Down to earth as reality bites
LPC chairman Dilip Joshi starts the month fullÂ of optimism as he looks forward to hisÂ teaching role but is brought backÂ down to earth at the end as a localÂ commissioner cuts service funding
Tuesday August 1
I meet a senior member of Kings College London School of Pharmacy, a good friend, at the university buildings in Waterloo to discuss the forthcoming academic year. The prevailing view is that pharmacy students need to have more exposure to â€˜real lifeâ€™ in addition to the taught curriculum and we discuss how we can place students in a variety of settings, in addition to working in pharmacies. Last year, we placed a number of second and third-year students at the Ace of Clubs, a charity for homeless and disadvantaged people. I was apprehensive at the time, as I feared students would be uncomfortable in a setting where many of the clients were substance misusers. In the event, students gave such positive feedback that we have now expanded the interaction and are seeking to make an aspect of this contact a major component of a final-year studentâ€™s project next year. We discuss my teaching involvement in the coming year. I look forward to working with students who are always fresh and optimistic and distinctly lacking in the cynicism that age and experience inevitably bring.
Thursday August 3
This evening, I am at a Community First Services (our provider company) planning meeting with the operations officer and our LPC CEO. Attempts at bidding for services have been a frustrating experience. Unlike GP-federations given seed capital (that many spent on establishing offices and engaging staff), in our model, administration costs come out of negotiated services income and there is no provision for premises or additional support staff. The other major challenge is the commissioning (perhaps, more accurately, decommissioning) environment where, instead of looking at new services, there is a drive to cut existing services to balance the books. We are here to discuss an opportunity through NHSTrust charity funding that is independent of CCG and Public Health. It is a diabetes service that ranges from general work that all pharmacies can provide (healthy living advice, health promotion signposting and early detection) to more specialised, longerterm management that involves independent prescribers working with GPs and nurses. Such bids tend to be more successful if there is a multidisciplinary component but, in this case, we want to ensure community pharmacy is the lead provider.
Thursday August 17
I am at the pharmacy today and have an appointment to meet a mature pharmacy student with problems. She comes to us periodically for work experience, while studying pharmacy at a university well away from her home and her two young children. She is a third-year student determined to complete her studies and qualify as a pharmacist but has had referrals in two subjects and is afraid she may have to repeat the year or, worse, leave if she does not pass the re-sit exams. She is tearful and needs reassurance not just in her ability to pass the exams but that she is doing the right thing by continuing her studies and neglecting her family in the shortterm. There are not many of us who have faced such pressures in our undergraduate days; I remember my carefree student days, when I had no responsibility for others at all. The student finds interacting with staff and patients therapeutic and leaves in a more positive frame of mind. I know she is capable and caring and would make a good pharmacist but wonder if she will be able to focus on studying while at home during the holidays.
Wednesday August 23
I take a break from pharmacy today â€“ although, I am with fellow pharmacists â€“ as I have an invitation to the West Course at Wentworth Golf Club. I am a keen (rather than good) golfer and it is a joy to be on a course where many champions have played. It is challenging and I am far from my best but the excellent company and studious avoidance of pharmacy-related matters is a welcome change from my daily routine.
Wednesday August 30
I am at a stop-smoking meeting of a providersâ€™ consortium looking at a proposal to develop the service, when Lambeth Councilâ€™s commissioner drops a bombshell. There is a Â£15m local funding gap and Public Health has to contribute approximately Â£2.8m of additional savings. There was already a reduced annual budget of Â£650,000 for the stop-smoking service when discussions started but that is to go down to a proposed Â£500,000. The commissioner murmurs that â€œthis news will be bitterly disappointing, especially given all the work undertaken developing the proposal to dateâ€ and â€œthe council understands that it may lead some partners to question whether they still wish to be involved in the processâ€. I believe the commissioner is embarrassed at having to convey this news, but any sympathy evaporates when he slips back to the â€˜party lineâ€™, stating: â€œHelping people stop smoking remains a key priority for the council, given the benefits to both individualsâ€™ own health and to the wider health and social care system. We want to continue working with our partners to deliver the best possible service to residents within the new proposed budget, taking account of local needs, priorities, evidence and the expertise that you all bring.â€ The consortium, after he has gone, agrees to modify the proposal in accordance with the funding and the council can reject the proposal if it wishes. It is no reassurance that this seems to be happening all over the country and, in fact, brings into question the whole strategy of devolving public health services to local authorities.