Lots of contractors are expressing the view that they are ‘not ready’ for Pharmacy First because they don’t have the headspace to think about the service and its implementation, says Nick Kaye…

A new year and new hope. Will 2024 finally see community pharmacies in England recognised for the hubs of clinical care and medicines supply expertise that they are?

We see the devolved nations enjoying an uplift in their global sum, most recently five per cent in Wales for the first time since 2015. We see pharmacies who sign up to the Pharmacy First common ailments service receive a £2,000 upfront payment on top of monthly and individual consultation payments, which will allow pharmacy owners to plan for the start of the service.

Maybe, just maybe, the start of 2024 will bring hope. But just as hope begins, the announcement comes that the clawback for January will cost us a business as much as the set-up fee for Pharmacy First, if not more. Now, I know these two payment mechanisms are different but somehow this doesn’t feel right.

In the real world of business, what happens is the total income will have to be taken into account when it comes to the safe running of the pharmacy and the paying of essential bills, from energy and wholesalers.

Although this is the true picture of what happens in the real world and despite the financial stresses of running a business, the funding that is allocated for safe time to train for Pharmacy First means that this training and preparation will still be done. But it will be done late at night or during a weekend when we should be spending time with family or de-stressing (if that is possible as a pharmacy owner) and that cannot be right.

I believe this is part of the reason that lots of contractors are expressing the view that they are ‘not ready’ for the service. I think this is due to not having the headspace to be able to think through the service and its implementation.

I genuinely don’t believe that it’s our clinical decision-making that will be causing any worry. As a pharmacist who worked for five years in general practice, I know our clinical skillset as community pharmacists is absolutely transferable and now NHS England is directing patients into community pharmacy rather than pushing them into GP surgeries.

We will be able to deal with the seven clinical conditions under Pharmacy First but we will also be worried about how to operationalise the service whilst dealing with the pressures of running our pharmacies.

Pharmacy First and the way our finances work (or don’t work) must get us thinking as contractors about the way we are paid, which hasn’t changed since the inception of the NHS, and what we are commissioned to deliver to patients as the five-year contract in England is coming to an end. Community Pharmacy England must be starting negotiations for our new deal, so how do we think that will look?

I suspect more services but what will those services be? Will local innovation be used to drive national services? Will they make use of independent prescribing?

What could new services look like? More on-the-day demand like Pharmacy First or would it be long-term condition management? If we make Pharmacy First business as usual, we will then be in a place to deliver more services because we will have an understanding of how to optimise service provision.

Should there be more money for dispensing even though we are told again and again that there is no more money for dispensing? It must be said, of course, that dispensing under the current deal is not viable, so should we have an increase in fees?

What about the £800 million margin? Do we understand the way margin is distributed? As far as margin distribution in concerned, we think we are winning because we all think we are fabulous at buying. But actually, at least 50 per cent of us will be losing because that is a sector average, not an independent average. Margin distribution is broken and we should be brave enough to look at something different.

Just think about that and let it sink in. In a contract of averages, at least 50 per cent are underpaid. Most of us used to feel like we were in the 50 per cent overpaid but if we are being honest with ourselves, it now feels like we are under the 50 per cent line.

There are so many questions for our profession to consider but do we have the time to answer them? We have a burning platform of underfunding and increased demand. We are seeing businesses fail, small, medium, large and multinationals. No-one is immune from the financial strains of the current contract in England.

The core contract is broken. We need more investment into the core contract but should there be more predictability in our funding model as we move forward? Is it time to start thinking differently?

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