NHS England’s decision to allow pharmacies to go ahead with pre-booked flu jabs in September has put community pharmacy in an awkward position because there will be cries of ‘foul play’ and ‘unfair treatment,’ says Nick Kaye…

Rules are a constant presence in our lives, sometimes prompting rebellion or evoking a sense of injustice.

In the realm of pharmacy, this sentiment holds true. Whether these rules manifest as specific service requirements or regulations, they wield influence over all aspects of our businesses.

The impact can be vexing, particularly when they seem to impede progress, and it's curious that we often lament the existence of excessive red tape. The pharmacy domain presents an additional challenge – the task of keeping up with a ceaseless influx of regulations.

Recently, two stories have emerged, both revolving around regulation and service specifications, which are poised to affect a considerable number of us.

One of these stories revolves around the abrupt modification of service specifications for this year's influenza vaccinations. The sudden decision to commence the service in early October instead of September has introduced an overwhelming wave of confusion (even though NHS England has since said existing bookings can be carried out in September).

This alteration casts doubt on the dedication and trust vested by community pharmacy owners in supporting a service that’s crucial for safeguarding our communities.

The practice of pre-ordering stock up to a year in advance and staffing up for the service's demands are suddenly called into question. Contemplating the ramifications of this unprecedented service specification change, one wonders whether the enthusiasm for such preparations will persist in the following years.

The financial implications are grave as well, with reduced payments adding to the destabilisation of finances. This precarious situation could potentially jeopardise the service's capacity in the year 2024.

Beyond financial concerns, the ripple effects of this change and subsequent confusion are felt at the local level, impacting systems and patients alike.

NHSE consistently emphasises the importance of stronger collaboration within primary care networks or integrated care systems (ICSs/ICBs).

The compromise made by NHSE to allow those with pre-booked appointments to receive vaccinations in September stands as a peculiar middle ground, exerting further pressure on relations between general practices and community pharmacies.

This pertains particularly to services that, at this time of year, remain a source of tension within primary care. Under heightened pressure, those who feel aggrieved tend to clamour for more stringent rule enforcement in an effort to curb perceived unfairness.

Consequently, cries of 'foul play' or 'unfair treatment' become inevitable, as the perception of being unfairly treated gains traction.

The confusion stemming from this situation also filters down to patients. The question will arise ‘why did some receive flu shots while others did not?’ Justifications like ‘they booked it in August’ may well surface, accompanied by sentiments of injustice. Defending this decision becomes a daunting task for frontline healthcare providers.

The notion that the decision-making process lacked input from those directly involved exacerbates the perception of unfairness, adding to the complexity of rule enforcement.

… and what of distance-selling pharmacies…

Another significant story that emerged centres on distance-selling pharmacies (DSPs). A report by colleagues at the Company Chemists’ Association challenges the status quo surrounding DSPs, focusing on the rules governing their operations.

If DSPs are acknowledged as a legitimate contracting method within the NHS framework, then, like any other contract, they should be held accountable for fulfilling their contractual obligations.

Should any obligations be deemed inequitable, unreasonable, or non-competitive, organisations ought to lobby for changes. This pursuit is driven by the shared goal of maintaining fairness and preserving patient choice.

Achieving a level playing field for all pharmacy providers, encompassing both DSPs and traditional brick-and-mortar establishments, is of paramount importance.

Approaching the rules, legislative frameworks and service level agreements in the realm of pharmacy warrants a patient-centred, frontline perspective. This should be coupled with an awareness of commercial dynamics that often shape behaviours.

When rules seem to deviate from these principles, it becomes imperative to advocate for change within the sector. Leadership bodies invariably bring their own perspectives, but a collective responsibility to collaborate prevails.

Disagreements are natural, but the key lies in recognising that differences need not lead to conflict.

This co-operative approach stands as the most effective means to propel the entire sector forward, fostering growth and improvement.

Nick Kaye is chair of the National Pharmacy Association and a community pharmacist based in Newquay. These are his personal views.