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Although the rate of pharmacy closures has slowed, we have lost an additional 70 contracts in England. That may not sound like a lot but when you consider we only have 89 for Cornwall and the Isles of Scilly, this is significant, says Nick Kaye…

It’s coming round again to the time of year when rumours start to fly about what the NHS contract in England will look like as the spending review draws to a close and the Department of Health and Social Care gets its spending allocation.

What will it this mean for us all? A closing of the gap between our current envelope and the independent economic review? A reasonable uplift or an inflationary rise?

I have no site of the offer or any inside information and even when I was National Pharmacy Association chair, I learnt of the current deal just two hours before the pharmacy press.

But my fear is that the narrative will come from the Government that we had a 19 per cent rise last year and we can’t possibly do the same again, even though after 10 years of stagnation, that is exactly what is needed.

It’s possible that readers may think I’m being pessimistic which is unusual for me. Who knows? A great deal may come. I certainly hope it does but we should plan for the worst and hope for the best, taking steps in our businesses to make sure we are braced and ready.

Significant impact on communities up and down the country

It's really sad to say that even though the rate of pharmacy closures has slowed, we have still lost an additional 70 contracts in England, which may not sound like a lot but when you consider we only have 89 for the whole of Cornwall and the Isles of Scilly, this will be having a significant impact on communities up and down the country.

If we do get a challenging settlement, we need to ask ourselves why? Did we not make a good enough case? Is there just no more money?

Having seen all the hard work lots of colleagues do across all leadership organisations in pharmacy, I would say the case for community pharmacy has been made and proven again and again.

Is there no more money? Well, maybe. Or maybe there’s no more money for what we currently do. Is it time to have a genuine look at the community pharmacy contract in England?

Does margin work for us? I believe it doesn’t work for the smaller pharmacy owner. It’s an average system and if you have a large estate, you can ride those averages but if you have one pharmacy, you can be at the complete whim of prescribing in your area and that will decide if your pharmacy is viable or not, which is fundamentally unfair.

So, should we be looking at what the government wanted to achieve for the population? We know it wants care closer to where people live. We know if you give pharmacy money, if we are in charge of our own destiny, then no referral is needed to deliver a service.

The government wants more primary care appointments, so why not a system where the NHS buys our clinical capacity? We will pay you for 10 or 20 appointments a day and if they are filled, great, but if not, a part payment is still released so we can cover our costs.

What about a Pharmacy First without referrals? We don’t have to reinvent these services. They are happening now at local levels and in our devolved nations.

So, as we enter the silly season of ‘guess what our contract will be’, I would again urge independents to plan for another difficult time ahead for the NHS contract. But then maybe we should think about whether our contract needs repurposing away from margin and into something else.

My final challenge to independents would be if the NHS is not going to keep us viable, then what next? I have been amazed in the way private services are now being embraced across the UK, with over 3,000 new pharmacists qualifying this year as independent prescribers.

Community pharmacy is now a place for care to be delivered and if the NHS won’t pay us to do it, then you know what the public is starting to want more and more. Where do you think you should spend your time? On an NHS contract that is struggling to keep you afloat or services that can decide your own margin?

But please, please don’t undervalue yourself. And if you are not doing private services, then start.

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