LPC chairman and NPA board member Dilip Joshi welcomes government moves to introduce organ donation opt-out and reflects on how a concept of essential medicines could work in the UK.

Tuesday: October 3

At an NPA senior management meeting we discuss essential support for members. The NPA has been at the forefront of campaigning against pharmacy cuts and although cuts went ahead, there is significant public sympathy and a raised profile for the profession. We consider how best to deliver practical support that goes beyond campaigning and focuses on the day-to-day needs of those of us at the coalface. The challenges of increased regulation, electronic prescription management, quality payment requirements that appear to be process-driven – as well as the unscrupulous practises of internet pharmacies – are all distractions from patient care. Additionally, cuts through central budget-reduction and decommissioning of local services have left a demotivated workforce. We agree to strengthen representations against misleading activities from online companies and provide support to meet regulatory requirements and resources for quality payments.

Wednesday: October 4

Prime Minister Theresa May endorses organ donation opt-out by announcing: “shifting the balance of presumption in favour of organ donations in England,” saying it will give more patients a realistic chance of receiving a transplant. Of course, this is a sensitive area where religious and cultural beliefs can be barriers. In addition, it is particularly difficult to ask grieving family members for consent. Yet, there are 6,500 on the transplant list today and 500 people died last year because a suitable donor organ was not available. According to Kidney Research UK, more than 90% of the organ transplant waiting list is for
kidneys and five people die every week waiting for a kidney transplant they cannot get. Community pharmacists are ideally placed to raise awareness and remind people to talk to their families about their wishes and engage in conversations to consider supporting a change in legislation. Under new arrangements, those with firm beliefs will still have an opportunity to opt out. In Wales, following several years of campaigning, legislation changed in 2015. Many will be aware that this was led by community pharmacist, Raj Aggarwal, as chairman of Kidney Wales Foundation, a personal friend and fellow NPA board member, from Central Pharmacy in Cardiff.

Monday, Tuesday: October 16 & 17

At NPA meetings, we discuss GPhC’s consultation on the proposal not to continue carrying out accreditation on training courses for support staff. Instead, the pharmacy owner would be accountable for ensuring competence of their support staff. On the one hand this suggests a degree of flexibility, but on the other, there is more likely to be variability in quality and equally as important, pharmacy owners will have additional responsibility to justify choice of courses and training for staff to the regulator. A regulator-approved course such as offered by the NPA has to be the lesser burden for pharmacy owners and we resolve to respond accordingly.

Tuesday: October 17

The LPC AGM is as usual well attended. NPA chief pharmacist, Leyla Hannbeck makes a presentation on Quality Payments (QP) support for members and there is good interaction with attendees. There are questions on the next iteration of QP but so far, there has not been an announcement from the Department of Health. It is pleasing to see the level of engagement from our contractors on QP, with the vast majority having completed their claims for the first period. There is a suspicion in the room that QP will continue to be used to increase workload in pharmacies without fair recompense – as is already the case – with some monies derived from cuts used to make payments. The LPC also hands out leaflets and posters to alert patients of unwanted approaches by internet companies. 

Sunday, Monday: October 22 & 23

I attend a wedding in Udaipur, India, of the daughter of a dear friend. I have not been to India for a few years and see the contrast between those with material wealth and those without. India has a relatively young population and I reflect on the differences in healthcare between India and the UK. In order to improve access to medicines for large numbers of the population, a concept of essential medicines was launched in 1977 by the World Health Organization. This concept defined drugs that satisfied the healthcare needs of the majority of the population that should be available at all times – in adequate amounts and in appropriate dosage forms, and at a price the community could afford. Ironically, in the UK with pressure on resources and an ageing population looking for ways to reduce medical expenditures, it too is embracing the concept of essential medicines. This, however, raises prickly issues such as GP restrictions on prescribing, perceived quality of healthcare and pressures on drug manufacturer margins. Pharma companies also complain about stifling innovation through pressure on prices. It seems long experience in developing countries has resulted in better implementation of the concept. However, because of a number of stakeholders’ interests, I am not sure such a model is easily translatable here.

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