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So PSNC has finally reached a funding settlement with NHS England. Was it worth the wait? Not really...

THIS SETTLEMENT is about what the Government can afford. It is not about what community pharmacy services cost to run, or about achieving pharmacists' full potential within a primary-care led NHS. To paraphrase the unfairly maligned Sue Sharpe, €now is an extremely difficult time to negotiate with the NHS€.

Anyone outside the profession may see the headline figure and think that we've just received a £300m funding increase €“ but, of course, that would be naive and incorrect.

Overall this settlement feels like a huge lost opportunity: 43 per cent of GPs are over the age of 50 years and the Government's answer to the capacity crisis is... to recruit more GPs. Astounding logic, which utterly fails to address the underlying problems of an ageing and ailing population, rising demand and poor public health.

Recruiting more GPs is like a sailor on a sinking ship saying he needs more buckets €“ the ship will still sink... the only question is when.

Mixed messages

My problem with this funding settlement is that it sends out mixed messages: we've been told that services are the future, yet practice payments have been slashed (again), and money has been added to the purchasing function (which is welcome, but I don't understand the logic).

We are being encouraged to do more NMS but, unless I'm mistaken, the money to support the service has come from the £300m added to the supply function. The MUR cap remains, which feels as though the NHS

is trying to put obstacles in our way and does nothing to encourage the delivery of professional services. It leaves me wondering what exactly NHS England's vision for community pharmacy is.

Scotland's 'Prescription for Excellence' has good and bad points, but at least it sets out its stall on where the Scottish Government wants to take pharmacy services. Don't get me wrong: I'm not advocating another document that just gathers dust on Whitehall shelves, but it would be useful to have a simple statement of intent that says €we want community pharmacy to be a fully integrated part of primary care, which will deliver an ever greater part of the NHS care programme€. At least then we can start work on how and what it is that we should be doing.

If we had a clear vision, we could begin to understand what skills our workforce needs, what our infrastructure should look like, and, dare I say, what resources are required from the NHS to deliver that programme.

Heading for a fall?

PSNC has said on a number of occasions that it was aiming for a multi-year funding deal but, in not delivering that deal, have they raised expectations and set themselves up for a fall?

Moreover, in reaching this agreement, we have definitely seen the end of the Cost of Service Inquiry. It is absolutely clear now that there will be no deal based on a jointly-commissioned, independent report on delivering fair funding for pharmacy.

Personally I feel that the Government has reneged on its commitment to the sector. Funding for the entire NHS is constrained, but if an independent report is saying that pharmacy needs a fairer slice of NHS funding, and that report has been ignored, we have every right to feel angry.

So what does all of this mean for my pharmacy? More of the same: a slow tinkering around the edges with contractual requirements, an odd bit of extra work here, a smidgen more funding there, but essentially the same job overall. The real shame of this deal is the failure to grasp a great opportunity to reshape primary care.

When I asked a GP recently if he was overworked, his reply was €Yes, of course I am€. When I asked what work he wanted to give up, €nothing€ was his curt response. This is partly down to control and, of course, money. There is a fear that by giving something up, there will be an inevitable budget cut.

The same GP said: €You chemists are in the wrong place; you're all in your little shops instead of in my surgery.€ Most practices would love to have their own pharmacy, employ a pharmacist who might be handy occasionally and, best of all, they'd be in control. It all comes down to being in control.

That is why I believe we cannot get meaningful reform and progress in pharmacy if we start to take work or, heaven forbid, money away from GPs.

In truth GPs are not really independent contractors to the NHS. They carry little or no risk and enjoy all of the benefits of employed status: very good pensions, training, holiday, sick cover and guaranteed rental income for their premises from the Government.

I doubt we'll ever see GPs move to employed status €“ a shame because such a move could see some of the barriers to progress start to come down.