Contractor views

Lessons from Borgen and a New Year message

Onlooker compares BBC4 drama Borgen to events at the Pharmaceutical Journal

Cuts and more cuts

Wednesday November 2 I am at the LPC Conference at the Congress Centre in London today and am surprised the health minister, David Mowat, attends and is robust in announcing that cuts will go ahead in the face of a lukewarm reception from delegates. He states an intention to move community pharmacy into a future shaped around services largely commissioned locally, admitting that this will be easier to bring about in some areas than others. Sue Sharpe speaks of betrayal by the DH’s disregard of the value of community pharmacy and dismissal of concerns of patients who rely on the care provided by community pharmacy teams.

Paying through the nose

Last month we heard the unedifying news that pharmaceutical companies were ripping off the NHS by charging inflated prices for generic medicines. The practice was first revealed in June 2016 by The Times, but it took a further six months for the Competition and Markets Authority (CMA) to announce its decision to fine Pfizer a record £84.2m and Flynn Pharma an additional £5.2m for charging “excessive and unfair prices” for phenytoin capsules. It seems incredible that generic medicines can be priced at levels many times higher than the cost of the original branded product.

Did Christmas come early?

Just this week, NHS England published its independent review of community pharmacy clinical services that was undertaken by Richard Murray of the King’s Fund. I wish I could be encouraged by it, but I’m feeling too disheartened by the way we’ve been treated this year. On the face of it, there’s abundant good news, but I don’t see how the report’s recommendations can be implemented without significant investment. We read that renewed efforts are needed “to make the most of the existing clinical services that community pharmacy can provide and to do so at pace”. Great!

Health warning: safety margin has been cut

A dispensing error has made the news. An unconscious baby was rushed to hospital after being given an anti-psychotic drug, olanazapine, instead of omeprazole. It was a case of the right label, wrong drug. The impact of such incidents on the patient and their family is uppermost in our minds when things go wrong because we share the pain, feel the anger, experience the hurt and reflect on the sorrow made worse by the fact that we’re to blame. Saying sorry is never enough, and there are no words to embroider around that fact.

Sore throats, mixed message

The big story about pharmacy in the past week or so (yes, I know – the only story we’re really interested in is the one about the looming pharmacy cuts – about which, more later!) has been the news that NHS England has selected the sore throat scheme piloted by Boots to be one of eight to be included in this year’s NHS Innovation Accelerator programme. For this year, the criteria for selection were that projects had to focus on prevention, early intervention and management of long-term conditions, all of which are highly relevant to community pharmacy.  

Geoff Booth, professor of pharmacy practice, remembered

I was saddened to learn of the death of Geoff Booth. Geoff turned pharmacy practice into an academic discipline and was the first professor of the subject, establishing a chair at the University of Bradford. He was a member of the Council of the Pharmaceutical Society and president for two terms in the 1980s. I heard him speak on many occasions over the years but (perhaps it is my age) I can’t remember a single thing he said, except for the phrase: “The Council does not give a monkey’s”. The context in which he used those words is a matter of minor dispute. But I need to set the scene. The Council of the Society in the late 1980s was agonising over just how pharmacists should exercise their responsibilities in the supervision of dispensing.

Hats off to Wales

For some, there’s better news “We’re recognising that it’s about quality, regarding community pharmacy remuneration. The health minister for Wales, Vaughan Gething, announced that, unlike in England, funding for community pharmacy wil lnot be cut. Hurrah! Instead, pharmacists in Wales will be rewarded for improving medicines safety and for providing clinical services. That’s not to say the pharmacy contract in Wales won’t change; it almost certainly will, but clinical services will take priority over dispensing. MrGething said: "We're recognising that it's about quality, not just quantity.”

OK computer

For most of us, the realms of IT stretch to sitting down with a cuppa, cranking up the computer, deleting every third email on the basis that if it was important they’d send it again, and checking the news on an app. I am no different, although I did chair the Pan- Pharmacy Information Management and Technology Group for six years after arguing how valuable such a committee would be for the Royal Pharmaceutical Society. It’s now called the Pharmacy Digital Forum and is no less important. When we started out we were talking about IT being a luxury to help our workload. Now it’s an obligatory tool we can’t do without. Back then we were about doing more with our glorified labelling machines.

Minister a messenger?

I am attending a breakfast meeting with Simon Enright, NHS England director of communications, hosted by Luther Pendragon, a PR agency in London. I am the only community pharmacist amongst a dozen invited guests from various healthcare sectors. Simon has responsibility for communications strategy and delivery across all audiences, including NHSE’s 6,000 staff, local NHS, the professions, wider stakeholders and the public. Heleads a team of 50 people headquartered in London and Leeds as well as regional communications teams throughout England, and reports directly to NHS England’s chief executive, Simon Stevens.

Cop out from Capita

Friday September 2 I see an email from a Capita official which simultaneously acknowledges a problem and abdicates responsibility. Apparently, the regional team received a large number of queries from London contractors regarding missing payments for August but the email states: “As Capita is contracted to manage and make monthly payments on behalf of NHS England, they should be contactedat PCSE.enquiries@nhs.net, copying the London Regional team at england.lon- pharmacy@nhs.net.” The email does not make any apology nor does it mention the financial impact on contractors.

The times are a-changin'

Years ago, when I got on a train, especially if it was full of commuters, nearly everybody would be reading a newspaper. Now, those newspapers, for the most part, have been replaced by the screens of smartphones. So perhaps it is no surprise that Chemist & Druggist has decided to ditch its paper version and become on-line-only from December. Something that has been in print since 1859 will have a physical form no more. What of other publications in the field?

Presented with a fait accompli

It was gratifying to see the media coverage of the government’s cost-cutting measures for community pharmacy this past week or so. No matter that the spokeswoman from Pharmacy Voice on Radio 4’s Today programme seemed a bit nervous, the message was clear: community pharmacy is facing big cuts and pharmacies will close. Establishment payments will reduce from December, with a 12 per cent cut in the global sum from December to March, followed by a 7.4 per cent cut in 2017-18. The pharmacy minister, David Mowat, calls them ‘efficiency savings.’ They are weasel words.

Tackling resistance to antibiotics and good sense

Today is just another day, and in the pantheon of world events it’s bit of a non-starter. By the way, if it’s your birthday, forgive me. Of course it’s important! But I’m on my way to the House of Commons to deliver a speech on antimicrobial resistance, in light of the latest strategy to tackle drug-resistant germs. There will be at least 100 MPs there for flu jabs, along with civil servants and various dignitaries, and I will be outlining what a world without antibiotics would look like if we don’t develop both a national and a global strategy, and now.  

An old friend and colleague remembered

Kirit Patel was an independent community pharmacist at heart, even though he had grown his business to nearly 300 branches and achieved success in other areas. Like many, I attended the life-celebration‘party’ at his home and funeral and, like the man himself, the party was anything but sombre. Today, at the start of a new month following his passing, I find myself reflecting on personal experiences rather than his achievements that are well- documented elsewhere. My MBA was from the same university as his, inspired through discussions with him and, I believe, it has encouraged me to think more broadly. He was a gracious host and I had the pleasure of visiting his home on several occasions, as well as attending his son’s wedding in Kenya.

A state secret?

I wonder how many of us knew that NHS England has a head of community pharmacy strategy. Her name is Anne Joshua; however, in her biography I can’t find any mention of experience of working in or with community pharmacy, or even primary care. Previously, she worked for 10 years as the associate director of pharmacy leading the Health and Medicines Information Service at NHS Direct, before becoming the NHS England pharmacist lead for the NHS 111 Digital Urgent Care programme. I wouldn’t hold any of that against her, and I have no reason to believe that she did anything other than a first-class job in these roles, but ...

A shocking disciplinary case

I was shocked to read that the nurse who contracted Ebola while working to save lives in West Africa ended up before a nursing disciplinary tribunal. Pauline Cafferkey has endured great suffering as a result of being infected by the virus when helping those in great need, so to be up before the tribunal on a technicality beggars belief. It was suggested that she might have been guilty of professional misconduct by concealing a raised temperature when she got back to Heathrow airport from Sierra Leone.

A visionary alternative

It is difficult to know what the final outcome will be of the government’s plans for pharmacy. I assume that the worst case scenario is that the full £170m cut originally proposed would be implemented from December. And the best case consists of whatever the Department of Health can be persuaded to do as a result of further negotiations and campaigning. There is no doubt that the strength of representations, including over two million signatures on a petition, has not passed unnoticed by politicians and government officials.

Question time

The season of flu vaccination is upon us and I have been busy doing my online refresher training, promoting the service, getting the staff trained up, checking and signing PGDs, notifying NHS England and ‘prepping’ the PR. Last year I alone did 800 NHS and private vaccinations and, although we can vaccinate right through until March 2017, the next two months without doubt will be our busiest – so busy that I envisage we will transmogrify from a community pharmacy into a ‘co-immunity pharmacy’!

One voice?

The One Voice Pharmacy group has urged its locum members to boycott Tesco for two weeks in September after the multiple announced a cut to its hourly rate. Bizarrely, One Voice Pharmacy said that a boycott was not the same as a strike, that locums already arranged should be honoured, and that the last thing they wanted was for Tesco pharmacies to end up without pharmacists.

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