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Dealing with the DH bombshell

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Dealing with the DH bombshell

LPC chairman Dilip Joshi has a month where the Department of Health’s budget cut plans dominate the agenda

Tuesday, January 12
The pre-Christmas bombshell announcement on cuts to the community pharmacy budget has been exercising minds locally and nationally. Today, I am at the House of Commons making a presentation sponsored by Kate Hoey MP. Other than MPs, the invited audience includes GPs, nurses, hospital consultants, local authority councillors, CCG chairs, people from Healthwatch, social services, patient groups and NHS England and, of course, pharmacists, including NPA and Pharmacy London chairs and the RPS president – a really eclectic group! Unfortunately, a consultant from St Thomas’ cannot come due to the junior hospital doctors’ strike, which is also today. Following my presentation, I have arranged for a local GP on the LMC and medicines management chair in Lambeth, a director of social services and the chair of Lambeth Citizens’ Forum to give brief presentations. These are followed by an interactive session. Strength of feeling against top-down cuts as a means of achieving efficiencies is clear, with sub-optimal medicines usage and wastage cited as examples where improvement in effectiveness and savings can be achieved.

Wednesday, January 13
Together with other NPA board members, I attend an emergency meeting with PSNC regional representatives in London this afternoon to receive an update and discuss the campaign against the DH announcement. Analysis of the Ridge/Cavendish letter suggests far-reaching consequences that go beyond the 6.1 per cent cuts proposed for this year and risk destabilising the entire community pharmacy sector. Remote distribution models and reduction in pharmacy numbers appear to be the central objectives, with clustering of pharmacies and more clinical care cited as drivers. There is no evidence to suggest that such models would be cost-effective. In addition, the problems caused by the ill-thought-through exemption that allowed 100-hour pharmacies to open will not necessarily be remedied as a result of forcing closures through attrition of low-volume dispensing contractors providing a vital service in deprived inner-city areas where need is great. The cost of short-term ‘efficiency savings’ is likely to be higher in the long run and damage to the community pharmacy network will be irreparable.

Thursday, January 14
This evening’s meeting of Lambeth Southwark and Lewisham LPC inevitably has the proposed cuts on the agenda. We represent more small, low-volume dispensing independents than other parts of the country.Confidence and mood is low amongst LPC members and the enthusiasm there was for the new provider company for commissioned services is somewhat tempered by the real risk to contractors’ businesses. We agree to hold a contractor event next month and resolve to invite our national body representatives as well as the MP for Lewisham East, who happens to be the Shadow Secretary of State for Health.

Monday, January 18
This evening I am at the Ace of Clubs AGM, where staff and some centre-users (the homeless and others in need) attend. There is an item on the agenda on funding kitchen refurbishment to increase capacity and efficiency. This example of investment to achieve greater efficiencies is a very different model to that proposed in community pharmacy! At the AGM, we hear a story from a service-user who, having lost his job and home, was suicidal until he discovered us. In the words of the chair: “Rupert really brought it home tonight as someone who clearly feels his life has been totally changed by Ace of Clubs and our dedicated staff team here.” We see many such people in pharmacy and probably have greater potential to integrate health and social care than other providers, as they tend to be either concerned solely with health or with social care.

HOUSE OF COMMONS MEETING: (left to right) Nicola Kingston (chair of Citizen’s Forum); Dr Diane Aitken (GP, chair of Lambeth Medicines Management and LMC member); yours truly; Kate Hoey, MP; Gill Vickers (director of Adult Social Care, Lambeth)


Tuesday, January 19
The National Association of Primary Care (NAPC) has diverse membership with a focus on collaboration in primary care. One strand of work is a type 2 diabetes care pathway advocating patient and carer navigation of personal healthcare needs. This builds on the Healthy Living Pharmacy model, where the health champion becomes a primary care navigator (PCN). Our health champion is a PCN and I have seen her grow in confidence since she took on the role. She confidently signposts patients to other diabetes services but, additionally, is happy to help with day-to-day issues that diabetics face and offer practical advice on diet and exercise. Today, I see diabetes patients specifically ask for her rather than other members of staff, including the pharmacist! This is a true reflection of effective skill-mix and vindicates my belief in supporting the HLP model, which is now widely used across the country.

Thursday, January 28
The London LPCs’ body Pharmacy London has a meeting today. Other than considering London’s response to DH announcements, we discuss how NHS England will communicate with contractors in the future. There have been inconsistent methods used recently, with some messages sent to the PL executive, others to LPCs and a number directly to individual contractors. Similarly, NHS managers have given undertakings of which other NHS managers are unaware. Today’s meeting is with a budget-holding official who takes pride in mentioning that he controls 1 per cent of the total NHS budget for England. He makes a point of mentioning other managers who aren’t budget-holders and, to add to the confusion, mentions that many of these are unable to give undertakings on behalf of NHS England. This tiresome behaviour leaves us frustrated and unsure of who we should be dealing with. We suggest future communications be sent to PL or LPCs rather than contractors directly and, as the meeting ends, I am glad this month is drawing to a close.

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