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Insight: More work for no extra money


Insight: More work for no extra money

Now we know what we always suspected. For the final two years of our five-year funding deal, the Government wants us to do even more work for absolutely no extra money, not even a dime...

So that’s it. The funding deal for years 4 and 5 of England’s busted contractual framework. There are some new services, not that you’ll have the time or the team to deliver them once the vicious impacts of inflation are fully taken into account.

If we pick over the bones of the announcement, I suppose the first thing to mention is the extra £100m of retained margin that is going to be kept in the funding pot.

If we take it at face value, this looks like £100m extra for the next year – but it is not clear whether it is money we’ve already had.

Why is this important? Because if we have already had the money, the chances are we’ve already spent it given the scale of rapidly escalating costs.

We can’t ‘unspend’ money that is keeping the lights on and paying the staff. Sure, it is better than if the DHSC said it wanted the money back, but it really isn’t going to help to defray mounting costs.

PSNC not to blame

PSNC is being blamed for the five-year deal, but in all honesty it could not have predicted the pandemic or seen the huge spike in inflation coming.

Our negotiator probably thought it had won a mechanism to secure uplifts as and when necessary, but the other side has viewed these annual reviews as nothing of the sort. A chance to compare the paperclips, but no chance of any extra money.

Years 4 and 5 look like a complete write-off. There is going to be slim to no enthusiasm from the sector to deliver the new contraception service, which cannot possibly cover its costs at £18 per consultation.

While I welcome moving this work out of general practice, I’m not having it dumped on pharmacy on the cheap, so I for one will not be signing up to offer this service.

I suspect that this service, along with the hypertension case-finding service, is being used to set us up for failure, because the real question isn’t what happens in years 4 and 5 but what takes place afterwards.

April 2024 seems like a lifetime away but there is unlikely to be a lot of extra public spending between now and then because of the awful mess the country finds itself in.

Health will be a key issue at the next election, but unless we start making some real noise now, we’re going to be somewhere in the queue behind the Association of Interventional Hypnotherapists when the money is doled out. Our best bet may be for a one-year extension to the existing deal and then hope for a change of Government.

In the meantime, it remains far from clear to me how we are supposed to keep services running on a funding formula from nearly two decades ago.

Put simply, unless emergency funding is forthcoming, the system is at risk of imminent collapse. It now appears entirely optional for some organisations to open their pharmacies – and this is putting those that do open at even more risk.

Show some leadership

The chief pharmaceutical officer needs to show leadership and ask NHS England for an immediate emergency cash injection to tackle the dangerous conditions we find ourselves working in.

It just isn’t possible to absorb a 40 per cent cut in real terms funding over five years without corners being cut, so endangering patients.

Could Amazon come in and replace us? Frankly, it is welcome to the lot if it thinks it can make this crazy system work. The number of times I have to step in every day to avert some disaster or prevent GP practices from harming patients is skyrocketing.

So, the key questions for the sector for the next two years boil down to: “what do we want?” and “how do we get it?” Things are getting desperate.

*Alexander Humphries is the pen name of a practising community pharmacist. The views in this article are not necessarily those of Pharmacy Magazine.How many pharmacies will close as a result of the latest funding deal? Email

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