Community pharmacy needs to make the case that it can make savings  

NHS economies signal tough times for pharmacy, so it needs to show that it’s good value for money and delivers genuine health improvements, says Pharmacy Voice chair Claire Ward

David Bennett, the chief executive of Monitor, recently wrote to foundation trust hospitals to remind them of the need to review spending and to find new ways of saving money in the NHS. He put it rather succinctly when he said that current financial plans for the NHS are ‘quite simply unaffordable’. Whilst reminding trusts not to fill vacancies unnecessarily, he was clear that this alone would not solve the massive black hole facing the NHS.

The letter also reminded trusts that this is the precursor to a report to be published by Lord Carter that will recommend ways in which hospitals can be more efficient and spend less money. There are many foundation trusts with big deficits – in fact the hospital sector debt is rising rapidly.

£22 billion is a big sum for the NHS to save over the next few years. What this does not take into account is the fact that saving this amount of money simply allows the NHS to stand still. It does not take account of increasing populations, the greater needs of an ageing population, or indeed the desire for new and sometimes expensive treatments and drugs.

So where does this affect community pharmacy? Obviously as the purse strings get tighter, negotiations for a fair deal for contractors will be harder. This is particularly difficult when negotiations on new services take place. Both NHS England and the government want to see more done for less money.

Filling in the gaps

The best outcome for pharmacy is to show that not only is it good value for money, but more importantly it delivers real patient health improvements whilst filling in the gaps in other primary care services. We all know that the shrinking number of GPs will continue to place pressures on primary and urgent care. The question is how can pharmacy support patients and be part of the primary care service, whilst continuing to recognise the necessity for it to make a profit as a private business?

In this environment, where a greater role for pharmacy is essential and yet funding is increasingly limited, we have to start thinking ahead to where the focus of attention for the government and NHS England will fall next.

When Lord Carter has finished his forensic investigation into spending in the acute sector, he may well be directed towards other parts of the NHS. It should be no surprise if pharmacy were to be an area of focus in the future. On that basis, as a sector we should consider now how we might respond rather than pretending that the questions will not be asked.

We all know that there are areas, particularly in drug supply, where more cost effective processes and supplies could take place. At the moment there is no incentive for pharmacy to cooperate. Why would any contractor proactively try to reduce some of the NHS costs when they believe they have been underpaid in other areas of service? But that will not be a sufficient answer for the likes of Lord Carter.

The case for pharmacy

Community pharmacy needs to make the case that it can make savings. This should be on a shared investment basis, with a significant proportion of the savings being returned to pharmacy for additional services. For the NHS it would be better to save half the money than none at all. Even better if it can do so in partnership and have an improved pharmacy and primary care services to boot.

The recently negotiated flu vaccination service is full of potential benefit for both patients and pharmacists. But how much better would it have been for patients if they had access to a national minor ailment service? How much more valuable would pharmacy become to patients if it was the place where such a service was delivered? It was both disappointing and shortsighted that an agreement was not reached on this.

Perhaps if Lord Carter looks at spending and saving in pharmacy he will understand that there is far more to be gained through investment in community pharmacy and, on that basis, pharmacy can assist by offering some areas where waste can be eradicated and efficiency improved.