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Insight: Cakeism at NHSE no longer feasible

It is good news that pharmacy will now be paid for some of the displaced minor ailment activity from general practice – but it doesn’t address the problem of how I’m going to find time in my working day to see more patients with complex needs...

As I sit here after the madness of five bank holidays in eight weeks, I’m left asking myself “what could we do differently?” and “how can we make it work better?. 

The bottom line is that we need more pharmacist capacity but, as we all know, there aren’t enough pharmacists in the community as it is, with significant numbers disappearing off into general practice or elsewhere in primary care. So we will need to use technology – and address some elephants in the room at the same time. 

Let me be blunt: about 75 per cent of my working day is currently spent checking prescriptions. I know this is not a good use of my time, but I’ve tried lots of options to build capacity, including training up my own accuracy checking technician, recruiting an ACT, using barcode technology... and nothing has worked. 

I don’t know how to solve this problem. Even if I did, it is inevitably going to increase the cost of the dispensing process, as we will have to add in an additional (and costly) skill set. 

The aim must be to redeploy a pharmacist, who is ultimately our most expensive resource, to provide other services. However, for this to offset the higher sums involved, any new income will need to significantly outweigh the cost of the more expensive staffing model. 

A full-time ACT is going to cost £28,000-£32,000 depending on where you are in the country – about the same as the potential income from the new Pharmacy First service. This is going to make it a tough sell for many contractors. 

Race to the bottom

Some of the larger and online pharmacies are trying to create more clinical capacity by recycling the initial clinical check on repeat prescriptions (the so-called ‘advance clinical check’). I’m really not sure about this and don’t think the GPhC has a handle on it either, as it hasn’t (as far as I’m aware) challenged what I consider is a very risky practice. Yet the reality is that we are in a race to the bottom on dispensing costs. Funding is so woefully inadequate that some pharmacies may be forced into taking such actions out of necessity in a bid to survive. 

“We need a new economic inquiry into the cost of providing the service”

The Welsh way?

We could take a leaf out of Wales’ book and switch to 56-day prescribing for all patients. Sure, at the moment it would cripple most pharmacy businesses because of the loss of vital revenue. But if the whole country did this, then the single activity fee would rise because there would be fewer dispensing episodes overall. 

I’m not a massive fan of raising the SAF because it just props up the online volume merchants, who add absolutely no value but raise significantly the overall costs of the system due to their working practices.

Whatever solution I consider leads me to conclude that we will need extra core funding to be even able to access the £645m investment that the Government is making.   

While I am pleased that it represents the first new money in the sector since 2014, when you look at today’s funding, it is worth about the same as we were getting in 2005. Even the best pharmacies are struggling right now because of the higher cost of employing quality teams and the right amount of people to do the job safely. 

In the long run we must have an entirely new economic inquiry into the real cost of providing the service, which is north of £3bn now. Some of this money will need to come from GP budgets as work is transferred from one sector to another. 

NHS England has tried to have its cake and eat it since 2015, but this is no longer sustainable. We are in budget airline territory now. If they want a sandwich at 30,000 feet, it is going to cost them.

Do you agree with carrying out advance clinical checks? Email

*Alexander Humphries is the pen name of a practising community pharmacist. The views in this article are not necessarily those of Pharmacy Magazine

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