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Crying out for common sense


Crying out for common sense

Sid Dajani gets distracted by a meeting about Healthy Living Pharmacy.

Last month I was asked to sit in a London studio for several hours at very short notice and do a mixture of live and recorded radio, as well as some regional TV, for national bug-busting day. It was exhausting. Not only do you have to sound as fresh for the last interview as you did for the first, but you have to remember all the key messages. I left home at 5am, and by 4pm, I was on a mad mission to make a local pharmacy meeting in Eastleigh.

This meeting was about becoming accredited as a Healthy Living Pharmacy in order to qualify for 20 Quality Payment points. And what do points make? Nope, not prizes – I’m not Bruce Forsyth – but funding. Who knows, maybe there’ll be prizes for making sculptures out of egg boxes next!

But this meeting was too important to miss. The good side is that my pharmacy is already up-to-date with processes introduced for the 2005 pharmacy contract, including SOPs and various advanced and enhanced tier services, so I’m keen to explore how my team and I can further add to the safety and quality agenda. Nothing was going to stop me attending – not exhaustion, and certainly not an invite to a glitzy evening at the House of Lords or an exclusive invite to dinner at a Park Lane Hotel.

So I swapped a glamorous evening involving dinner jackets – usually the velvet sort with ribbon-edged lapels mentioning Alexander Wang, Carven, McQueen, and no doubt D&G. Yep, I swapped the whiff of expensive perfume, tasty morsels, and all that jewellery glittering under the chandeliers, for over three hours of traffic jams out of London, unattended motorway roadworks, miles of cones, disgusting petrol station lavatories, and queues for petrol.

Christmas in February

For some, Christmas is a time of increased loneliness and despair, but for pharmacists with a political role, Christmas can be every week! I got to the meeting 20 minutes late. Hunger and fatigue did not dampen my spirits in pursuit of learning about building yet more capacity around throat-slashing funding cuts and yet another expensive reorganisation that (if history means anything) will fail.

At the same time, I appreciate that we can’t turn back the clock. We are in the healthcare business, not a Tardis. We are where we are. What matters is what happens next, and so there I was. We live in interesting times. In the ‘60s people took acid to make the world look weird, but now the world is weird and people take antidepressants to make it seem normal. At this meeting, I wanted to stand up and scream. I’d like to shout at the computer screen right now, but that won’t change anything either, and I can’t type any louder!

Whatever school of management you might have studied at, if you have a calculator and an ounce of common sense, you could see what a totally, utterly, stupid, wasteful, and just plain daft idea this meeting was. Now, before you reach for the green ink and write to me, I absolutely support progress, technology, efficient new ways of working, and better outcomes. I’m just trying to get my head around it all.

Mixed messages

One of the main messages from the evening was that Healthy Living Pharmacies would gain us recognition from commissioners, and therefore a better future. I disagree. The commissioners have long known of our expertise but don’t commission us because the GP lobby is too powerful and there is no funding for us. Many of them have been in post for a long time, are marinated in their tasks and too entrenched in their organisations to think differently.

If ignorance is their only defence then they’re doing their jobs very badly, because they’re not doing their homework. NHS England could commission a common ailment scheme, it could have us on local strategic groups, CCGs and health and wellbeing boards. The theories of HLP could have simply been put in the essential tier of our contract, without any cuts required. It has even been reported to the Royal Pharmaceutical Society that the Department of Health is ignorant of its role in education. This is despite it having had this role since 1841, and many DH staff being former RPS employees. It seems that ignorance can only be a defence in government. Civil servants’ excuse for not delivering is to pass the buck and blame a lack of evidence, despite the huge wealth of independent data like the Murray report, the Cost of Service Inquiry 2009, PwC’s 2016 report, and so on.

Hubris, cronyism, hypocrisy, call it what you will, they’ve sidelined common sense, experience and know-how by ploughing on regardless with silly, baseless, failing, distracting, frustrating and expensive reforms which have far less evidence than they’ve called for from pharmacy. Without a reality check we have no compass, the evidence is simple and the bottom line is this: communication is only complete when the receiver understands the information provided by the sender. When the receiver chooses to be selectively deaf and blind, even HLPs are not the answer to reset the thinking of commissioners. There’s more chance of boiling an egg by sitting on it, finding life on the sun, or breathing under water without air. We must stay focused on what matters and not get distracted by what doesn’t. Whatever the well-meaning benefits of HLPs, they are extra work and aren’t the answer; they are merely excuses for cuts to distract from the DH and NHSE doing a smash and grab on community pharmacy.

My only losses from attending the meeting were an evening without silver service, without an ingenious soup with croutons, and without individual pots of caramelised cassoulet of beef. But that’s nothing compared to what patients and pharmacy will lose as a result of the cuts.

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