Community Pharmacy Northern Ireland is skilfully creating a state of mind among contractors that is pernicious, negative and ultimately self-defeating, says Terry Maguire…

In the last full week of March, the arrival of brighter evenings and the annual Northern Ireland pharmacy ball brought an uplift of sprites after a punishing winter.

The best of pharmacy teams arrived in black tie and swishing frocks to drink lots of sparkle and have fun while celebrating all that is truly great about community pharmacy. There was an air of pride and generous applause for the category winners and a standing ovation for the recipient of the best contribution to pharmacy.

Being recognised by one’s peers is particularly satisfying. Over a sumptuous dinner and too much wine, a local celebrity compere navigated the evening until the music took over and the senior members retired to more comfortable chairs to catch-up in less noisy surroundings. It was there and then that the talk reverted to how bad things are in community pharmacy and the cold winter gloom returned.

Contractors had been called, at short notice, to a meeting in the very same hotel earlier in that week. Community Pharmacy Northern Ireland had only bad news. Their success at Christmas when industrial action was called off was, it seems, short-lived.

The follow-up meeting as agreed with the permanent secretary for health to invest additional funding had been cancelled. There was no more money CPNI were told and with our complex funding model, it looked like we were down £4 million in 2023-24 compared with 2022-23.

These contactor meetings are, as one colleague described them, brutal events.  They have followed the same format over the 20 years I have been attending. Representatives from the CPNI Board outlined in the harshest terms how dreadful the funding envelope has got.

Then the discussion is opened up to the floor and we hear angry individuals argue how they just can’t go on – and yet no business seems to close or is forced to close. Any hint of CPNI criticism is hammered flat or glossed over.  Then we get to possible and potential actions which get a cursory show of hands and the suggestions, we are told, will be brought back to the CPNI Board.

We all leave the meeting depressed, get into our cars and drive home. It is at this point, for some strange reason, I am reminded of a professor of clinical pathology who, many years ago when giving a CPD lecture, started with the quip that he knew he was at a pharmacy meeting when he saw the quality of the cars in the car park.

As I have said, in spite of the dire financial crisis, pharmacies don’t seem to close. Ok, what about Lloydspharmacy? It’s difficult to know what to make of Lloyds’ withdrawal from Northern Ireland. Aurelius, its parent company, is re-evaluating its pharmacy estate. It is an impressive company and is focused across four domains; retail, homecare, digital and wholesale and it’s been advised that it does not need as many brick-and-mortar outlets in its future.

Indeed, all the local Lloyds contracts were snapped up quickly; the one in Sainsbury’s Ballymena is to be closed in July, I understand. Predictably, there was anger that bids from key account holders only were entertained. Funding might not be as bad as we are telling ourselves and of course, it could always be better.

I wonder if CPNI might eventually do things differently. I have often wondered if a more positive collaborative approach with our funders would bring greater rewards. CPNI are primarily concerned about the well-being of its members, yes, but if it took a more pragmatic interest in the challenges and concerns of our paymasters, this would create opportunities that would bring better income streams. CPNI Board members have told me I’m a fantasist.

Core to CPNI’s approach was that the clinical future the Strategic Planning and Performance Group and Department of Health are seeking for the pharmacy network could only be delivered when the fundamental baseline funding is in place. That position seemed to have been addressed some years back but now things have reverted. CPNI’s actions are only reactionary and confrontational. 

‘Without a vision the people perish,’ as the old saying goes and CPNI does not have a vision; a place it wants the network to get to. Perhaps the nature of its Board, given the many conflicting and competing views it reflects, makes setting a vision all but impossible.

Perhaps many Board members are opposed to a clinical future. Has anyone asked them? One thing is for sure; CPNI is skilfully creating a state of mind among contractors that is pernicious, negative and ultimately self-defeating.

I was delighted that at the pharmacy ball, a service development project I was involved in won in its category. Our test-and-treat cough and cold service has the potential to improve the management of the most common winter aliments while improving antimicrobial stewardship.

Sadly, in our current state of mind, I can’t see it being commissioned and rolled out any time soon.

Terry Maguire is a leading community pharmacist based in Northern Ireland.