Presented with a fait accompli
A dogâ€™s breakfast thinlyÂ camouflaged by cynical protestations that pharmacy must take its fair share of the burden of health efficiencies
Our correspondent is in despair over the governmentâ€™s treatment of community pharmacy in England
It was gratifying to see the media coverage of the governmentâ€™s cost-cutting measures for community pharmacy this past week or so. No matter that the spokeswoman from Pharmacy Voice onÂ Radio 4â€™s Today programme seemed a bit nervous, the message was clear: community pharmacy is facing big cuts and pharmacies will close.
Establishment payments will reduce from December, with a 12 per cent cut in the global sum from December to March, followed by a 7.4 per cent cut in 2017-18. The pharmacy minister, David Mowat, calls them â€˜efficiency savings.â€™ They are weasel words.
The government is not interested in efficiency. If it were, it would acceptÂ the findings of the recent report by PricewaterhouseCoopers (PwC), which estimated the direct value of community pharmacy services to the NHS at Â£3bn. In an earlier report (2010) â€“ commissioned by the DH â€“ PwC presented its findings relating to the costs of community pharmacy.
The costs for the average pharmacy were Â£3.03 per item. The proposed cost cuts will mean that, six years later on, our funding will be well below this level.
Letâ€™s be clear: what this government wants is to close pharmacies, but its doesnâ€™t have the decency to be honest about it. In 2015, the chief pharmacist said there were 3,000 too many pharmacies. How many will be left in 2018 is anybodyâ€™s guess, because thatâ€™s what all this is based on.
There isÂ no rationale, no modelling, no evidence that the cuts will achieve â€œefficienciesâ€. David Mowat has said that the community pharmacy sector does not do enough to â€œpromote efficiency or qualityâ€. Really,Â Mr Mowat? Do you have evidence thatâ€™s different from the PwC report? If you do, why donâ€™t you show us? And if you want efficiencies, why donâ€™t you just come out and tell us what efficiencies you want?
On top of this there is the insulting Pharmacy Access Scheme, which will provide support for one in 10 pharmacies. The criteria for inclusion or exclusion are completely arbitrary.
Pharmacies in the top 25 per cent (by dispensing volume) are automatically excluded. Why? Why notÂ the top 50 per cent? Pharmacies that are located more than a mile from another pharmacy will be automatically eligible. Whatâ€™s the rationale? Whatâ€™s the difference between 1 mile and 0.95 miles? Distance from another pharmacy is no measureÂ of patient need, especially when most pharmacies deliver medicines anyway.
In a shoddy attempt to create a smokescreen, David Mowat pre-empted news of the cuts by announcing a scheme to promote an urgent repeat supply role. If this is so important, why undermine it before it even starts? It beggars belief.
I applaud the response from PSNC. They are talking tough. It will get us nowhere, but then, I donâ€™t think anything will. PSNC has rejected the proposals unequivocally and detailed 16 objections to the Pharmacy Access Scheme.
In an open letter to theÂ DH, Sue Sharpe pointed out that the cuts will have a disproportionate effect on low- volume pharmacies in areas with the highest health needs. â€œThey would see funding reduced by over 10 per cent next year, at aÂ time when the NHS has said that efficiency targets of 4 per cent are too high to be achievable, and has reduced targets to 2 per cent. This cannot be right.â€
Iâ€™m less impressed with the response from the RPS. A statement from Sandra Gidley, chair of the English pharmacy board, on the RPS website, offered, at best, a lukewarm condemnation of the governmentâ€™s proposals. She said that the profession had spoken with one voice. She could have said, as Pharmacy Voice did, that the proposals were â€œincoherent, self-defeating and wholly unacceptableâ€, but she didnâ€™t. Instead she said: â€œWe have consistently asked how the governmentâ€™s aspiration for the future of community pharmacy to be at the heartÂ of the NHS can be squared with large reductions in funding.â€ Nice to see such unstinting solidarity. Thanks for that.
What we have is a dogâ€™s breakfast thinly camouflaged by cynical protestations that pharmacy must take its fair share of the burden of health efficiencies required between now and 2020. But the proposed cuts are nothing to do with taking ourÂ fair share.
As the PSNC letter makes clear, the DH was asked for the rationale and evidence that would enable an informed consultation to take place; however, no evidence or rationale was forthcoming, only the oft-repeated mantra of efficiency. PSNC even put forward its own proposals to involve community pharmacy in reducing burdens on other parts of the NHS, including reducing the costs of medicines.
These proposals were rejected because the benefits would accrue to CCGs and not to centrally held funds. PSNC noted: â€œUnlike the collaborative working that characterised previous negotiations with you, we have been delivered a fait accompli.â€
This decision is NOT about improving the efficiency of community pharmacies, itâ€™s about closing them. Why, I have no idea, other than the view I have expressed before that the government is bent on destabilising the NHS in preparation for privatisation.