Opinion: Drive reform or face the consequences

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Now that the dust has settled on the new contract announcement, it is probably worthwhile picking over the bones of what is potentially its most important component: a promise of reform. Could this be the hook that finally allows us to overcome some of the many problems associated with our dead-end contractual framework? 

Clear commitment to change

This is the first time that I can remember there being a clear and explicit commitment from a Minister to changing the contract in partnership with the sector. The last time ministers decided to change the contractual framework, they cut core funding, got rid of establishment payments, and introduced the Pharmacy Access Scheme and Single Activity Fee. This was done to us. 

At least now there is a commitment to work with the sector to (hopefully) deliver something better. And, boy, there really is a need to face into some very difficult issues. 

Growth trajectory

Take prescription item growth for a start. We’ve already hit 1.25 billion items a year – and since 2005, dispensing workload has gone up by 75%. 

Taking into account all the extra services we now provide (flu and Covid jabs, NMS, Pharmacy First, to name just a few), workload has more than doubled – and that is before we even think about the impact of private services, or the growing demands and expectations of the public. 

We can’t keep doing all of the things we’ve always done in the way that we’ve always done them. Technology is undoubtedly part of the answer, but it is not the whole story. 

Should we be paid per patient rather than per prescription item? Contractors have also lost faith in the margin system, partly because of the way it works, and partly because it can be manipulated by local prescribing policies. Our funding should not be dictated by the actions of others. 

Not just a numbers game

Some would argue that there are too many pharmacies (not me), but I would point to the number of 100- (now 72-) hour pharmacies and DSPs, which should be the first to go if we’re looking to cut numbers. But in reality, it won’t save any money because we no longer have a fixed payment per pharmacy. 

The proponents of a smaller pharmacy network point to it being more efficient to have fewer, larger pharmacies, which is great in urban areas where you can throw a stone at a dozen pharmacies. But in, say, deepest Cornwall, merging with a pharmacy two villages away isn’t going to be better for patients because it will mean longer journey times and less choice. 

The list of difficult choices goes on, but we have to face them as there is not a bottomless pit of money to fund a perfect pharmacy service. We need to get involved and drive the sort of change that we want to see. The challenge for all pharmacists is to articulate what we want, and how it will benefit patients and the Government. 

Independent aspirations

I’ve heard a lot of moaning about the new prescribing service and I probably agree with some of it: the plans are not ambitious and the money is nowhere near sufficient. But what do we want it to look like? How do we want it work? And how should it be funded? 

There might be more money for a more ambitious service that starts to tackle long-term conditions, but the barriers to entry are obviously much higher – and the sector simply isn’t ready for that type of responsibility at scale. 

We need a long-term roadmap showing where we are trying to get to, what the milestones look like, and – crucially – what investment the Government will commit to supporting that journey. Reform has to come with the money to enable it; pharmacies have no cash left to invest in premises or even in staff development. 

Most pharmacy owners agree what the problems are, but the much more difficult challenge is to agree on the solutions. However, if we fail to grasp this opportunity for reform, the future is even more bleak with AI and automation potentially capable of apocalyptic change if we are concerned only with the supply of medicines. We have to take this leap of faith now before it is too late.

  
* Alexander Humphries is the pen name of a practising community pharmacist. The views in this article are not necessarily those of Pharmacy Magazine. What contract reforms would you support? Email pm@1530.com