Dealing with the problems of outsourcing primary care support services to Capita is one of the issues considered by LPC chairman Dilip Joshi during July

Tuesday July 5

I am at a Southwark commissioners’ meeting this evening. It has been called by members of the local GP federation. They wish to learn more about our LPC’s service-provider model with a view to working for mutual benefit. There are suggestions of operating through Local Care Networks in the presentations.

GP federations have been funded to assist with their set up, whereas our provider company has not. A key difference is that GPs seem to have used their funds to create various remunerated positions and are looking to make them sustainable through additional funding of commissioned services. We have, on the other hand, started a low-cost model without extensive infrastructure or office facilities, opting instead to pay for administration costs through top-slicing monies received for services. This, to me, seems to be a more efficient model than PCT-like administrations with associated costs and red tape.

Saturday July 9

Ace of Clubs’ 21st birthday celebrations are taking place this afternoon in the grounds of St Mary’s Redemptorist Monastery in Clapham. The charity’s focus, over the years, has changed from supplying food to the homeless and disadvantaged – which is still done all-year-round – to include rehabilitation. Users have access to a computer room, mock interviews for job seekers and a bicycle club that not only encourages cycling for fitness but runs maintenance workshops providing training to City & Guilds standards.

Many are able to obtain jobs and become reintegrated into society. Money-raising stands at the celebrations supply food and show local arts and crafts. We hear supportive speeches from Lambeth’s deputy mayor and local MP Chuka Umunna. Chuka visits our stand (providing photographic portraits) and has his photo taken. I thank him for his support and speak to him about the role community pharmacy plays, both formally and informally, to help disadvantaged members of our community.

Wednesday July 13

This evening’s LPC meeting is sponsored by a specials manufacturer that produces licensed liquid products at (according to them) reasonable prices, thus avoiding the need to use more expensive or unlicensed alternatives, or the need to open capsules or crush tablets. We are conscious of unwanted effects, resulting in possible litigation, if a pharmacist suggests taking a medicine in a way not covered by its product licence. We resolve to send a reminder to our contractors.

Our guest is from South London Cares, a community network of young professionals and older neighbours ‘hanging out’ with one another (as stated on their website). This involves making contact with an older neighbour and sharing time in one-to-one activities, as well as offering practical help and human companionship. The network want to use community pharmacies as centres for their messages and we readily agree to support them.

Thursday July 21

Regular readers will recall my concerns about NHS England outsourcing primary care support services to Capita, which won a £1bn contract last year for a seven to 10-year period. Months of failures that go beyond ‘teething’ troubles have led the General Practitioners’ Committee to pass a motion of no confidence and claim patients are at risk. A catalogue of failures include patient notes going missing, and supply, delivery and payment problems.

This has led the Information Commissioner’s Office to enquire about information governance breaches. Pharmacy is not immune to Capita’s shortcomings. The PSNC has raised concerns and sought remedial action, asking NHS England to postpone plans for Capita to take on further work involving community pharmacy.
And it has also demanded that losses incurred by pharmacies relating to Capita’s management of market-entry provisions be dealt with speedily and fairly by NHS England. Is this just one example where cost-cutting in the interest of maximising profit could damage healthcare? What if this is translated into outsourcing healthcare and not just administration?

Wednesday July 27

I attend a Lambeth Borough Prescribing Committee meeting and hear about a change to yellow slips (instead of books) for patients on anticoagulants to record their INRs. When I receive this news with less excitement than the CCG pharmacists think it deserves, I am told this has been running for more than 10 years outside London. This relatively low-level decision is passed but I reflect on the constant tinkering in such matters and have a concern about patients losing slips or bringing old ones to clinics.

This will not be universally adopted; some trusts will continue with books. I wonder how many NHS decisions not considered important enough to challenge lead to inconsistencies. Next, a manager tables a preferred list of incontinence products, promising £130k of savings. Worryingly, there is also a preferred list of suppliers.

We learn that the manager had previously worked for one of the companies excluded from the list. This looks like a case of decision by personal experience, rather than robust selection process.

Next, we consider Greenwich CCG’s position statement on prescribing medicines that are available to purchase OTC. The CCG is asking GPs to encourage patients to purchase OTC medicines rather than prescribe them. An example of 25p instead of £1.50 for OTC purchase of paracetamol tablets is quoted. I suggest our minor ailments scheme is the best compromise for access to effective medicines from a regulated formulary.