LPC chair Dilip Joshi is pleased to get some good news for a change – the backtracking on hub and spoke

Thursday June 2

Continuing with its nomadic existence, Pharmacy London meets today in London Councils’ offices at 591⁄2 Southwark St (shades of Harry Potter). Strangely, it is cheaper than hiring a room at the RPS’s new premises, even after members’ discount.

We have a dilemma. Some see Pharmacy London as the pre-eminent organisation for pharmacy contractors across London in both a representational and negotiating role. In recent times, it has done both. NHS England has used PL for disseminating information and negotiating the vaccination service. However, increasingly, NHS England has been using our meetings as reason for cutting other engagement at local level.

We make a bold decision to invite NHS England to meetings on specific issues and, in order to fulfil their requirements to consult with pharmacy representatives, they will still need to arrange local meetings at ‘cluster level’. NHS England needs to work as an equal partner and not as if it has the upper hand.

Tuesday June 7

Some good news at last: the government has backtracked on hub and spoke. In a mealy-mouthed retraction, we learn that the enacting of legislation in October of this year has been suspended pending further investigation. This does not mean the issue has gone away but advisors who were relied upon when the unequivocal assertion was made to go ahead with hub and spoke must be in an uncomfortable place.

I wonder if this means ministers might feel ‘advice’ around cuts and other proposals also becomes questionable? I know this has not simply come about by a change of mind; rather, it is due to significant modelling work and pressure by pharmacy organisations, led by the NPA, pointing out a mismatch between draft regulations and the narrative of the ‘consultation’.

Wednesday June 8

I attend a PSNC chairs and chief officers meeting at the swish premises of the Royal College of GPs at 30 Euston Square to hear an update from Sue Sharpe and her team at PSNC on recent developments. It is the last public meeting for Steve Lutener – he is being replaced by Gordon Hockey, also a pharmacist with legal qualifications, as head of regulation and support.

I have known Steve for a long time, through my PSNC and LPC memberships, and he has been wonderfully supportive of LPCs. We collectively express heartfelt good wishes for a happy retirement.

Our briefing is largely depressing, with threats to establishment payments in order to reduce pharmacy numbers. Goodwill values, tax avoidance allegations for some large multiples and recent reports on staff bullying have added to negative perceptions of pharmacy; and accusations of ‘commerce before care’ are made openly.

Many of these relate to larger players but it seems we are all tarred with the same brush. The big threat, however, is a potential massive shift towards remote dispensing purely based on savings per item for delivery. The ‘spoke’ is a red herring as there is no requirement for spokes under the proposed arrangements. Clearly, the benefit of pharmacies and the opportunity of delivering other services are not high on the agenda and results of this dangerous experiment may not be realised until numbers of pharmacies are greatly reduced.

Friday June 10

Dr Margaret McCartney, a Glasgow GP, writes in the BMJ (June 6): “Community pharmacists should work directly for the NHS, mainly in general practices, and not in private chemist stores. This intervention would be radical and unusual, directing people back towards the NHS rather than to private business.”

She goes on to mention seeing a sign, in “official NHS Pantone 300 blue”, offering NHS services such as stop smoking and repeat prescription orders in a pharmacy which is also doing “brisk trade” in products without good evidence of effectiveness. She declares: “The sign might say ‘NHS pharmacy’ but it is Pantone 300 blue lipstick on a corporate pig.”

This vitriolic attack must be an attempt to provoke a reaction, it seems to me, rather than a real belief in the assertions made. GP access does not compare with that of community pharmacy. Many GP surgeries close at weekends and also at lunchtime and on some afternoons. Waiting times to see a GP can be up to four weeks. Furthermore, in our area, pharmacies carry out more EHC consultations and supply than all other agencies combined, and uptake of flu vaccinations in pharmacies has been popular due to convenience. Patients rely on community pharmacies to provide immediate advice, support and specific services to reinforce the care and treatment initiated in primary and secondary care.

As for range of products, this offers choice and meets the needs of an open society, even if health benefits have not been fully established. A pharmacist is always present to provide advice.

Tuesday June 14

Today, I receive a letter from NHS BSA for doing 401 MURs. Is this a congratulatory note on helping patients to better understand and use their medicines? Sadly not. It is a factual letter informing me that the BSA is authorised to recover the fee for the one MUR that exceeded the target of 400.

At least this is a much softer stance than one adopted two years ago when a colleague received a threatening letter implying a false claim and mentioning NHS recovery action. His crime: carrying out 403 MURs! This, once again, raises the quality versus quantity argument – an arbitrary cut- off could disadvantage patients that would benefit from an MUR. On the other hand, a push for numbers by some organisations (as seen in the press recently) without ensuring quality is likely to be counterproductive when considering continuing or expanding the service.