In a month when LPC chairman Dilip Joshi helped serve Christmas lunch to the homeless, he learns of a bombshell of a ‘Christmas present’ from the Chief Pharmaceutical Officer spelling out a severe cut in pharmacy remuneration

Thursday, December 3
A Journal of Forensic and Legal Medicine review says that 13 doctors died while the GMC failed to act on the emerging link between doctor suicides and the fitness-to-practise process. The review goes on to say: “The GMC has to protect patients, but it also has a duty of care to those doctors that it investigates”. It is interesting to see the parallels between the GPs’ regulatory body and our GPhC. I am often told by many contractors that the inspectorate is heavy-handed and unhelpful.

I have provided detailed feedback online and directly to the chief executive, Duncan Rudkin, to say that the vast majority of us try to do a good job and operate to the highest standards, and that supportive measures are as important as policing measures. Fortunately, GPhC visits, according to my local contractors, have improved recently and it appears that they are responding positively to feedback.

Tuesday, December 8
Today, I see a patient prescribed amoxicillin in error returning with a prescription for erythromycin. Fortunately, they have not taken any, although two capsules are missing from their blister packaging. Apparently, the patient’s allergy to penicillin was recorded in their notes but not picked up by the prescriber. My technician records this on our PMR, however. The issue is that the patient has to pay another prescription charge and asks who is responsible for reimbursing him. I am sure many of us have faced this dilemma and I express sympathy but can do no more. I decide to seek GPs’ views on this and am amazed to see a contribution online from one GP who states: “Contrary to common public perception, GP practices aren’t that profitable. We do not have a budget to refund patients for this type of prescribing error. There is the equity issue as well: if we have to refund patients when our actions have resulted in unnecessary expense, should we not be able to charge patients when their actions have led to unnecessary expense for the practice – such as when they do not attend appointments?” I feel compelled to post a comment and write: “Is it fair to expect a patient to pay another charge for an alternative prescription when it is clear that the prescriber has made an error?” I resolve to bring this up at the next practice meeting of the local GPs I attend.

Yours truly (left) at the Ace of Clubs Christmas lunch

Wednesday, December 9
This evening I have a dinner meeting with the head of school and a senior lecturer at King’s College School of Pharmacy in Waterloo to discuss how to best implement my role as visiting senior lecturer. We discuss various tutorial roles and combining ‘real-life’ experience with taught elements. We agree to timetable events in the new year and I consider how we might include evaluation of activity in community pharmacies to provide robust underpinning of commissioned services.

Thursday, December 17
A bombshell! I learn of a letter to the PSNC and other pharmacy bodies about a 6.1 per cent cut to the community pharmacy budget in the coming year. The letter announces a mixed package that includes a reduction in pharmacy numbers, a click-and-collect type medicine distribution model and pharmacists acquiring a ‘more clinical’ focus. We have no details nor evidence on which the proposed measures are based but this is clearly unprecedented as no negotiations took place with the PSNC; instead, we get this letter sent to all pharmacy bodies in England and signed by the Chief Pharmaceutical Officer at the DH and a top DH official. It has been sent without any discussions or consultations outside of the DH. I truly believe this to show a complete lack of judgment that could be disastrous for the pharmacy network and patients.

Friday, December 25
Christmas Day and, as usual, I am the first to rise. I make my way to the Ace of Clubs as a volunteer getting things ready for serving a special Christmas lunch to users of the centre. As a trustee, I attend meetings but don’t often manage to visit otherwise. This, however, is the day to see the centre at its best, with everyone in good cheer. Users tend to be alcohol and substance misusers, often without a fixed abode and come today for a free lunch which volunteers cook and serve. Most of the attendees are not served alcohol but this does not dampen spirits. There is a sing-song as we serve Christmas pudding for desert and I reflect on the fact that, for many, the other visitors to the centre are the only ‘family’ they have. I count my blessings as I make my way home to be with my family looking forward to a few days of doing very little.

Thursday, December 31
We are open ‘normal’ hours today. In days gone by (I remember nostalgically) Christmas and New Year’s Eve opening hours were ‘flexible’ in that, after about 4pm, it went very quiet and we tended to close at least an hour early. In those days, very few places were open; even petrol stations were closed for a few days so we had to make sure we had filled up. I also reflect how this used to be the busiest month of the year for small independents, with good over-the-counter sales, including gifts and perfumes. Sadly, in many inner-city pharmacies, this business has all but disappeared through the advent of supermarkets opening all hours. Today is spent in providing service with little reward as it becomes a day of ‘borrowing’ – it surprises me how many people run out of their medication at this time and throughout the country. Many pharmacies like ours are there to save the day. This could not happen without ‘real’ pharmacists in ‘real’ pharmacies caring for their patients and the personal relationships built in communities that simply is not possible in remote supply scenarios.