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Insight: We must make the contract work

By Alexander Humphries*

Even Donald Trump would find it difficult to call the new contract settlement “the best deal in the history of deals” but the ink is now dry and we have to make the most of it...

Back in 2015 I thought we would never get here as the Government at the time seemed hell-bent on the destruction of community pharmacy. With the multi-year contract settlement that was announced last month, at least there is now hopefully a future in there for some of us.

In particular, the prospect of the Community Pharmacist Consultation Service (CPCS) has caught my eye and my imagination. However, we cannot repeat the failures of the past when rolling out a new service. I need only assemble the dreaded letters NUMSAS to conjure a vision of absolute incompetence...

Game changer?

If the Government is genuine about wanting to work with the sector, instead of against it, CPCS could be an absolute game changer. Why?

Well, we will actually be paid for providing care and advice to patients. The fact these patients will have to put their hands in their pocket should medicines be required is at least a recognition that shunting workload in our direction should be remunerated.

Direct referral from NHS 111 and in time from GPs as well is a good start. But in the long run we have to allow patients to self-refer to the scheme in the same way they do for many other NHS services.

The benefits of this new service are clear: for patients a same-day appointment with a healthcare professional; for the health system a release of much needed capacity from general practice; and for us a new remunerated service that plays to our strengths.

In the short-term I don’t expect much will change – the NHS is like a supertanker and takes ages to change course. In the long-term, as the volume of consultations begins to rise, the new service will become more and more important for the survival of general practice.

I’ve predicted this since 2015 as it was clear that it just would not be possible to recruit, train or retain enough GPs to make a dent in the ever growing list of things that patients want from them.

Pharmacists in general practice were never going to be able to scale to a point where it was going to make a meaningful difference to demand in surgeries. Why would it? Putting more services into surgeries just makes them even more of a bottleneck than they already are.

Once the ‘patient’ (i.e. the NHS) is hooked on being able to push people to community pharmacy, it will become very difficult to reabsorb this workload should Government decide that it no longer wants to fund a network of reliable and conveniently located healthcare providers in every community in the country. In other words, we get something which we’ve never really had: leverage.

But we must learn from the mistakes of the past. Medicines use reviews have been much maligned mainly because they became target driven, linked as they were to fixed packets of revenue.

The CPCS won’t have the same pressures associated with it because it will be a ‘push’ service from NHS 111 and general practice; we can’t ‘pull’ patients in the same way as we could with MURs. Personally, I hate being reliant on another service provider for work – but I can live with it as long as we eventually end up in a position where patients can begin to self-refer.

Absolute disaster

NUMSAS was an absolute disaster of a service because it was massively over-engineered and clearly designed by people who had not set foot in a pharmacy for years. We have to learn from this mistake by getting real live pharmacists to play an active role in designing and piloting the new service.

Then there is the NMS. It is not perfect, but has a lot going for it. In particular, it has a strong evaluation, including health economic evidence which has protected it from being decommissioned. The CPCS has to have the same robust evaluation to make sure that it is protected in the long run and can continue to demonstrate good value.

Look: like you, I’m knackered. Like you, I had hoped for more from this settlement. However, we must all dust ourselves down and get ready to go with this new service because it is so important to our long-term survival. I urge you to think about how you are going to make it work.

It will be challenging incorporating on-demand consultations into already packed workflows. So look for solutions and try and make it easy for patients because this is how you protect your future.

PSNC: please take heed. CPCS has to be simple and the sector needs enough time to implement it properly. We don’t want another NUMSAS on our hands.

* Pen name of a practising community pharmacist. Alexander Humphries’ views are not necessarily those of Pharmacy Magazine. What do you think of the new contract? Email pm@1530.com

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