Your intention is to drive patients to a commoditised supply service, which bypasses the access to the support and advice available in their local pharmacy
PSNC is concerned that NHS England is aiming for a far larger cut to pharmacy funding in 2017/18 than the 6 per cent it has proposed for 2016/17, and has said that it will not begin negotiations on a 2016/17 deal until NHSE shares further detail of its longer term plans.
The statement came in a letter written last Friday, which is a response to NHSE's proposals and follows a series of subsequent meetings with NHSE representatives. In the letter, PSNC chief executive Sue Sharpe said: "The government appears to have a settled intention to proceed on a course of action that will run counter to its stated ambition to develop a clinically focussed pharmacy service, and be damaging to patient care. It will miss the opportunity to develop the community pharmacy offer through well-evidenced service developments we have put forward, that will bring real value and cost-effectiveness to the NHS and support integrated working in primary care. We will not accept this."
During one meeting, NHSE admitted that it had published its proposals to make clear that the £170m funding cut for 2016/17 would not change. Figures for subsequent years were not forthcoming, which meant that PSNC felt "deprived of information essential for ... a proper consultation". Mrs Sharpe went on to say that: "We fear you aim for a cut far larger than the 6 per cent stated in the letter, in 2017/18"
NHSE's professed ambition to develop a more clinically focused community pharmacy service was entirely incompatible with the £170m funding cut, which was likely to simply result in reduced staffing levels. And at the meetings NHSE confirmed it had no plans to consider further service development in 2016/17.
NHSE had failed to elaborate on proposals for cutting pharmacy numbers, nor its rationale for them, although it suggested that its Pharmacy Access Scheme would apply to “many hundreds of pharmacies”. No evaluation of the care provided by a pharmacy should be based on such a crude measure as dispensing volume, said Mrs Sharpe. But there had been nothing to suggest that NHSE had examined the levels of advice or other elements of the pharmacy service provided by these pharmacies.
"It seems clear that you are proposing to drive ahead to radically change the market with a real paucity of knowledge essential for good decision making. We do not oppose in principle any reshaping of the market, and we know that the consequence of the ill-advised introduction of partial deregulation in 2005 led to a substantial increase in pharmacy numbers. However we still have fewer pharmacies per capita than most countries in Europe."
PSNC did not oppose further development of online pharmacy, and as soon as general practice was able to make online prescription ordering convenient for large numbers of patients it promised to support and enable pharmacies to offer this service. "We suspect however that this is not your aim, and that your intention is to drive patients to a commoditised supply service, which bypasses the access to the support and advice available in their local pharmacy, thus further reducing the viability of anything resembling the current network."
The proposed Pharmacy Integration Fund would be just £20m in 2016/17, although NHSE expected it to grow in future years. But this would not be specifically for community pharmacy and, given the current drive to develop the role of pharmacists working in general practice, PSNC expected that it would overwhelmingly be directed towards increasing opportunities for those other than community pharmacies.
Mrs Sharpe warned of the impact of the proposal to increase prescription duration, expressed in the letter as “steps to encourage the optimisation of prescription duration" on an increasingly fragile supply chain and the consequent risk of pharmacies being unable to supply prescribed medicines.
"We believe this is a very damaging consequence of this limb of your policy. Our belief is that the policy has been driven only by an ill-considered push to cut costs, coupled with ignorance about the damage and consequences that follow." Mrs Sharpe suggested this could increase medicines waste, rather than decreasing it, as NHSE suggested.
PSNC will host a meeting of LPCs on January 20 to discuss its response to the government plans and consultation and is also working collaboratively with the other national pharmacy organisations.