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Stop worrying about unintended consequences – and deliver!

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Stop worrying about unintended consequences – and deliver!

We can talk about visions for community pharmacy all day long but they will be hard to achieve without skilful leadership, says Nick Kaye


I have been part of various panels at the Best Practice Show and Pharmacy Show over the past few months. I am always inspired by the good things that are going on up and down the UK in community pharmacy and it’s great to meet new people, or people you have only ever ‘met’ in the virtual world.

Human connection always seems to add so much when it comes to understanding another’s point of view. The topics for the panel discussions seemed to be things we have been wrestling with for a long time - supervision, hub-and-spoke, workforce, and where next for community pharmacy. 

It is fascinating to hear many different views and everyone speaks with such passion, articulating why this or that position is the right one for them or the groups they represent. You hear about the unintended consequences of the decisions we are advocating, be that remote supervision or the creation of large dispensing hubs, and what it might mean for you and me.

It’s also interesting to see people’s opinions change as they hear the arguments and become better informed. Their views are often formed by what drives their choices. Does ‘your’ position undermine ‘mine?’ Is your position based on economics, or is it a strategic benefit to improve the delivery of care for patients and communities and prepare for a different future?

If we are being honest, both things need to be true but particularly from an economic point of view for both ourselves and the organisations paying for those services. The problem in England is that we are not sure what that future might look like in 2024 when the current five-year contract framework agreement ends.

When you consider the vision delivered by the Royal Pharmaceutical Society and the work being done by PSNC, which has commissioned Nuffield Trust and The King’s Fund to develop a new vision and “strategic options” for community pharmacy, it will be interesting to see what they actually look like and how they might unify the sector.

A vision is critical for the next steps for community pharmacy in England. The vision will have to be acceptable to the majority of community pharmacists, whether they be owners or employees. It will need to be acceptable to commissioners, who are the customers for community pharmacy services, and to the patients we all serve.

Probably the hardest problem to sort out is who decides the vision? How will the stakeholder groups be brought together and, given that our sector at times seems so divided, how does ‘my’ voice get heard? Is it right to have a contract that is not based on prescription volume, with commissioning managed in a different way? Is it appropriate to add more volume-based services?

Whatever that vision is, it is right to recognise that different parts of the sector have different business models. We shouldn’t be scared of that, but bringing all those voices together in a unified vision will be essential.

It will take skilful, humble and egoless leadership and this can sometimes feel hard to achieve. Once the vision for our future is articulated and agreed, it must then be costed in a way which allows owners of pharmacies to invest in our pharmacies. It should contain a roadmap for delivery to allow for a sustainable, resilient network and workforce and, of course, delivery of first-class care.

Once the vision is agreed, maybe, just maybe, some of those difficult questions we have been struggling with such as supervision and hub-and-spoke might start to make more sense. And when it comes to panels at events like the Pharmacy Show and Best Practice Show, the discussion might be around solutions for delivering the vision rather than worrying about the unintended consequences.

Only then will we know what we are moving towards. And by that point, any fear of the unknown will be much reduced and that is no bad thing.

We all need a bit of stability in our world right now.


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

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