In Health & NHS

Follow this topic

Bookmark

Record learning outcomes

The chief pharmacist at an integrated care board (ICB) in the north of England has warned uncertainty around the community pharmacy and general practice contracts risks impeding pharmacists’ attempt to establish themselves in the Government’s neighbourhood health service as enshrined in its 10-year NHS plan.

Ewan Maule, the chief Pharmacist and director of medicines and pharmacy at North-East and North Cumbria ICB, told the Clinical Pharmacy Congress on Friday that as the British Medical Association ballots doctors on strike action, there was “no chance of a GP contract having any more clarity that helps (pharmacies) in local conversations”.

“We’re going to keep dealing with this for a long time,” Maule said, speaking in a personal capacity on strategic commissioning in the NHS.

He insisted pharmacy’s “best opportunity” to “develop into important parts of the neighbourhood” was through local commissioning. He urged local pharmaceutical committees “and others around the community pharmacy landscape” to build “really good strategic relationships with integrated care boards”.

However, he warned that with talks on pharmacy funding for 2026-27 still ongoing and a “vague” contract being “imposed” on GPs, collaboration between the two professions in local neighbourhoods may become harder to achieve.

“We know the GPs are going to undertake collective action. They’ve done it before and we know it’s going to happen again because there’s a contract that’s been imposed on them,” Maule said. “What that means is they push back on work they perceive is unfunded and the problem is it’s impossible to say what’s unfunded in the GP contract. The way it’s written is so vague.”

He added: “Because those negotiations are so difficult to have at a national level – and Wes (Streeting) seems to have decided he’s going to take on the BMA – there’s no chance of a GP contract having any more clarity that helps us in local conversations.

“That’s going to have an impact on the interface and that’s going to have an impact on other sectors of care. My worry is we’re going to start seeing this from community pharmacy as well because again, there’s a contract negotiation ongoing, we don’t know what the outcome of that is going to be.

“We all know and we all hear regularly from our community pharmacy colleagues how difficult a business that is to run. So, we’re going to see more tension at the interface. One of the ways this is going to play out is in neighbourhoods.”

Power struggle

Maule also warned a “power struggle” between GPs and Foundation Trusts (FT) over who runs neighbourhood health services in communities across England could ensue. That, he said, would impact pharmacies.

“GPs think they should be running the neighbourhoods, FTs think they should be running the neighbourhoods. There’s a feeling that FTs have got big, comprehensive back-of-house functions that can do a lot of that kind of work,” he said.

“But if you say to a GP their local Trust is going to be running the neighbourhood, then that doesn’t land well. Then think about, not just community pharmacy, but the voluntary sector and everybody else who provides stuff…how do they fit in with all of that? That’s going to be a total power struggle.”

Loss of organisational memory and expertise

Last month, Nick Hunter, the chief officer of Community Pharmacy Nottinghamshire and Derbyshire, said pressure was increasing on LPCs because there were “very few people with any community pharmacy expertise left” in ICBs.

Labour is cutting 18,000 posts in ICBs, including pharmacists and pharmacy technicians in medicines optimisation teams, which it said will generate more than £1 billion for frontline patient care.

When asked if a lack of pharmacy expertise in ICBs will hinder LPCs’ attempt to build relationships with ICBs, Maule said: “There are barriers. The key to me is less about the number of people. That is a challenge and it’s really difficult. We are losing a lot of organisational memory and expertise.

“But what we still have is pharmacy leadership and relationships. So, there’s a difference between the people doing the work and people understanding that the work needs to be done directing others. 

“I would much rather we weren’t losing the number of people we are for all sorts of reasons but as long as what is retained is still a professional voice for pharmacy that is influential, we will still be able to do that kind of stuff.

“Let’s say, for example, an ICB has only got one pharmacist in it. As long as there’s enough people listening to that pharmacist, then we can still be very influential. So, I would say it’s not ideal but I wouldn’t say all hope is lost.”

Maule said although “pharmacy and medicines still doesn’t look like it’s at the top table” in ICBs, he was not “terribly bothered we’re not sat at board level”. ICB boards typically have 11 to 24 members and bring together leaders from the NHS, local authorities and partner organisations to manage local health services.

“Every board has a chief medic, chief nurse, chief finance officer. There’s not a chief pharmacist on any execs or boards as far as I can see and that feels like a gap to me,” Maule said.

He added: “I don’t aspire to be on the board. It’s a crap job. Being on an exec, being on a board is a really rubbish job. I don’t want to do it. But I use it as a kind of shorthand and a proxy for influence with authority where you can say ‘I am the...insert title here…’ therefore, stuff happens because I tell people I need stuff to happen.

“There’s a difference between that and influence without authority. Influence without authority is where our profession has let ourselves down. We’re experts but we don’t apply that well enough to influence.

"What I’m bothered about is when people don’t listen to us. But if people don’t listen to us, it’s not their fault, it’s our fault. There’s so much good stuff happening in pharmacy but we’re also very internal-facing.

“We’re still not very good at telling the rest of the world…being smarter, being cleverer, being more influential in the way we make stuff happen. That’s a really big gap for us.”