The C word cropped up again and again at Sigma’s 11th international conference in Oman. Well, lots of C words, actually: collaborate, change, contract, cuts – to name just a few – but especially collaborate.
Community pharmacy’s place in the new NHS landscape shaped by the Long Term Plan and five-year GP contract was a recurring theme. Sigma managing director Bharat Shah summed up matters succinctly: change, make yourself relevant or get left behind.
However, calls for unity and a positive vision of change put forward by speakers on the platform stood in sharp contrast to some behind-the-scenes bickering between pharmacy leaders and a mood among delegates that was occasionally frustrated and fractious.
Their demeanour wasn’t helped by prime minister Theresa May in her traditional letter of support read out at the start of the business sessions referring to the event as the “2019 Sigma Retail Community Pharmacy Conference” (my italics).
‘Retail pharmacy’ isn’t a phrase we’ve heard since health minister Dr Gerard Vaughan’s infamous speech at the BPC of 1981. And to think community pharmacists are hot under the collar about not being considered ‘clinical’. Maybe the PM had other things on her mind…
Pharmacy minister Steve Brine, in a pre-recorded video message, said the Government was “crystal clear” about the importance of pharmacy’s role. The NHS Long Term Plan set out the Government’s ambitions to better utilise the skills and reach of community pharmacists to deliver more services and relieve pressure on other parts of the system. “These are ambitions I know the sector can deliver on.”
Pharmacy Integration Fund pilots had played a key role in helping the NHS understand how new arrangements might work through schemes such as the urgent medicine supply service (NUMSAS) and digital minor illness referral service (DMIRS). The Government will look to build on these pilots in the national contractual framework, he added.
Delegates listened politely. They had heard it all before.
PSNC chief executive Simon Dukes, also in a pre-recorded video, struck an upbeat yet pragmatic tone. He said new contract discussions would hopefully begin in April (an interim funding deal was agreed as we went to press with this issue). There would be opportunities for contractors arising from the NHS Long Term Plan, both locally with funding flows through primary care networks and nationally from a new contractual framework. “We have to grab them,” he said.
However, the sector faced capacity challenges to free up the time to deliver more patient facing clinical services. “Difficult conversations” were needed, Mr Dukes said, concerning hub and spoke and automation, supervision and delegation, and even the thorniest issue of all: are there the right number of pharmacies in the right places?
This seemed a realistic appraisal. After all, the Government’s concerns about clustering, the overall number of pharmacies (too high) and the cost of paying for medicines distribution (also too high) are well known.
PSNC director of pharmacy funding Mike Dent, again speaking on video (the conference at this point was beginning to resemble an edition of Top of the Pops circa 1984), said the committee in its upcoming negotiations with the Government will ask for a multi-year funding settlement like the GPs, with recognition of the costs of FMD implementation and a call for more timely payments since the volume of EPS prescriptions was reaching between 80-90 per cent.
A longer contract would give pharmacy owners time to plan and prepare their businesses accordingly, he said. Mr Dent also gave delegates some practical, if rather obvious, advice: “Look at your pharmacy like a business. Don’t leave money on the table. Don’t put money back into your business unless you have a clear plan and you are confident it is a good investment. Diversify your income sources.”
The trouble is, leaving money on the table is exactly what contractors are doing. Carole Alexandre from IQVIA told the conference that independent pharmacies in England claimed a measly £11.6m from a possible £24.8m in MUR payments last year.
With 93 per cent of contractors expecting their profits to drop in the coming year, as revealed by Pharmacy Magazine editor Richard Thomas, updating delegates on new reader research, this really was a case of the sector shooting itself in the (financial) foot.
Several speakers urged pharmacists to get to grips with the new localised NHS agenda. Did they know their sustainability and transformation partnerships from their integrated care providers? It was time to collaborate (that word again) with other parts of the health and care system, federate with each other and form alliances with, well, anyone, really.
North East London LPC secretary Hemant Patel described an exotic-sounding future for pharmacy, featuring population health and stratified care, shared decision-making and personalised health data. However, the nub of the matter was that pharmacy’s business model had to change as prescription numbers were predicted to drop by as much as 40 per cent by 2025.
“Pharmacy needs to change its image,” he declared. “No more rubber ducks or baby foods. The current business model, with its reliance on script numbers, is dead. With GP numbers in decline, if community pharmacy can’t fill the clinical void now, when will it?”.
Mark Koziol, PDA chairman, told the conference that the PDA is to test a new clinic pharmacy model in Dudley, backed by a local advertising campaign. The trial will look at patient-facing population health programmes, including antimicrobial stewardship, blood pressure monitoring, atrial fibrillation detection, and asthma and inhaler techniques.
Pharmacists needed to change the public’s perception of what they can do. “Three things are required: mind set, case studies and funding.” Patients will buy into the concept of pharmaceutical care, with pharmacists taking full responsibility for meeting their medicine related needs. “We need to say to the public – pharmacists can help with your medicines issues.”
A surprising number of pharmacists back in the UK broke off from Steve Wright’s Sunday Love Songs or walking the dog to follow a “leaders’ question time” panel discussion featuring senior figures from various pharmacy bodies, broadcast live via the PM website.
Unfortunately, questions sent in from Blighty didn’t reach the panel on stage, including one on why the profession’s leaders were all so male, pale and middle-aged...
Others resorted to sniping on Twitter about where the conference was being held. It was that kind of week.