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We’ve shown practices an IP roadmap and support offer in Greater Manchester

We have been engaging with GPs and primary care networks for some time whilst deploying Pharmacy First and the hypertension case-finding service.

We realised early on that we needed a collaborative approach with the integrated care board and our primary care provider board at Greater Manchester level. But the real change happens when you contact PCNs/practices, speak to them and show them a roadmap and also a support offer.

We were commissioned by the ICB to set up a programme team which also included engagement leads working alongside us to hold webinars, attend practice managers forums PCN meetings.

It was quite difficult at the start of the community pharmacy consultation service and we had a great deal of resistance as well as engagement but over time, as traction started to build and community pharmacy delivery built their confidence, it started to improve.

The key is engaging system leaders, GPs and wider colleagues early and helping them understand what we are doing, the progress supporting with troubleshooting, problems and progressing that way. 

For the IP pathfinder, the sites were spread across GM and many of those pharmacies started building good relationships and were supported by our clinical mentors and wider engagement and support and leadership from our ICB leads – and it progressed.

The foundation for building this engagement started in 2020 and we do the rounds for all our services, present data, insights and are willing to take feedback patiently.

Often, its due to not understanding what pharmacy can do, capacity pressures and other things like medicines shortages that cause the friction, so you have to be willing to take the feedback and work towards outcomes that will be beneficial to everyone.

Luvjit Kandula, director of strategy and transformation, Community Pharmacy Greater Manchester.

Rybelsus prevented £2.6m losses – but it shows a control gap

Community Pharmacy England estimated in August that the Rybelsus redetermination prevented £2.6 million in losses, but the episode also reveals a basic control gap: August reimbursement changed whilst the published Drug Tariff continued to show £78.48.

Contractors should not have to reconstruct the payable position from separate announcements after stock has been bought and prescriptions dispensed.

Every in-month redetermination should appear immediately in one authoritative, date-stamped register showing the product, payable amount, effective date, prescriptions affected, superseded tariff entry and publication time.

That would not repair the wider reimbursement system, but it would make the change explicit, auditable, and easier to act on.

Pharmacy owners already carry acquisition-cost risk. They should not also carry avoidable uncertainty about which official price will govern payment.

Varun Sharma, founder, Neuvior.

I’ve injected £80,000 from my personal funds and we’re just barely keeping afloat!

We have six branches and have been running them for up to 40 years. The last two years have been the worst I have known in running my pharmacies and I see no future in it if there is no change!
We’re still having great difficulty with cashflow. The two directors have taken no salary for six months. I’ve have had to inject £80,000 from my personal funds and we’re just barely keeping afloat!

Wholesalers now taking monies earlier, before the end of the following month, which does not help. There’s over 200 lines on price concession, which means that even if we can get the medicines, the price we buy them at is at the same or very slightly cheaper than price concession, so we make no purchase margin money and rely solely on dispensing fees.

On most other lines, our purchase price is still over the price concession. We cannot survive like this!

Why does the NHS deduct the 20 per cent and five per cent from our Drug Tariff prices? It is very misleading when everyone uses the full basic price when the actual price paid to pharmacies is much less.

Increases in the national insurance, minimum wage, new employment regulations, rates, utilities, etc, etc, means we have no money to invest in resources, additional services and have to run on skeleton staff which affects the service we give to our patients. It's very demoralising and stressful for everyone. 

Very concerned independent pharmacy owner.