will use. Previously, we had considered a limited liability partnership (LLP) and a community interest company (CIC) as models but our aim is to be fully inclusive. This model enables CCA members to join without becoming shareholders or board members. The membership fee, initially, will be £50 per contract to encourage maximum uptake, with an increased fee likely for those joining later. I speak about our three objectives: low risk, low investment and maximum inclusivity and together we answer questions to ensure attendees are satisfied with our approach. This is reflected in a unanimous vote in favour, including CCA representatives present, and I believe this collective strength will be important in persuading commissioners to use our company. As I leave the meeting, I think that this is just the beginning. The hard work starts now, with thorny issues such as allocating services, monitoring and compliance and how to deal with poor performers becoming real challenges for the new company.

Monday, November 30

I am attending a meeting of the Lewisham Forum of Pharmacy Contractors this evening. There is a specialist respiratory nurse speaker, supported by a pharma company with interest in this area. It is an opportunity for me to update the forum about the provider company. We have joining forms ready for distribution. I speak to the sponsoring company representative and mention our plans for future service procurement through the provider vehicle. He is alive to the possibility of having a relationship on a more commercial footing, which is, of course, not possible with the LPC. I reflect on the need for sound governance and managing conflicts of interest of the provider company in order to maintain credibility with commissioners as we move forward.