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Dilip Joshi's diary from September

Monday September 1

I make my way to Waterloo for a meeting to consider integrating pharmacy services into the wider healthcare agenda for Lambeth residents. What a novel idea, I reflect, as I enter the building €“ the same building outside of which, many years ago, I witnessed pallet-loads of stationery put out for destruction simply because the family health services authority had changed name and, in those 'computer-lite' days, use of pre-printed stationery was the norm. As I recollect this, I wonder about the scale of wastage in the NHS over the years, both in bureaucratic and clinical terms, and whether this is inevitable due to the unwieldy nature of the organisation, or if the juggernaut that is the NHS can become more efficient through the imposition of further 'efficiency' cuts and increased localisation. I have my doubts and believe further cuts are likely to damage management and clinicians alike, with an inevitable negative impact on patient care. The meeting is fairly uneventful but all agree to a patient-centred approach €“ as they always do. It is agreed that the description of a care pathway be based on patient need and providers most suited to meet needs be mapped to the pathway. No doubt that access, informality and cost- effectiveness will feature in making every contact count and I am optimistic again as I leave.

Monday September 8

We start a two-day NPA board meeting on strategy. The topic is board development. A facilitator is present and the aim is to consider how board members can individually and collectively interact with the membership to both understand and support needs, now that there is a clear focus on independents. It is recognised that, while representation is important, independents truly value practical support, as most do not have back-office facilities that multiple colleagues enjoy. One suggestion is that the NPA should develop greater resources in this area. A number of 'Your Voice' events, planned throughout the country, will be used to garner members' views.

Tuesday September 16

Today is an LPC strategy review day and my CEO and I met earlier to refine our presentation. Members are divided into teams representing each of our boroughs (Lambeth, Southwark and Lewisham) and, following my scene-setting presentation, are asked to consider how we can best engage with the vastly increased number of stakeholders and at the same time ensure our contractors are provided with excellent downstream support. It is agreed that we engage well with external stakeholders, but our immediate challenge is with contractors delivering what we promise on their behalf. A number of issues are identified. First, finding time for training €“ daytime meetings incur locum costs and evening meetings impact on family time. Secondly, there are complaints that services are poorly remunerated and not paid for on time; in some cases, due to commissioning changes, contractors have not been paid for several months. Data ownership and LPC access is a further challenge, with commissioners often contacting the office to complain about non-performance at a late stage. On the basis of prevention being better than cure, it would be useful to have ongoing access to performance data so that early interventions can be made as necessary. It is also recognised that contractors who indicate a wish to be involved in services face barriers that cause them to struggle €“ these may include confidence, time- management and effective delegation. We decide the LPC needs a good understanding of these to better support the small number of contractors concerned. Through collaboration, we are greater than the sum of our parts.

Friday September 19

Yet another development and strategy review day €“ this time of the NPA Insurance board. Discussions focus on ensuring the strategy is aligned with the NPA and its focus on independents and continuing to make sure offers are relevant and valued. There is good retention and a high satisfaction rating among members.

Monday September 22

We receive some good news from local authority commissioners in Lambeth following the LPC's strong representations about late payments. Our contractors are to be given a three-month advance on payments for enhanced services and it appears that, at least for the time being, pharmacy is considered as the preferred provider, and 'any qualified provider' is on the back-burner!

Tuesday September 23

I am in the pharmacy and carry out a number of flu vaccinations. This year we have obtained stocks before our GP colleagues and, protracted though negotiations with NHSE were, it has been recognised that pharmacy is preferred by many service-users due to access and convenience and I believe we will exceed last year's performance.

Wednesday September 30

This evening, I attend a 'Stop Smoking' training update on varenicline and only those that attend are issued with a revised PGD. Disappointingly, only six turn up even though more than double that number had put their names forward. I reflect again on discussions at the LPC strategy day and realise there is much to do to engage with our contractors and provide support. This will be an LPC priority.