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Wouldn’t it be great if commissioned services in community pharmacy were not dependant on referral or any other part of the health system, says Nick Kaye…

The weather is changing and as I write this, I’m in the middle of a yellow storm warning. It’s not great when you are about to get on a plane, which, as can happen in these situations, has been delayed.

Sometimes, owning a community pharmacy can absolutely feel like we are in the eye of the storm and it’s much-needed change that gets delayed.

We are balancing funding issues, staffing issues, patient expectations, clinical questions and medicine shortages but, ironically, it’s often right at the heart of the storm where we find things are the calmest.

It never ceases to amaze me how we manage this situation. Your resilience constantly astounds me because these are massive issues that we all deal with on a daily basis.

Now, as the next round of funding talks begin in England, we are facing what I believe is the biggest single shift in workforce in over a generation. The fact that all graduates will be independent prescribers (IPs) means 4,000 new prescribing pharmacists this year and every year from now on. Quite frankly, 4,000 is seismic.

I was speaking to a pharmacist the other week who was one of the first IPs. He got his annotation 24 years ago and national systems have been wondering what to do with this skillset ever since.  

Scotland and Wales have led the way and hats off to them. England is following suit with the IP pathfinder sites but what next? This is a really big question and starts to raise the bigger questions about all of our national NHS contracts.

If you are an IP and maybe involved in some private services, I’m sure your eyes have been opened to the value the public place in our skills. I use the word ‘value’ deliberately.

It’s about the value in seeing a clinician quickly who can serve their needs more than 80 per cent of the time. It’s about financial value too. I have been surprised that people are willing to pay £30 for a consultation for advice which, in the past , I would have given away for free.

We as professionals need to value our skills more and yes, I know, this can feel uncomfortable because we’ve been brought up in a system which is free at the point of delivery.

But, of course, the NHS is not free. We all pay for it. However, this does raise questions about the way in which our national contracts are funded.

I’m certain, given the way the NHS 10-year pan is being focused, that community pharmacies will move away from dispensing to a service-base role.

So, what does that mean? Dispensing is and will continue to be a core part of what we do but the way we get paid for it will fundamentally change in my view. I think the single actively fee will stay but margin will be, and should be, reduced or removed.

The challenge is can we say, as independents, that a contract which is based on averages works for us? We may think it does but is chasing pennies off dispensing items a good use of your time?

I would say no. We should commission services that are not dependant on referral or any other part of the system to implement. Yes, I accept that we should accept referrals but this can’t be the only gateway to access services.

I believe fundamental change over the next three years is coming. I think more and more pharmacies will blend NHS and private services, so the question is ‘are you ready for this?’

Do you have a team around you who can help you take advantage of supervision changes and service delivery? I completely accept that when you are in the eye on the storm, it’s hard to think about these things, but we all need to be ready to adapt and survive.

I know we can rise to these challenges. Sometimes, when we can see that change is coming, we forget how far we have come as a profession.

I’m not scared to admit I’m 50 this year. I qualified in 1998. At that time, there were no consulting rooms, no vaccinations, no electronic prescription service, very little in service income (maybe truss fitting) and no prescribing.

We have embraced these changes and done them well for the most part. Moving to a service-based contract is the next challenge to be embraced and overcome.

Nick Kaye is a National Pharmacy Association board member and pharmacist based in Newquay. These are his personal views.