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Plus and minus in December


Plus and minus in December

The month in which Christmas falls was a time of taking away as well as giving last year, as LPC chair Dilip Joshi reminds us

Thursday December 1
The dreaded cuts come into effect today in spite of our collective efforts, resulting in a flurry of activity by pharmacy organisations. The NPA has been at the forefront of campaigning, raising an unprecedented 2.2m signatures opposing cuts through community pharmacies in England.

I speak to several colleagues, whose views range from anger to disbelief. Many did not expect the cuts to be implemented as proposed, hoping for a last-minute reprieve or, at least, some concession. Some criticise our negotiators and others the campaign but, delving deeper, they admit they are looking for a scapegoat and that pharmacy organisations have generally done their best. All agree this is a gloomy day for community pharmacy and our patients.

Monday December 5
I am at a meeting called by Lambeth Local Authority to discuss commissioning arrangements for 2017. One of the commissioners, whom I know from his PCT days, informs me that, despite doing his best for community pharmacy, budgetary cuts and competition from other areas (including social services) mean there is less to spend. NHS Health Checks are to be decommissioned in Lambeth but all else would be preserved, he announces.

Of course, he says, this is subject to consultation, but it is clear that the decision is made and a ‘consultation’ has to be carried out to tick the process box! I express disappointment, as the health checks have the potential to save costs through early detection and prevention, and to promote lifestyle changes; however, there seems to be an unwillingness or inability to invest in such services. Furthermore, there has been no fee review for the past four years.

As I leave the meeting, I wonder how long community pharmacists can continue to provide services with a large measure of goodwill, hoping for wider commissioning and sensible remuneration; many I speak
to are losing heart in providing what have largely been loss-leading services, while hoping for role expansion and greater recognition as healthcare professionals.

In the afternoon, I attend a so-called Southwark Collaboration meeting to consider remodelling the stop smoking service. There are CCG and local authority representatives as well as secondary care providers – in fact, every stakeholder involved with commissioning and providing stop smoking services are there. Southwark Council’s lead proposes a new model, where a funding envelope is made available but responsibility for provision is through collaboration of other stakeholders.

After a brief introduction, we are left to work up a model among ourselves. This is a most unusual arrangement, and immediately there is jostling for lead provider position among secondary care colleagues – so much for collaboration! As complex interventions are carried out by Guy’s and St Thomas’ NHS Trust, they express a wish to lead and liaise with primary care providers such as community pharmacy to determine service specifications. GP providers, we learn, will be decommissioned from stop smoking services from April 2017. As we continue discussions around budget constraints, I wonder whether GPs will lose any sleep over being decommissioned.

Wednesday December 21
I learn that the High Court has granted PSNC leave for judicial review of the cuts decision. The hearing is to be expedited to the week commencing 6 February 2017. In response to a request for more time, a judge has indicated that, if the Secretary of State seeks a later hearing date (which would give him more time to prepare his case), the question of whether there should be a delay in the implementation of the legislation while the case is ongoing will arise.

Does the request to prepare indicate a weakness in the Secretary of State’s case? My excitement is tempered with the knowledge that judicial reviews have a low chance of success, as the burden of proof that the government has acted unlawfully is the test that will be applied. Most colleagues, however, support PSNC’s action and the announcement that the NPA will also act raises some hope.

Friday December 23
Today, NHS England issues guidance on the gateway criteria for the Quality Payments Scheme. The scheme is part of the Community Pharmacy Contractual Framework announced by the DH, where those meeting the criteria have an opportunity to receive some funding. In a classic case of taking with one hand and giving some of it back with the other, more work dressed up as ‘quality improvements’ are to partly redress cuts dressed up as ‘efficiency savings’.

For a pharmacy to become eligible for payment under the scheme, it must meet four gateway criteria: provision of at least one specified Advanced Service; NHS Choices entry being up to date; ability for staff to send and receive NHS mail; and ongoing utilisation of the Electronic Prescription Service. Further guidance on the Quality Payments Scheme will be published in the New Year.

Sunday December 25
I am at the Ace of Clubs at the Christmas lunch for centre users – on dishwashing duty this year! The usual nominal charge of £1 is waived for Christmas lunch and the centre is packed. For most, the community here is all the family they have and, without the Ace, many would be alone and certainly not enjoying a hot meal on Christmas Day.

For many of us, as the cuts bite, Christmas may turn out to be the season when we buy this year’s gifts with next year’s money, but I reflect on the plight of others who are considerably worse off and these are the very clients, often unregistered with GPs, for which community pharmacists are most needed to provide care.

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