As the review steering group ploughs on with its reforms, there is a risk the new arrangements could build in a perpetual majority for the multiples within PSNC, says Sanjeev Panesar…
 
 

Independent pharmacy contractors spin many plates at once and sometimes it can all feel too much. We have to think about our patients, staff, paying the bills, complying with environmental and business regulations, Covid security, developing new services, relationships with the local NHS and our suppliers. Oh yes, and engaging with the review of pharmacy representation in England.

The review is important. Everyone will benefit if PSNC and LPCs sort out an end-to-end form of representation that positions the sector effectively at local and national levels. What is more, the PSNC and LPCs cost on average £1,000 a year per pharmacy in levy deduction payments and they deserve to get best value from every penny.

But that is a plate someone else could be spinning on independent contractors’ behalf - if only that were allowed. I’m referring to the National Pharmacy Association, which has the vast majority of independents in its membership and is a strong representative voice for the sector (note for example NPA’s work to secure a process for repayment of Covid costs).

The NPA has given a lot of thought to the review and set out some eminently sensible principles about the way forward. They include continued investment in local leadership, equitable governance in any new structure, reform of the PSNC mandate and accountabilities (focusing PSNC more sharply on negotiation of the national contractual framework) and improved transparency in relation to expenditure.

Yet the NPA’s request to formally represent independents in the review process was denied. In contrast, the Company Chemists’ Association and Association of Independent Multiple Pharmacies do have places on the review steering group (RSG), giving them a distinct advantage.

This has led to a process which is unbalanced and has the potential to disenfranchise independents in future arrangements. For example, the vast majority of independents have found it hard to find the time to attend RSG focus groups.

The proposed voting mechanism means a very small number of large pharmacy businesses could outvote thousands of independent contractors. The NPA has suggested that an absolute majority of all eligible independent voters should approve any new structure, as well as an absolute majority of multiples, in addition to a two-thirds majority overall. This so-called ‘triple unlock’ is designed to ensure a cross-sector mandate for change.

If you asked an independent and a multiple to write a wish list for pharmacy most of it would be the same. Yet the characteristics, experiences and needs of independents are significantly different from national multiples in many important respects. That’s why their distinctive voices must be heard, respected and reflected in governance locally and nationally.

Unfortunately, looking forward, there is a risk that new arrangements could build in a perpetual majority for the multiples within PSNC. What’s more, equity is not just about having the right number of seats around the table - it also means independents having the same level of back office support for representation as the multiples enjoy.
 
 
Sanjeev Panesar is a National Pharmacy Association board member.
 

NPA principles on the Representation Review:
·      The voices of independent contractors must be properly heard in this process, by getting the explicit consent of the independent sector through a fair vote. The NPA has been arguing for an approach which requires a clear majority of each part of the sector to be committed to whatever changes are proposed.
·      Continued investment in local leadership. Costs released from streamlining the network of LPCs should be re-invested in local support and representation. The NHS has begun to move decisively in the direction of commissioning for population health needs at a local level.
·      Equitable governance in any new structure, to ensure that the voices both of independents and multiples are fairly represented in local and national leadership.
·      Reform the PSNC mandate and accountabilities, focusing PSNC more sharply on negotiation of the national contractual framework, which is in desperate need of reform.
·      Better define ‘what good looks like’ for a contractor in terms of what they get for their levy investment into PSNC and LPC; and improving transparency and accountability in relation to its expenditure.