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NHS under threat from ‘more for less’

Lambeth, Southwark and Lewisham LPC chair Dilip Joshi wonders whether the quest for efficiency savings will kill off the NHS

Thursday April 7

Jeremy Hunt is in trouble. “This is his IDS moment”, says Chris Ham of the King’s Fund in a Guardian Online article today. “Hunt now faces unpalatable choices about the direction of health policy, akin to the dilemmas that led Iain Duncan Smith to resign as Work and Pensions Secretary. Just as Duncan Smith felt his mission to reform welfare was undermined by budget cuts, so Hunt’s ambition to improve quality of care is at risk from financial constraints.”

It is becoming increasingly recognised (I suspect, by policy-makers, too) that improvements in care cannot be delivered with reduction in resources; and the incessant march towards the £22bn in productivity improvements by 2020/21, based on NHS CEO Simon Stevens’s Five Year Forward View, is widely believed to be unachievable.

What then is the ‘big idea’? If the NHS in its present form is unsustainable, are we storing up much bigger problems for the future? Public support for community pharmacies is as high as ever, as seen by signed petitions approaching one million, but the government’s position has not changed. Are well-meaning politicians ill advised by civil servants or is there a grand pharmacist and owner plan that puts the NHS on a path that will make it unrecognisable and irrecoverable? Is it cock-up or conspiracy?

Monday April 11

Maddock Pharmacy in Southwark is hosting a visit by Councillor Maisie Anderson today and I am delighted to be invited. Visiting local pharmacies in my area is definitely one of my more pleasant duties and this forward-thinking pharmacy is a shining example of modernity. They have excellent relations with their local surgery; in fact, a room in the surgery is made available for our discussions. I see staff enjoying their work and, from patients’ reaction, it is clear that these well-trained and highly motivated individuals are valued as a team.

Such visits are being organised for MPs and councillors throughout the country and I believe that, however many signatures we collect, they are no substitute for seeing pharmacies at first-hand. Maisie knows little about community pharmacy but is very interested and surprised at the range of services offered.

She also listens attentively to examples of interventions that help the most vulnerable and promises support for our campaign and to raise pharmacy’s profile with fellow councillors and MPs.

MADDOCK PHARMACY VISIT: (left to right), yours truly, Kavita Shah, support pharmacist, Alain Kwizera, trainee dispenser, Gladys Asafo-Adjei, ACT, Councillor Maisie Anderson, Isaac Adeniyi, pharmacist, Vandana Patel, superintendent pharmacist and owner

Thursday April 14

At Pharmacy London meetings today, we are informed that a national provider company – Community Provider Support Services Ltd (CPSS) – has been set up with the involvement of AIMp, CCA, NPA and PSNC, with a board of directors from PSNC and the NPA. The company will advise and support LPCs and pharmacy contractors in negotiations with commissioners.

This is long overdue, and, at London, Southwark and Lewisham LPC, we will be amongst the first to work with this company. Our provider company now also has a name: Community First Services Ltd. We have deliberately chosen a name that allows engagement with a range of health and social care services without being tied down to specific areas of activities.

We learn that LPCs have had issues due to new arrangements with Capita, which took on responsibility for the delivery of NHS England’s primary care support services. We have had reports on problems with stationery supplies and contract matters. The new name for the service is Primary Care Support England (PCSE). By some ingenious logic, we learn, the London office will be moved to Leeds or Preston by July.

Monday April 18

Pharma companies are increasingly interested in our provider company. Today, we meet senior managers from AstraZeneca who have agreed to support a pan-London education programme for pharmacists on asthma, diabetes, cardiovascular disease and COPD.

They speak of “non-promotional support”. However, they are keen to explore “commercial opportunities” with our company. It remains to be seen what these might be, but I know the LPC will need to be at arm’s length and ensure proper governance and transparency.

Monday April 25

At NPA meetings, which start today, we receive a report on the work of the Rebalancing Board
established by the Department of Health to consider changes to the application of law and professional regulation. It seems, at long last, a Section 60 order providing defences for pharmacists and staff against criminal charges for dispensing errors will be passed by Westminster and Holyrood by this autumn. Supervision, on the other hand is more contentious, as it is linked to responsible pharmacist regulations.

There may be agreement allowing dispensed and checked medicines to be handed out when no further intervention is required but more complex scenarios involve consideration of staff competencies and patient safety. A subgroup has been formed to consider details but I wonder how enabling legislation proposed for later this year around hub-and-spoke models will impact on these deliberations and patient safety.




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