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Mukesh Lad, chief executive of Mr Pickford's Pharmacy, looks back on a year of change and suggests how independent contractors can keep up with progress

Reflecting on 2014 as the year draws to a close, one thing that has remained constant is change. Greek philosophers first noticed change being central to the universe in around 500 BC. Whether we choose to call it change or better still, evolution, the same principle is still affecting us over 2,000 years later.

The NHS restructuring is well into its second year and we're starting to see an emerging trend of integrated health and social care, delivered in the community. So far, it's been a slow and laborious transition with many independent pharmacists not understanding the process and not realising its true impact on their business.
In March, the Pharmacy Call to Action gave us the unprecedented opportunity to market and promote the value and capabilities of our profession to NHS commissioners.

It was our chance to underline why pharmacy is such an untapped resource that could and should be mobilised to support primary and secondary care. It wasn't the futile exercise that many independents seemed to think. Something will come out of it eventually because, if nothing else, it's allowing NHS England to review, compare and, hopefully, rationalise GP and pharmacy contracts.

Looking for opportunities

However, I'd like to think more opportunities are being identified. With improved incentives we could provide services integral to clinical pathways that were delivered in the community.

Greater ease of access and high standards of delivery can lead to increased patient self-management. This is particularly true for those patients with long-term conditions, including diabetes and respiratory and cardiovascular ailments. Independent contractors could be right in the middle of improving patient outcomes and helping to reduce unplanned hospital admissions as well as the unnecessary use of A&E services.

As a priority, I would suggest a New Year NHS resolution to start involving pharmacy at the outset of patient pathway redesign. Commissioners can no longer afford to just add us as an afterthought to mop up poor levels of delivery by current unenthused contract holders.

Probably the issue with the greatest impact on our day-to-day professional duties in the past 12 months has been the introduction of the new General Pharmaceutical Council pharmacy inspection prototype. Without question, it's highlighted the need for us all to raise our game and make major improvements in some, if not all, of the five principle areas.

It's imperative we ensure our practices are fit for purpose and safeguard the health and safety of the people we serve.

There's no reason why independents can't be leaders in pharmacy change

The new model focuses on gathering evidence for how well a pharmacy is operating. This 'show and tell' approach requires a major shift in mindset for us all. By far the most important area we need to focus on is governance; we need to provide evidence that we are achieving high standards and minimising risk of patient harm.

A worthwhile investment

This does require a radical review of our contractual obligations, processes and procedures. However, we also need to recognise the importance of investing in our staff and their training. I appreciate staff costs are our biggest business expense when reviewing a profit and loss account after the stock purchase figure. But investing in trained staff is going to make or break our survival not only at inspection level but also in the ever-increasing market competition.

Of course, the most enviable combination going into the New Year would be competent and professional staff together with drug purchase at the most competitive price available. The US giants are already on our doorstep and they've not come for seasonal carol singing. With the Walgreens takeover of Boots, and McKesson in charge at Celesio (LloydsPharmacy and AAH wholesalers), independents need to make some firm resolutions for 2015.

Our survival in the face of this stern competition will depend on excellent service levels from trained and informed staff operating from a professionally managed business. There's no reason why independents can't be leaders in pharmacy change. We're best placed for local knowledge, patient trust and, most importantly, the ability to adapt quickly to change. Plenty of professional business support is available from organisations such as the NPA. And this last year has also seen the emergence of local pharmacy federations.

These are legal commercial entities made up of independent contractors to form a pharmacy provider company that benefits from shared resources such as back office functions, to provide economies of scale. The main purpose of these federations is to support independents, often as many as 100 contractors, to bid for the supply of clinical services being procured by CCGs and local authorities.

Looking forward

As the year draws to a close, we have to learn from the experiences, good and bad, of the past 12 months. One thing we can be sure of in the coming year is that our healthcare system will continue to change. We therefore need to transition our business to new care delivery models under changing reimbursement structures.
My three New Year's resolutions for independents are:

1. Get ready for GPhC inspections. Understand the five principles and make preparations including investment in your business and staff training
2. Get ready for more competition. Think outside the box €“ you can't keep doing the same thing and expect different results
3. Start collaborating with other independents. There is strength in unity.

As we begin the New Year let's work together as independents. We are and shall remain an integral partner in the evolution of healthcare in this country. Finally, I wish you all a Merry Christmas and a Happy New Year.