We live in interesting times...
The first deadlines in the five-year CPCF have come and gone – and some hard choices are being made, says Patrick Grice…
“We live in interesting times … both in terms of community pharmacy and the wider political landscape,” said Gerard Greene, chief executive of Community Pharmacy Northern Ireland, at the Independent Pharmacy Awards last month.
The event took place at Westminster where the House of Commons would be sitting the next day just down the corridor for the first time on a Saturday since 1982 to vote on the latest Brexit deal. It seems like a long time ago now…
But whereas Brexit deadlines have come and gone with monotonous regularity, the end of October has marked two genuine one time only deadlines for contractors in England. Those who signed up to the new Community Pharmacy Consultation Service can claim a transition payment of £900, while November 1 was the deadline for claiming an Aspiration payment under the Pharmacy Quality Scheme.
PSNC has been pushing hard to get pharmacists and their teams up to speed with the requirements of the new CPCS service, along with the PQS with an endless stream of ‘Checklist’ emails. So does the figure of 8,649 CPCS registrations by the 29 October deadline meet expectations? It amounts to almost three quarters of pharmacies in England.
Given the timeframe and the requirements of the 25 page Advance Service specification, contractors who are new to NHS 111 referrals will have earned the transition fee. However, over 3,500 pharmacies have been part of the NUMSAS pilot and some 1,900 signed up to offer DMIRS: that these are tested models should provide some encouragement to those who are new to such services.
But it should be borne in mind that funding for the CPCS comes from redistributing money from within the existing annual funding envelope and is only budgeted at £4m for 2019/20. The number of referrals pharmacies can expect at this stage will be low.
DMIRs referrals averaged 4.5 consultations per pharmacy over an eight month period, according to data presented by NHS England at the LPC conference in September. The latest referral data for NUMSAS indicates an average of only 2 referrals per pharmacy a month.
Anne Joshua, head of pharmacy integration at NHS England, said at the Pharmacy Show that at least 4,000 pharmacies needed to have registered by the go-live date to provide critical mass for the new service. That number has been well exceeded – time now, perhaps, for NHS England to get properly behind the service.
Much will depend on how well NHS111 call centres engage with the CPCS, and how quickly public awareness builds. It is unhelpful that the service specification says the service must not be actively promoted directly to the public by either the pharmacy contractor or the NHS.
Although the CPCS holds considerable promise for the future, it is going to be a slow burn, and will need careful nurturing.
Aspiring contractors might see the £75m budgeted for the PQS as a more immediate source of income. For Michael Lennox, the man tasked with leading on pharmacies’ integration into PCNs, the priority for contractors should be to nail bundle 4 of the PQS, the one on PCN engagement, before the February 2020 deadline.
This is, perhaps, a more onerous task, since it means teamwork and collaboration, things that do not grow overnight, and the 12.5 points on offer could earn you only £800. But PCNs do offer the opportunity to bring new money into community pharmacy from the £4.5bn earmarked for the direct enhanced services that GPs are going to have to commission. So it’s more difficult to do, but with greater potential reward.
The carrots on offer for hitting these various deadlines are in themselves small change, but the ones you focus on will determine the shape of your business in the future. So what are your priorities? Which deadlines are the most important to meet? Where do the best opportunities for you lie?
How do you best manage five years of flat funding under the CPCF? What do you say to your staff when they tell you they can get paid more by the multiple up the road without having to do ‘extra stuff’? The need to train and retain staff is ever more critical to service delivery in our brave new world.
As the realities and complexity of the five year CPCF sink in there are hard decisions to be made. Limited time and resources mean pharmacies have to prioritise. How that will manifest itself at local level will be something that LPCs need to keep a close eye. There is some unallocated funding in each year of the settlement. How it is directed will be important.
There are four home nations…
The focus on the roll-out of the CPCF means England has been grabbing the headlines yet again, and has proved that the pharmacy press is no better than our national media when it comes to recognising that that there are four home nations that make up the United Kingdom.
Mr Greene’s speech at the Independent Pharmacy Awards was a timely reminder of this. Northern Ireland is rarely part and parcel of the daily discourse in the pharmacy media when it comes to community pharmacy, he said, and rightly reminded his mainly English audience that what goes on there – and in the other home nations - is just as important for the future of the sector as what happens in England.
The NHS in Scotland and Wales has been more forward thinking and engaged more effectively with community pharmacy in recent years than England. But like England, community pharmacy in Northern Ireland has been at odds with its paymasters for some years.
CPNI has been in a long running dispute over funding with the Department of Health in Belfast, not helped by the absence of government from Stormont. Only a year ago, in November 2018, it was warning that the consistent underfunding of the community pharmacy network meant that many contractors were struggling to keep to their credit terms with suppliers and wholesalers.
The situation was so acute that several wholesalers reportedly contacted the Department of Health to warn that the ‘supply of medicines will grind to a halt’ because of the poor credit worthiness of pharmacies.
Northern Ireland has also had a long period without a chief pharmaceutical officer, but the post has finally been advertised – applications closed on September 20 – and news of the appointment is awaited.
But according to Mr Greene, the Northern Ireland Department of Health’s 10 year plan, Health and Well-Being 2026: Delivering Together, published at the end of 2016, has been the catalyst for a new service development programme that is now coming to fruition. A series of nine roadshows are under way a outlining the development work stream and the timeline for implementation.
But while the DH giveth, it also takes away. Last month the CPNI highlighted that the community pharmacy sector in Northern Ireland is facing a workforce crisis. A progressive practice based pharmacist recruitment programme, underinvestment in the pharmacy network and falling numbers of pharmacy graduates means that 400 pharmacists have walked away in the last two years and 70 per cent of contractors have been unable to fill advertised roles.
That sounds pretty scary when you consider there are only 530 pharmacies in Northern Ireland. And the worrying thing is that it is not too hard to see the same thing happening elsewhere.
Patrick Grice is the contributing editor of Independent Community Pharmacist.
Picture: YinYang (iStock)