By Alexander Humphries*

A new member of staff recently asked me how some brown stains had come to mark the ceiling of the dispensary. It was odd, she said, because it is a very high ceiling.

I’ll tell you the story in a minute, but it got me thinking that sometimes it is difficult to explain how we got to a particular place as the evolution gets buried by layer upon layer of dust. The pharmacy contract is like this, built layer upon layer until it is almost unrecognisable from what it was intended to be at the outset.

The 2005 contractual framework may not have been perfect, but it was a start, something to build on as pharmacy embarked on its journey towards a service driven model and the sunny uplands of clinical care.

Stunning myopia

Sadly, the upside we were sold has never materialised thanks to the Department of Health and then NHS England consistently acting with stunning myopia. The goalposts have been constantly moved, along with a stubborn refusal to unleash the full potential of the community pharmacy network, settling for piecemeal pilots and localised commissioning.

Time and time again we have walked up the mountain with white papers, reviews and promises from ministers, and each time we have ultimately returned empty-handed.

We need a new contract with new and better mechanisms that reward pharmacists for doing things that help patients and the wider NHS.

For instance, I’m fed up of giving free consultations to people referred to us by NHS 111. A packet of paracetamol or some emollient cream doesn’t cover the cost of 10 minutes of my time. The NHS might not want to pay for what is euphemistically called ‘self care’, but it isn’t really self care when it requires us to direct patients to what they need.

No other part of the system accepts referrals without the corresponding funding. Pharmacy should be no different in this respect. Our main strength is our accessibility, but with that we have become demystified to the point where commissioners don’t respect what we do or value the vital function we perform.

Elephant in the room

Any new contract has to tackle the big elephant in the room: the greater cost of providing care to older people.

As an example, pharmacy gets castigated for providing monitored dosage systems, which are by no means perfect but definitely have a role to play in helping patients, even if the powers-that-be look down their noses at them.

Right now, the local medicines management police say “thou shalt not ask for seven-day scripts”, which is fair enough if they paid properly for the pharmaceutical care of older people. But they don’t. In some cases they even insist on 56 or 84-day scripts to save money.

Every other healthcare system recognises that the more older people you look after, the more it costs. With the number of elderly patients on medication rising every year, there has been no corresponding increase in the allocation of resources for pharmacy.

I’d like to see pharmacy funding follow long-term condition management because, as we’ve seen recently, lots of pharmacy operators are reducing services in order to survive. But I don’t want to just survive; I want the sector to thrive.

For this to happen we need a new contract with the NHS and Government that says they want something more than an ‘Amazonised’ supply service.

Character stain

Back to the stains. About six years ago I found myself on my own in the dispensary with a script for Polytar. After reaching in vain to get it from the top shelf and deciding that kick stools are for wimps, I thought the best option was to jump. It was, after all, only just out of reach.

I made contact with the Polytar but suddenly it was spinning ominously towards the bench. “Nooooooo”, I screeched in slow motion. Bounce, phew, bounce, phew, bounce, then “nooooooooo!”. The bottle split on the third bounce, covering me from head to foot in brown, oily residue.

I had to call in an emergency clothing drop courtesy of my wife as everything I was wearing had to be binned. Despite my best efforts to clean up, the smell lingered for months, the marks on the wall and roof serving only to remind me that I am, in fact, an idiot.

* Pen name of a practising community pharmacist. Alexander Humphries’ views are not necessarily those of Pharmacy Magazine. What's on your wishlist for an NHS community pharmacy contract?  Email pm@1530.com