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New year, new decade, familiar concerns

Although this is supposed to be a time of optimism and renewal, I am wary about what 2020 might bring, writes Patrick Grice...

 

 

There is every sign that community pharmacy in 2020 will see change on a similar scale to last year. Some things might be specific to England, others could affect all the home nations.

There could be changes to the regulations around hub-and-spoke dispensing. There could be changes to regulations around supervision – the DHSC has been tiptoeing around this one for long enough.

There will be more pharmacy closures as multiples continue with store rationalisation programmes.

Pharmacy First – a new common clinical conditions service – starts in April in Scotland, although some of the building block are already in place.

It is viewed by Community Pharmacy Scotland as a step change, making use of independent prescribers and properly involving community pharmacies in the management of long term conditions.

While community pharmacy in Scotland and Wales clearly has strong political support, the absence of political oversight in Northern Ireland makes business day-to-day a challenge and forward planning difficult. The priority, says the CPNI, is to stabilise the network – sort out sensible funding and ease the recruitment crisis.

There will be the continued pain and the evolution of the five year CPCF deal for contractors in England. But on a positive note there might be new service developments around urgent treatment, palliative care and point-of-care testing.

It may be that Mr Hancock really will ‘unleash the potential’ of community pharmacies if the fledgling CPCS delivers real benefits. It would be a welcome change to see something more than hot air from our politicians.

And who knows where the review into PSNC and LPC representation and support will go? The purpose of the review is to produce recommendations which will “optimise PSNC and LPC contractor representation and support.”

Professor David Wright is felt by many to be an unusual choice to lead the review, but as a knowledgeable outsider he should be as objective as anyone.

PSNC has long felt it is under-resourced to properly support contractors, yet a proposal to increase the LPC levy which funds the organisation was rejected last year.

LPCs vary wildly in their finances and effectiveness and, given the changing face of NHS primary care, some have questioned whether they can properly provide the local support and leadership contractors need.

Getting the right structures in place locally will be a vital part – from a pharmacy perspective – of making primary care networks function to best effect. PCN integration will be one of 2020’s most awkward challenges. The Wright report should be completed by the end of March.

Although it will not impinge much on the day-to-day activities of your average community pharmacist, my bet is that the education and training of pharmacists will see more change than most other areas of practice in 2020, although the impact may take years to show.

More than a quarter of pharmacy graduates who took the pre-reg exam in summer 2019 failed – the highest number since 2011. Over 800 students who had graduated with an MPharm were deemed to be unfit to practice.

That is a pretty scary figure. Rather closer to home, the pass rate among community pharmacy pre-reg graduates was a poor 63 per cent compared to 93 per cent from the hospital sector.

Brighton, Wolverhampton and Central Lancashire were bottom of the league table for pre-reg exam passes in 2019.

But whether it is the quality of intake and teaching at schools of pharmacy that is to blame for the poor results, or how the pre-reg year is managed, is a moot point. If the standards have remained the same, then it is hard for the schools of pharmacy to be seen as blameless.

Meanwhile pharmacy across the UK is moving to become a five year integrated course. The GPhC’s proposals to integrate the standards for the MPharm and preregistration year so that the preregistration year will be replaced by 52 weeks of work placements — known as “learning in practice” — embedded within the undergraduate programme are planned for September 2020.

Scotland is also introducing a five year degree from this year, with the pre-registration element nationally funded by Scottish Government and managed by NHS Education for Scotland. In Wales the NHS is ‘taking over’ the pre-reg year.

Pharmacy graduates will have four month placements in hospital, community and primary care, and be regarded as NHS employees with a £25,000 salary.

The proposal from the CCA dominated pharmacist apprenticeship development group is currently being paused, but it won’t be for long.

The PDA and the Guild of Hospital Pharmacists may have legitimate worries about the motivation behind the proposal, but this second attempt to get a pharmacy apprenticeship off the ground through Skills for Health suggests it might be better focussed than the first. It is the make-up of the employers’ group that is more of a concern: it is a long time since pharmacy multiples acted in the interests of the profession rather than themselves.

And while we are talking about workforce, a cautionary note from Alison Leary, professor of healthcare modelling at South Bank University.

Writing in The Independent before Christmas, she argued that the NHS staffing crisis is about expanding the knowledge gap – not just the numbers. Her words (paraphrased) can equally well apply to the pharmacy workforce.

“When we talk about workforce, the focus is always on numbers. There are campaigns for safe staffing ratios and government ministers like to tell us how many more nurses we have” she wrote. “But safety is not just about numbers. Recent workforce policy decisions have promoted a more-hands-for-less-money approach to staffing in healthcare. More lower-paid workers mean something in the equation has to give. In this case, it’s skill and expertise. Healthcare has failed to keep frontline expertise in clinical areas due to archaic attitudes to the value of the experienced workforce.

“I am often told by nurses that to be promoted, they have to go into management – but their skills and experience remains unrewarded. This is very different to other safety critical industries where such skill is more readily remunerated and staying at the frontline more readily accepted. We need to fill the vacancies, but we also need to fill the ever-widening skills gap that has emerged.”

Pharmacy has plenty of skills gaps. Some have arisen from an expansion of new roles, such as GP pharmacists.

The PDA has issued several warnings about the risks of pharmacists acting beyond their competence in this area of practice. Others will arise as new services evolve.

If you are going to make a New Year resolution, perhaps it should be to your own little bit to fill your own particular skills gap?

 

 

Patrick Grice is the contributing editor of Independent Community Pharmacist.

Picture: hernantron (iStock)

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