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The Christmas spirit is evident in more ways than one for independent contractor Dilip Joshi

Wednesday, December 10

Christmas has come early for Southwark residents! After years of frustration and lobbying on behalf of Southwark contractors, commissioners have declared that a minor ailment scheme, healthy living pharmacies and paperless service management will go ahead, allowing Southwark residents to be on the same footing as their Lambeth and Lewisham counterparts in being able to access these pharmacy services. Despite barriers that have seen these and other services being blocked in Southwark, it seems the LPC participation at a public meeting and a commissioner/contractor meeting (ICP, January, p32) has reaped dividends.

Friday, December 12

I have the joy of a dental appointment this morning and I'm not sure if I would have included this in my diary were it not for the fact that, while in the waiting room, I reflected on patient perception of the two professions. Although payment is clearly attached for services rendered for both, no dentist physically handles money, whereas pharmacists commonly make recommendations and take payment at the till. This, in the patient's eye, gives a clear association between advice, recommendation and payment and introduces connotations of self-interest and shopkeeping. In my pharmacy, I make a point of never taking payment directly, instead referring patients to an assistant. My advice is always frank, suggesting the most cost-effective option or refusal of sale, if appropriate, as I am sure is the case with colleagues, but I find not handling cash enhances patient confidence in the advice given and they never feel obliged to make a purchase. Soon, a pain-relieving needle is painfully inserted into my gums and my attention is diverted.

Friday, December 19

I am reading with concern a Guardian (December 18, 2014) article about the NHS offering GPs incentives for on-site pharmacy services. The article refers to a €glut€ of pharmacists and states that pharmacists' training is not as long (implying not as good) as that for GPs, while considering how the excess pharmacists might be used by them. Provision of medicines support is suggested in the article as a service that might be carried out by employee pharmacists in surgeries. It adds that, as there are no record-sharing issues, it would be quick to implement. Political will backed up by promise of additional GP funding and patient support could bring this about.

The truth is that all this talk of using pharmacists as a cheap option for various tasks could come back to bite us by encouraging services away from pharmacy premises. I think darkly of a Doomsday scenario in which community pharmacy services (medicines optimisation, domiciliary visits, vaccinations, health checks, etc) are led by GPs from GP premises with remote medicines supply. Patient choice, conflict of interest and all eggs being in one basket, I believe, are strong arguments to resist this model, not to mention the likely adverse impact on the pharmacy network.

It is time workforce issues were properly considered so as to avoid the so-called glut in the interests of the long-term health of the profession.

Monday December 22

I read a Citizens Advice report, 'Evolving expectations of GP services', which reveals that people aged 18-34 are more than twice as likely to go to A&E or an NHS walk-in centre when they can't see a GP than those aged 55 and over. Also, only 30 per cent of younger adults rate GP service as €very good€, with one in eight not getting any professional help for a health problem when they're unable to see their GP. Of the ill-conceived walk-in centres (when investment in the pharmacy network would have yielded far better results), 50 have shut down since 2010. Gillian Guy, chief executive of Citizens Advice, says: €It is in the NHS's interest to get primary healthcare for younger adults right and ensure services fit around busy working lives. A failure to meet their needs piles more pressure on budgets and is an inefficient use of scarce NHS resources.€ I read that using pharmacy more effectively can meet this need and realise that what we have been saying for a very long time has dawned on many stakeholders who, not so long ago, knew very little about community pharmacy. The challenge now is how can protectionist barriers be broken down and self-interest given a back seat to deliver relevant and fit-for-purpose healthcare.

Thursday, December 25

I have worked with a local charity, the Ace of Clubs, for some time and was recently appointed as a trustee. It provides support to the homeless and the vulnerable through provision of hot meals, showering and clothes-washing facilities as well as learning opportunities through free courses, such as basic computer skills. I am at the charity's premises on Christmas Day for a few hours as a volunteer and help to serve meals and wash dishes. There is no shortage of volunteers of all ages and backgrounds and there is an excellent turnout with a festive atmosphere and decorations.

Some of those present are alcohol and substance misusers and considered to be 'difficult' but, as many pharmacy colleagues know, getting to know them better can be rewarding and any help provided is well-appreciated. Carols are sung and spirits are high even though no alcohol is permitted at the centre. As I leave to join my family for a late lunch, I reflect on the excellent work staff carry out to make sure these people enjoy Christmas like everyone else and who would, otherwise, have had nowhere else to go for a hot meal on Christmas Day.