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Advocate of the Year Dilip Joshi is not at all happy about the way that NHS area teams, with their standard operating models, are behaving

Tuesday July 1

After several meetings of the the South London Area Team (SLAT), I have been wondering whether the motive to engage with us is largely for their convenience as a single point for giving information (rather than exchanging it). I have noted that €not wanting to go there€ or €open that particular can of worms€ are common responses to queries and these are used again €“ in relation to prescription switching by pricers €“ in the meeting I'm at today.

Contractors have got a one-sided deal when it comes to prescription switching, where there is no opportunity for what is essentially a clerical error to be rectified. The penalty for each item switched is £8.05. How can it be just for such a penalty to be applied when patients are exempt from payment and have not paid?

The real €can of worms€ here is the case for retrospective adjustment that the Department of Health avoids at all costs. This is why they cling on to the rule that contractors need to ensure declarations of exemption are made prior to submission. I wonder if a test case brought against the DH might succeed.

The SLAT's stated wish to ensure consistency through the use of standard operating models (SOMs) means that there is little room for discretion or a common sense approach. Today, I learn that standardised disciplinary letters have been drawn up and a colleague cites an example where the 'offender' is a contractor who has carried out 401 MURs €“ one over the limit! He had received a harsh letter stating that the extra money paid would be clawed back and any further breach could result in disciplinary action.

Area teams have the power to rescind contracts and I think that, if LPCs were not around to moderate their action, contractors would be likely to receive breach notices for things that were previously sorted out through a phone call. I am tired of hearing that cutbacks and capacity are reasons for prioritising limited resources to the detriment of contractors doing their best in a difficult environment. Of course, a serious breach should not be condoned; however, the SOM approach is flawed and inflexible and LPCs throughout the country will need to be vigilant in ensuring contractors are dealt with fairly. 

Tuesday, July 8

We are at an evening meeting with a local authority manager in Lambeth. He is the only person engaged to deal with enhanced services. We hear a preamble intended to induce sympathy about capacity issues and how he has to deal with everything. This appears to be the standard opening for all commissioner discussions and I find myself increasingly unsympathetic the more I hear them. We too, operate on a shoestring with limited human resources.

He, however, is a former PCT manager and, as such, has a good understanding of community pharmacy because of it. Who would have thought we would yearn for the 'good old PCT days'. He informs us that, owing to system integration (and of course, €capacity€) issues, contractors are being paid late and he apologises profusely.

Some contractors have not been paid for five months. The manager is as helpful as he can be and we find ourselves glad of his understanding. I have met other local authority managers who have no appreciation of healthcare and some who see social and healthcare budget integration as an opportunity to tap into the latter to address shortfalls in the former.

Monday July 14

It's the start of my family holiday €“ at last! It seems it has taken an age to arrive and I look forward to some much-needed down time. Wednesday, July 30 I am attending a €Health Checks Integrated Commissioning€seminar today, as Lambeth and Southwark local authorities are looking at commissioning future NHS Health Checks through a ring- fenced public health grant. Present are local authority commissioners, nurse practitioners, outreach providers and a token pharmacist €“ me!

The seminar starts with two real-life patient experiences. Both speak of life- changing experiences following a health check. Two providers €“ a nurse practitioner and an outreach worker €“ are then invited to speak about how they carry out the service. I pipe up when they finish to explain how pharmacy in Lewisham, for example, has delivered more health checks than other providers and is a natural setting for screening and prevention.

There is more than a little embarrassment from the organisers for forgetting to mention pharmacy and they try to redress this by saying how important pharmacy is to their future plans; they generally speak my words for me. Group sessions follow and it is interesting that, during feedback, all mention the vital role of community pharmacy in providing health checks.

Thursday July 31

I am attending a Pharmacy London meeting where there is a discussion of budgets and work plans. There is a great opportunity for Pharmacy London (which brings together all but one of the London LPCs) to act on behalf of London pharmacies and there are potential advantages for similar larger groupings across the country. There must be a large measure of goodwill and willingness to give up some decision-making within LPCs for this to happen. Bigger, in this case, might indeed be better, but much work remains to be done.