LPC chairman Dilip Joshi begins his month with a prescribing committee meeting where he is surprised to learn of the level of rebates CCGs get from pharmaceutical companies whose products are well prescribed

Thursday, March 3
I attend a Lambeth Borough Prescribing committee meeting where pharma company rebate opportunities is a key item for discussion. A legal opinion is included in the papers suggesting CCGs are able to take rebates as incentives. Company names and percentages are mentioned but commercial sensitivity, we are told, restricts wider reporting. I am surprised to see numbers ranging from 10-35 per cent and shocked to see higher incentives for reaching manufacturer-set targets.

Apart from the moral issue around encouraging prescribers to specify incentivised brands and the argument that dispensing remuneration will be unchanged, community pharmacies will be affected if the precedent set here becomes widespread. The previous drive towards generics will be undermined and pharma companies will have less budget to support other activities. The position of accepting rebates is justified by CCG pharmacists who say they are not asking prescribers to change what they do but collect the rebate anyway. Cash is king!

Monday, March 7
Jayesh Patel (Lambeth, Southwark and Lewisham LPC CEO) and I are meeting two potential recruits likely to shape contractor provision of public health and other commissioned services through our provider company. First, we meet a service manager currently working with a CCG to consider appointment as a service coordinator. This role involves working across the three boroughs we represent. (We are looking for one team to perform all administrative functions.) Our next meeting is to consider a prospective CEO for the provider company.

The LPC will coordinate and facilitate the setting up of the company but needs to be at arm’s length after that. We have identified a good candidate; however, our dilemma is how to recruit good people without a large budget. Our model will fund administrative costs through top-slicing service funding received before paying contractors. This avoids having to raise large start-up costs from our contractors. We agree low-level basic pay with increases based on services procured. This should incentivise the CEO to work hard on behalf of contractors.

Friday, March 11
Today, we get some good news about the Community Pharmacy Assurance Framework (CPAF), which is monitored by NHS England. Historically, a small sample of contractors, usually those who had not demonstrated compliance or, in some cases, not completed the original return, were selected for monitoring. Sadly, due to inadequate understanding of requirements, a manager randomly selected a number of pharmacies to carry out a full resubmission, most of whom had made returns declaring compliance, whereas those who had not made returns remained untargeted.

Through Pharmacy London and with PSNC support, we refused to accept this and today we get an NHSE climb-down. The response states the original list of pharmacies chosen for a monitoring has been withdrawn and a revised list of non-compliant pharmacies substituted. This moves back to the national guidance. A very satisfactory outcome indeed.

Thursday, March 17
Today we have an LPC/stakeholder meeting supported by a number of pharma companies to which commissioners from Lambeth, Southwark and Lewisham, as well as an NHS England representative are invited. The LPC has always worked well with pharma, with a clear understanding of boundaries. We allow them to share coffee with commissioners and sit in on my scene-setting presentation about our vision for service provision in pharmacy, only asking them to leave prior to commissioner presentations and table discussions

 So they get value for their support as well as getting an indication of how we go about LPC-commissioner engagement. They are clearly impressed that we have a close relationship with so many decision-makers. Commissioners appear to be interested in our provider company model, which includes geographical distribution, training, data collection, monitoring and evaluation. Our next step is to persuade them to release pump-priming funds to help set up the company. Soundings are encouraging.

Friday, March 18
I see a presentation from a company engaged to link apprentices to employers under a government scheme. The apprentices would get the new Living Wage and there would be day-release to attend college. I am undecided whether small independents could benefit from the scheme. Those taking on apprentices should be aware that the positive contribution of helping young people to acquire skills needs balancing against maturity, reliability, productivity and prospects of retention once trained.

Thursday, March 24
I have not left my information governance submission to the last minute through choice but due to problems in connecting to the website. I raised this issue with the helpdesk towards the end of last year but was asked to take it up with my IT department. I explained that I was the IT department; it was clear that the helpdesk had no idea of how small community pharmacies worked.

After much toing and froing, and various attempts to complete my submission, I received an email recognising that there was a problem and saying that it was being investigated by the ‘hosting and infrastructure’ team. A problem had been found within the BT network, and their computer people were working to fix it. I got lucky today and managed to both access and complete my submission before the deadline.