Politicians and the NHS appear to have given up on creating national services
The recent announcement of the pharmacy funding settlement brought little but heartbreak and sadness for thousands of contractors, especially independents, who had been hopeful over the past 11 months that the government may reverse its intention to implement cuts to the community pharmacy budget.
Despite a huge campaign and the efforts of all the pharmacy bodies, the final announcement, apart from an adjustment to recognise the delay from an October to December start, changed very little from the initial terms set out in the infamous letter of December 17, 2015.
Whatever action others might take in response to this settlement, one of the responses from Pharmacy Voice has been to signal that we intend to hold NHS England to account, together with the Department of Health and ministers, for the statements they have continued to make about a better future of community pharmacy. We were told several times over the past few months that community pharmacy is valued and that ministers expect the sector to play a bigger role in healthcare.
The pharmacy minister David Mowat described the Community Pharmacy Forward View – a joint vision of the future published by PV and PSNC supported by the RPS – as “spot on”. But words of support come too easily. If they mean it, they are going to have to show real intent to a sector that does not believe them, through the delivery of programmes that will integrate pharmacy into primary care.
Politicians and the NHS appear to have given up on creating national services, and that’s pure politics. As well as landing the NHS with an unwelcome top-down reorganisation that cost £3bn to achieve little, Andrew Lansley’s Health and Social Care Act attempted to remove direct responsibility for the NHS from the Secretary of State for Health.
If ministers implement national schemes then they get held responsible for them. Pushing the responsibility to local commissioners gives ministers the opportunity to argue that they are not responsible when things go wrong, even if local service managers are working with one hand tied behind their backs thanks to the overall funding settlement for the NHS. In that respect, we are not alone – think tanks, commentators, provider organisations, and health professional bodies are pretty much unanimous that there’s not enough money going in in the first place.
We can continue to argue why they are wrong about this (which they are) or we could make the current system work better, and accept that, if our hopes lie only in national services, we could be waiting a while for the political wind to change again. Given the state of the polls, that could be a long wait. However, nothing in the Forward View was new, so we could take examples of what works well and replicate them. We have some fantastic work being undertaken by LPCs, who are already showing what can be achieved in local partnership, but they need support and they need encouragement.
As much as I disagree with what this government has done, and however much
I support the campaign against these changes, it would be wrong in my view
to not show how capable this sector is of engaging and making a difference. We have already set out our vision for the sector in the Forward View. We have also taken that thinking further in working out what it would take to turn that vision in to a reality – the IT, the investment in skills, the need for proper planning for scale up and implementation, and the importance of a real partnership between the NHS and the community pharmacy sector that underpins the commitment of both parties to make things happen.
I believe this is achievable. We may have to swallow hard in doing so, but this could have not only a massive impact on the lives of the patients affected, it could also transform the way in which community pharmacy operates as a fully integrated part of primary care and the NHS.
Right now contractors are focused on how the numbers simply don’t add up for them. They are wondering how they are going to manage and what changes they will need to make in order to survive. If we are to show leadership, our role is to show them that there is a path through this.
As I have said so many times before in this column, let’s start talking to those contractors – especially independents – who are, and have been, making changes to the way they deliver to patients and working in partnership locally. The sector itself is best placed to find the answers to the problems that neither the Department of Health nor NHS England appear to have.
So let’s get past the warm words. If we are to see this happen the responsibility is not ours alone. What NHS England, in particular, does next will be important in telling us whether they mean it.