LPC chairman and NPA board member Dilip Joshi hopes that a fundamental review of pharmacy’s contractual framework happens sooner rather than later, and finds that perseverance pays off.

Friday - December 1

Community pharmacy is as close to crisis point as I have known in my time as a pharmacy contractor. We know the funding cuts have been brutal, but shortages and fluctuating prices now make it uncertain whether buying costs will be reimbursed, which is not only demoralising but unfair. Instead of caring for patients, much of a community pharmacist’s time is spent trying to obtain everyday medicines in short supply at Drug Tariff prices.

PSNC has always been aware that some medicines cost more than the reimbursement price, and although it is wrong to have to supply them at a loss, this situation was never as widespread as it is today. Over 150 lines, including commonly dispensed items, are not obtainable at Tariff prices, meaning there’s uncertainty about the viability of dispensing activity, especially for smaller businesses.

We have had reports of contractors
feeling suicidal, and many have contacted the NPA to ask if they would be in breach of their terms of service by refusing to supply medicines at a loss. A few have stated they can no longer continue and are considering closing their pharmacies. Some local pharmacists are frustrated at not being able to provide the best care for patients due to the distraction of meeting regulatory requirements and trying to source medicines.

Sadly, patients suffer, and often don’t understand the complexity of the supply chain and reasons why pharmacies are struggling to obtain medicines. I hope the pharmacy contractual framework undergoes a fundamental review soon, as this situation cannot continue.

Monday - December 4

I am at a Diabetes Health Innovation Network meeting today. We discuss how patients can be better involved in self-managing the impact of diabetes on their lives. Three strands of support are put forward: increasing access to technologies; structured education and related support; and most importantly, improved integration of care across the health system.

There is a debate on how to achieve cost- effective delivery through better awareness, and delaying the onset of complications to improve quality of lives. Community pharmacy has a role to play in all aspects of long-term disease management, but also with modifying behaviours through health promotion messages, and early identification of diabetes through screening high-risk people (according to Diabetes UK estimates, there are half a million unidentified diabetics in the UK).

As the meeting concludes, there is an inevitable reference to cost: a manager privately tells me that commissioners do not have resources to deal with newly-identified diabetics this financial year!

Thursday - December 7

The LPC meeting this evening is followed by our Christmas Dinner. The discussions continue lightheartedly as our partners join us, and for the rest of the evening we try to put the trials and tribulations of our profession to one side. In my address, I reflect that this will be the last Christmas with the present committee in post, and pay tribute to the personal sacrifices of the committee members and partners, who have kept going in the face of a challenging four years. 

Volunteers on Christmas Day 2017 at the Ace of Clubs (yours truely on the left)

Thursday - December 21

A shoplifter known to us had been identified from CCTV recorded in August. We had initially contacted her to give her an opportunity to pay the £10 that the item cost. She did not deny taking it, but told us to report it, as the police would not do anything for an item of such little value. To my dismay, she was right! I was told that items below £50 are considered to be of low importance and a policy decision had been made not to expend police time, unless the offender was habitual. I was unwilling to let the matter rest, and questioned the wisdom of a policy whereby theft below an arbitrary amount could be committed with impunity. I escalated the matter to the Metropolitan Police Internet Platform, suggesting the quality of evidence should be considered. I had a visit from the investigating officer the next day who subsequently issued a police caution to the shoplifter. Today, I had a phone call from her offering to pay the £10 plus expenses. I settled for the £10 plus a donation to a local charity. This is an important lesson for colleagues who experience similar frustration: if there is good evidence, it is worth pursuing the matter, sending a clear message to other potential perpetrators.

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