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Pharmacists and commissioners are not on the same page when it comes to understanding each other's priorities. Mukesh Lad, chief executive of Mr Pickford's Pharmacy and chairman of Pharmacy Northants-MK, suggests how to align your views

Independent pharmacies... should we stay or should we go? After a long day of meetings with the NHS area team and a two hour drive back to base for a buying group meeting, it was a question I couldn't help asking myself.

Let's take a case study of a typical independent pharmacist who's posed himself the same question and decided to stay. What should he do to maximise the profitability of his business?

Without doubt, there's huge disparity between the independent proprietor's view of business and the future for pharmacy and that of their local CCG and other commissioners or stakeholders. In fact, strike through 'disparity' and replace it with 'opposing views'. The majority of independents truly believe they're doing a great job and are an essential pillar of society. The CCG, on the other hand, believes that, beyond the medicines supply function, community pharmacy adds no value to the wider primary healthcare agenda.

Compare and contrast

So how have such differing views come about? Most CCGs don't fully appreciate the mechanics of running a retail pharmacy business and the challenges it poses on a daily basis. Added to which, many local pharmacies struggle to understand the meaning of a local health strategy, how it's commissioned and the mandatory requirements of targets and health outcomes within prescribed budgets. I'm convinced that the origins of the divergent views lie somewhere among these misunderstandings and assumptions.

With the NHS in financial difficulty and the prospect of no additional pharmacy funding, the challenge we have to overcome is how to narrow this knowledge gap. Independent pharmacists need to understand the health and wellbeing priorities for their area. Knowing these local priorities will help you understand how best to align your business strategy with that of the local CCGs, the NHS England area team and your local government authority €“ which is now responsible for commissioning public health services. Your local LPC should be able to help you with this piece of work.

"The cost to the local authority of a hip replacement is a minimum
of £50,000 and 20 per cent of these patients will
die within a year of their operation"

A good example of how we can become an active part of our local healthcare economy aligned to local needs and priorities is the 'slips, trips and falls' agenda, particularly among those in residential care. It's shocking that the cost to the local authority of a hip replacement is a minimum of £50,000 and that 20 per cent of these patients will die within a year of their operation. It's obvious that this is a preventable tragic loss of life as well as a huge avoidable cost to the NHS.

My response on behalf of our profession was to participate in our county council's recent 'slips, trips and falls' conference as a keynote speaker. More than 150 care home managers and staff were present and all were virtually oblivious to medicines being a potential cause of slips, trips and falls.

This type of incident, particularly in the elderly community, is a high priority for Northamptonshire. Yet when we dispense an antidepressant or a sleeping pill do we ever talk to the patient or carer about the possible side-effects and the likely chance of a fall? This one intervention, as part of our essential services or an MUR in our advanced services, that could make a huge impact on the health outcomes of the local population and the better use of NHS funds. This is a prime example of another way that we could save a life and unnecessary expense for an already ailing budget.

Knowing about the health and wellbeing strategy as well as the commissioning priorities in your area can allow you to focus on local needs without having to make a huge investment in your practice. It will attract commissioners' attention to the fact that you can make a real difference. Of course, the icing on the cake is the ability to record these interventions as proof of our potential to support the local healthcare economy and add value over and above the essential services we're already known for.

Align practices and processes

We can and must show our capabilities to commissioners. We have to align our practices and processes with local priorities. It's also vital we maintain effective record keeping through the efficient use of our PMR system.

Incidentally, good data collection in these circumstances is a key element to help your LPC move forward with service bids. Every intervention with positive patient outcomes is valuable evidence for your LPC to make a business case for local commissioners to invest in community pharmacy.

We, the pharmacists, need to own pharmaceutical care. We then have to align our pharmaceutical care service with the healthcare priorities of local commissioners. In this way we will be perceived as added, valuable members of the primary care team. This will, in turn, make us indispensable.

And finally, by proving my theory you'll be implementing the best business sense for your own practice €“ to keep your patients healthy and alive for longer.