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‘Powerless’ ICB tied itself up in knots over Pharmacy First, says LPC chief


‘Powerless’ ICB tied itself up in knots over Pharmacy First, says LPC chief

By Neil Trainis

Exclusive: Community Pharmacy Nottinghamshire chief officer Nick Hunter has spoken in detail about the demise of the local pharmacy first scheme which ended in March after 20 years, insisting Nottingham and Nottinghamshire Integrated Care Board failed to decide whether to keep the service going having “tied themselves up in knots.”

In an interview with Independent Community Pharmacist, to be published in next month’s edition, Hunter (pictured) said he and his colleagues at CPN campaigned to get the service recommissioned, lobbying MPs, local councillors and Healthwatch, a committee of the Care Quality Commission. The service was decommissioned on March 31.

Hunter said his LPC secured the support of a GP who was on the local clinical commissioning group and now sits on Nottingham and Nottinghamshire ICB as well as its chief pharmacist’s medicines optimisation team.

However, Hunter said the ICB was unable to make a decision on recommissioning the service and claimed its directors “were not that interested” in reviewing it because they were preoccupied with other issues, such as ambulances with patients queuing outside hospitals.

“We couldn’t get a decision in the ICB about ‘where does (the pharmacy first service) need to go?’ We had an options paper for proposals on it, and wanted the ICB to make a decision so we could then take it to the next stage. But the ICB couldn’t make a decision,” said Hunter, who described Nottingham and Nottinghamshire ICB as “powerless.”

“It needed to decide what committee it needed to go to in order to make a decision to keep the scheme going. It was decommissioned by default because they couldn’t make a decision about re-commissioning it. This was Nottinghamshire ICB.

“It’s dreadful really. We shouted and ranted and cajoled and did whatever we could. We spoke to some MPs about it, we spoke to local councillors and wellbeing boards, Healthwatch, and so on, and we had a huge amount of support for keeping something.”

Hunter insisted the cost of running the pharmacy first service was not significant – “the spend on that service struggled to meet six figures over the course of the year” – but his LPC was unable to get clear answers from the ICB as to why it was not being recommissioned.

“We were trying to get the context of why the directors in that ICB were not that interested in getting the minor ailments scheme being reviewed and recommissioned because they were being perplexed by ambulance queues,” he said.

“The BBC were beating them up. Rob Sissons (a reporter at BBC East Midlands) was outside Nottingham University Hospitals Trust saying ‘how bad is this? Look at this queue of 25 ambulances tonight.’”

Hunter added: “The ICB didn’t have the capacity to make a decision of what the pathway to make a decision was. That’s how crazy it was.”


Situation got almost comical

When asked if he felt the ICB ignored his LPC’s pleas to keep the service going, he said: “Yes. It was almost comical because the medical director was on BBC East Midlands Today on the Thursday before Good Friday telling the wider public to go their community pharmacy over the four-day Bank Holiday weekend for any minor ailments.

“But they had decommissioned that service three days beforehand. It was almost laughable.”

Nottingham and Nottinghamshire ICB has been contacted for comment.

Insisting he was not blaming any individual, Hunter said: “It’s like the holes in the cheese. Circumstances conspired against everybody. Nobody in the NHS, either a healthcare worker or a commissioner, gets up in the morning and thinks ‘I’m going to make life difficult for so and so or for such and such a profession.’ It’s a complicated machine, the NHS. It sometimes gets the better of us.”

On the government’s pledge this year to inject £654 million in fresh funding over the next two years to partly fund a national pharmacy first scheme in England, Hunter said: “The devil will be in the detail of what it actually commissions. I’m a little bit concerned that the £645 million, which sounds like a lot of money and it is a huge sum of money, has got to fund a lot stuff.

“As well as the common conditions service, on top of that, it’s got to fund the IT to support that. It’s also got to fund extra activity in the contraception service and extra activity in the BP service.

“So, how does that £645 million get sliced up? And how much money does the NHS waste on talking about IT again rather than just cracking on with something? The lack of a joined-up IT system has held so much stuff back.”



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