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What the hell is wrong with NHS England?


What the hell is wrong with NHS England?

They never hold their hands up and say ‘we got this wrong’ or ‘how could we make this better?’ That speaks to organisational arrogance or obliviousness, says Mike Hewitson


The question in the title of this article is one I ask myself pretty much every day – more so when there is an entirely predictable balls-up like the flu vaccination roll-out.

Inevitably, I come back to the same conclusion. The entity that is NHS England doesn’t understand community pharmacy . It is my belief that this is mainly because none of their senior leaders has any recent, relevant experience in community pharmacy.

It might not be a popular view among contractors but I don’t think that people are evil or bad, they’re just trying to do a job like anyone else. What marks NHSE out is the fact that they never hold their hands up and say ‘we got this wrong’ or ‘how could we make this better?’

That either speaks to organisational arrogance or obliviousness. You may say ‘so what?’ After all, none of this is anything new. I’ve written about this for what feels like the last 15 years.

What’s different is that next year is likely to be an election year. And it is likely to be an election where we get a change of direction. The problem is that NHS England are almost entirely unaccountable to anyone.

It is independent in that it has its own Board, it has a budget set by the Department of Health and Social Care, it publishes accounts and an annual report. But it isn’t really accountable to anyone.

The Secretary of State can set a mandate, a wish list of things that he would like it to achieve, like a balanced budget. But there is no real sanction if they do not deliver. I’m an elected Councillor and if residents of my division aren’t happy with how the Council works or the representation they receive from me, they get to sack me at the next election.

NHS England can carry on regardless of performance and there is very little that anyone can do about it. Public satisfaction with the NHS is at its lowest ebb since the service was founded, and the government will be held accountable for that at the ballot box.

It will be the Secretary of State who will find himself getting an electoral kicking for the performance of NHS England, which he has very little power over. I can’t see the next government wanting to continue with this crazy set-up. They will want more direct control because they will need to make changes to ensure that the service survives and they will ultimately be accountable to the electorate.

Coming back to the pharmacy team, they seem utterly terrified of a pharmacy service that is too successful. You can see why. What a terrible thing it would be if we saved more GP appointments than we said we would, or if people got access to treatment sooner than expected.

NHS England is hosing general practice with money 

I get that there is only so much resource to go around, but NHS England is hosing general practice with money and people in an effort to keep it afloat. What I can’t understand is why they don’t see community pharmacy as another leg of the primary care stool.

Hurting pharmacy just ends up hurting general practice in the long run. An example is where a drug is out of stock but available as a more expensive brand. Rather than trust us to sort it out reasonably as professionals, we have to contact the surgery and get the prescription changed, which adds more workload to the practice and the pharmacy and it saves precisely no money because the patient ends up with the brand anyway.

We’ve got to look at how the contract can be tidied up to reduce unnecessary workload and friction. For anyone that has spent any time in pharmacy recently, all of this stuff makes absolute sense.

I sometimes speak to colleagues who haven’t been in a community pharmacy in a while and universally they tell me how surprised they are at how much more difficult things are now. If we can get senior NHS leaders into a community pharmacy on work experience, it would go a long way to getting them to understand what is wrong with the system and what can be done to make it better.

Community pharmacy feels broke in every sense of the word. We need a new approach and fresh leadership to show what we can do to alleviate the pressures on other parts of the NHS. But we can only do this if our doors remain open, which is far from a given right now.

It would be encouraging if NHS England looked like it understood the extent of the challenge facing community pharmacy and was more welcoming of new ideas.



Mike Hewitson is a community pharmacist based in Dorset and a council member of Somerset Council. These are his personal views.



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