Terry Maguire wonders why industrial action aimed at increasing core funding has ended up with £22 million being funnelled into a new adherence service…

In the busy last week of December 2022, to end industrial action across the pharmacy network, the Department of Health made an offer. The CPNI Board considered it and, while it was viewed as insufficient, it was accepted.

There was courageous pragmatism in this. Everyone, it seemed, nurses, lecturers, postmen and ambulance drivers, were on strike and public sympathy might be stretched perhaps too far. It was better, the CPNI statement intimated, to bag this offer to relieve the pain of current funding and meet again with the new Permanent Secretary in March 2023.

So, what exactly did we get? Well, it seems that the adherence slot on the pharmacy payment spreadsheet got a lot more money. About £22 million of new money was offered to deliver an adherence service.

Of this, £14 million will be shared out by the end of the financial year to help with cash flow and some was paid in January. The other bits and pieces amount to a warm feeling and a clap on the back, and we’ve had enough of that for far too long.

So, what was CPNI looking for? That was a question I asked myself many times through fractious meetings last autumn. When contractors agreed to industrial action it was because of a general lack of funding, and a figure of £20 million to £30 million was mentioned to put this right. This was a cry for more core funding, not a request to get a specific payment for a specific service. Or was it?

As the only region of the UK to have a community pharmacy adherence service, I do wonder where the lobbying for this service is coming from. It seems CPNI has been focused over a number of years in securing payment for MDS specifically.

The new service has three patient cohorts. Cohort 1, patients on medicines likely to be abused, is the easy cohort. Cohort 3 is patients assessed in hospital by a clinical pharmacist and deemed in need of compliance support, for example an MDS tray.

On discharge, an Adherence Referral Form (ARF) is sent to the community pharmacy that submits the form for payment which supports supply of an MDS. The annual payment per patient is £600.

The service spec for Cohort 3 was introduced last year, yet to date I have only received one form. Indeed, £4 million was set aside for this cohort last year and not much has been claimed. Hospital colleagues seem reluctant to issue the ARF forms.

Cohort 2, the community-based patient, most likely with a domiciliary care package, represents the biggest and most challenging cohort. We were assured there was progress on defining this cohort so funding could be accessed, but so far I have not seen details. As contractors can’t access the money through service delivery in the current year, it will just be shared out.

The way the money is divided among contractors is opaque, to say the least! CPNI is not sharing how each contractor will benefit, but judging by disbursement of a similar adherence pot in March 2022 I will lose out as I got well below what I might have expected.

That, no doubt, is because while I am around the average in the number of prescriptions I dispense, I have fewer than average patients on MDS trays. Over the years MDS supply was not something I lobbied for as the risk, cost and manpower required for no remuneration made little sense to me.

There is little if any evidence base supporting the use of MDS trays but I suppose their use allows Social Services to avoid training community care staff. Now, because of this CPNI agreement, I am obliged to provide the service.

Moreover, I worry that a group with a very specific vested interest in MDS and in the robot technology that allows industrialisation of this service have had an exaggerated influence on CPNI negotiations.

At the risk of being accused of showing no gratitude, I wish to point out that it was general funding most contractors wanted, not funding for MDSs. The only real funding we got was for an adherence service.

Yet in December 2022, when CPNI was negotiating this, it blocked the roll-out of Pharmacy First “Winter Pressures” and “UTI” services that would have been much more beneficial to my business and to my patients.

Terry Maguire is a leading community pharmacist in Northern Ireland.