In Views

Follow this topic

Bookmark

Record learning outcomes

Working within the new NHS landscape is, without doubt, becoming more difficult, especially for the independent pharmacist. The NHS efficiency savings figure of £20 billion is now up to £30 billion and likely to continue its upward trend, yet pharmacy is expected to deliver its core contractual obligations with a funding settlement that's unlikely to change. In real terms, we're going to be delivering more through essential and advanced services in our core contract with NHS England while earning less.

Working within the new NHS landscape is, without doubt, becoming more difficult, especially for the independent pharmacist. The NHS efficiency savings figure of £20 billion is now up to £30 billion and likely to continue its upward trend, yet pharmacy is expected to deliver its core contractual obligations with a funding settlement that's unlikely to change. In real terms, we're going to be delivering more through essential and advanced services in our core contract with NHS England while earning less.

At the National Primary Care Network meeting this month, discussion focused on the delivery of these savings through innovation, new methods of commissioning and even federating GP and pharmacy groups. Key NHS England speakers heard how 98 per cent of pharmacy income is derived from our medicines supply function and just 2 per cent from clinical services. One delegate went even further, suggesting community pharmacies as we know them today may become a thing of the past in much the same way as bookshops and libraries.

Have we ever considered that people could get their medicines from Amazon following a visit to their GP? Amazon-employed pharmacists, operating from a central management hub and linked via Skype or telephone, could provide patients with all the necessary advice for their medicines.

It's a fairly shocking prospect to the traditionalists among us but it does highlight one glaring weakness in our profile. Community pharmacy, now more than ever, needs to show increased value for the NHS investment into our sector and we need to prove we are more than a medicine supply function.

Considering the conundrum

And this is the conundrum now facing us, particularly in independent pharmacy. How do we show increased value to the NHS when 98 per cent of our income is derived from our supply function and we don't have the time to show the added value we are capable of delivering?

To me, the answer is simple. We need to work together and create a network of local and national pharmacies that can achieve the necessary economies of scale. The NHS is not cash rich and, therefore, now demands more for less. It wants quality services and better patient outcomes without spending additional money.

In Leicestershire, I've done just this by instigating an independent contractor meeting to discuss the merits of federating to create a legal commercial entity. The initiative originated as a response to the announcement of the first any qualified provider (AQP) procurement process for a clinical service commissioned by the county's three CCGs. Looking ahead, it's going to be almost impossible for a single-handed independent pharmacy to devote the time and have the expertise to complete the arduous tendering procedure.

"The time has come for us to operate as a network of organisations, leaving behind our silos of the past"

How to work together

With more than 40 representatives from 50 independent contractors across the county attending the meeting, I was convinced there's a desire and willingness to achieve more positive ways of working for the benefit of our profession. The meeting was on a freezing Monday evening, but the interest was genuine. And there are options available, as confirmed by the senior accountant advising us of the legal entities available and their tax implications.

Should we become a limited company or a 'social enterprise'? What's the difference between a community interest company (CIC) and a limited liability partnership (LLP)? How will the members of this organisation benefit from such a cooperative? How should we structure the organisation? How much will it cost and will it be worth the investment? There were almost too many questions to answer in the time available. The most important outcome, however, was the fact that we were engaged in one room discussing our options and, most importantly, our future.

The meeting was chaired by an impartial senior university lecturer in pharmacy, with a thorough knowledge of the independent pharmacy business. Her academic and professional experience allowed her to command the respect of all those present and she chaired a constructive and well-balanced meeting that gave every member the opportunity to voice their opinion and ask questions.

The intense discussions were followed by a vote on whether those present wanted to create a legal entity. The outcome was unanimous and we are now pursuing the route of federating into one legal commercial entity that will work for the common good of its members.

The Lincoln approach

As Abraham Lincoln said in his Gettysburg address: €... of the people, by the people, for the people...€. For me, it's €of the independent, by the independent, for the independent€. We can work together for the common good of NHS value for money and to achieve the necessary economies of scale that will allow us not only to survive but also to prosper in the brave new NHS world.

It felt like a historic decision for the future of our profession locally, and work has begun to breathe life into an organisation representing the interests of its members. Structure, financial support and a mandate approved by all members are fundamental to any successful federation.

But this is the beginning of something I believe was inevitable. There is no new money. Independent pharmacy has to raise its game and show more value if we're to stave off the threat from multi-national corporations. The time has come for us to operate as a network of organisations, leaving behind our silos of the past.

As one director of public health recently told me: €I simply cannot and will not expect my local authority legal team to issue 257 individual pharmacy contracts for just 3,000 stop smoking quits€. You do the maths.

If you're interested in federating and want to find out more about the process, contact me at mukesh@pharmacynorthamptonshire.co.uk.