Never mind the quality, feel the pain
After the difficult transition to the quality payments scheme, Mukesh Lad asks what happens next?
The Quality Payments Scheme (QPS) has created a level of stress that has never before been seen among community pharmacy owners.
The sprint to cross the finish line at the second review point has left many people exhausted. Iâ€™m not referring to the actual fulfilling of the criteria but moreover the constant challenges posed by NHS information technology and digital portals that simply havenâ€™t been fit for purpose in allowing us to create, amend, review and validate the information required of us.
Among the 50+ independent pharmacies with which Iâ€™m in contact on a regular basis, almost everyone has had their claim challenged by NHS Business Services Authority with regard to completion of the process. Many contractors are affected by missing pharmacy profiles on the NHS 111 Directory of Services and the profiles for NUMSAS (NHS Urgent Medicine Supply Advanced Service) to which weâ€™ve all signed up are, in most cases, non-existent.
The entire way in which the management of the QPS has been handled, has been anything other than â€˜fit for purposeâ€™. Furthermore, it begs the question of how much precious funding has been devolvedÂ to such an inefficient process and, for that matter, to NHS online platforms such as NHS Choices that has quite obviously been unable to handle the volume of traffic. This was evident from the number of times the system was â€˜experiencing technical difficultiesâ€™ on the most critical days when contractors needed to login and meet deadlines. The changes to criteria specifications throughout the process and the need to constantly request clarification, has led us down a path of unnecessary additional bureaucracy and time wasting that has created unprecedented anxiety and which should have been all together avoidable.
And the timing of it all couldnâ€™t have been any worse. The impact of the funding cuts, category M changes and stock shortages all happening at the same time as QPS, has brought several contractors to the brink of breakdown. For many, itâ€™s been the tipping point to selling their much-loved livelihood.
What I cannot fathom is why the PSNC allowed this to happen. Why couldnâ€™t there have been better planning and preparation? The criteria specifications should not only have been agreed, but also planned and announced with more lead-time. While I fully support the need for improved quality and standards across service delivery inÂ our profession, the ramifications of the individual criteria extended far beyond the immediate capabilities of many pharmacies. Take Healthy Living Pharmacy (HLP), an excellent framework and most definitelyÂ a step in the right direction for the futureÂ of pharmacy. It will allow us to add value
to the services we provide in addition to dispensing. But itâ€™s also a complete change of clinical and business culture and not just a tick-box exercise.
Eager for HLP
Yet despite all the challenges, pharmacy owners and their teams are still eager to meet the requirements to achieve HLP status. This was evident at a recent training event I chaired in my home constituency of Leicestershire and Rutland.
Every LIPCO Independent Pharmacy Federation member attended complete with pharmacy teams. Some 100 healthcare professionals were willingÂ and able to engage, out of hours and in their own time, with HLP Lead, Deborah Evans in order to embrace a new way supporting their local communities. AndÂ in so doing, their pharmacy will not only continue to supply medicines but also help local residents access greater healthcare information and more services that will make a real difference to the health and wellbeing of the population.
Of course, any one of us is alreadyÂ willing and regularly does go the extraÂ mile to support patients. Only recently a Leicestershire contractor put out an urgent call among local colleagues for a desperately needed vaccine for a sick young child. ItÂ was actually the GPâ€™s surgery that had run out of stock and had turned to community pharmacy with a plea for help. Regardless of the barrage of negative publicity run by local GPs against pharmacy throughout this yearâ€™s flu season, the pharmacies rallied to source and deliver the vaccine within 24 hours. This is exactly the type of professional feel-good factor that is consistently overlooked by
our commissioners. Even our representative bodies, who are supposed to be negotiating in our favour, donâ€™t appreciate the dynamics or challenges of retail pharmacy business when they fail to prevent the imposition of administrative processes that are, in practice, difficult to implement with short lead times.
Lessons from the past are still not being heeded by those with the authority to make a difference to the process of pharmacy commissioning. When introducing new services â€“ whether itâ€™s the MUR or NMSÂ or regulatory requirements such as the quality payment scheme â€“ there has toÂ be a realistic framework with detailed specifications in place at the outset.
The QPS is an exciting opportunity for the Government and us. So far, independents have declared their enthusiasm for a new model of healthcare but it will also need consistency and commitment from the Department of Health to continue whatÂ it has started. It will also need adequate resources to ensure we can continue to build on the quality and improvements that weâ€™ve started to deliver in 2017. And perhaps, most importantly, a little recognition for the unsung hero that is community pharmacy, which is truly struggling to meet each and every criterion in addition to serving the public any time of day.