What's our contract actually for?

In Opinion

Follow this topic

Bookmark

Record learning outcomes

The Community Pharmacy Contractual Framework is fiendishly complicated. I once heard it compared to the impossibly complex ‘Schleswig-Holstein Question’, a 19th-century diplomatic dispute of which it was famously said: only three people have ever really understood it – one is dead, one has gone mad and one has forgotten all about it…

As for the pharmacy contract in England, it has SAFs, tariffs, margins, Cat M, Cat H, averaging, clawbacks and all the other jargon we have to contend with. Such complexity makes informed discussion difficult.

Back to basics

So let’s break things down to the very basics. What is the CPCF actually for? This is my ‘top 10’ list of answers:

1. Ensuring safe and timely access to medicines, prescription and non-prescription, with a second highly qualified professional checking appropriateness (especially at transfers of care) and advising on safe, effective use, including advising doctors on alternatives when medicines are in short supply
2. Providing local access to NHS pharmaceutical care, including walk-in access to a healthcare professional for advice, support and treatment
3. Reducing health inequalities, and safeguarding and supporting the vulnerable (addiction services, sexual health, and so on)
4. Incentivising excellent patient care
5. Shifting more care from hospitals to communities
6. Exerting downward pressure on the NHS drugs bill and protecting taxpayers from financial shocks caused by price spikes
7. Safeguarding medicines efficacy, for example through antimicrobial stewardship and safe disposal
8. Supporting healthy living and prevention, including vaccinations, and giving expert advice to people with long-term conditions
9. Treating common conditions and referring people whose symptoms may indicate something more serious
10. Saving lives – and not only during a pandemic.

Not fit for purpose

Viewed through this lens, the contract is clearly inadequate. In fact, it is utterly broken. Even the most familiar and ‘basic’ element at the top of my list, timely access to medicines, cannot be guaranteed under current arrangements. (‘Basic’ does not mean easy or lacking value.)

Recent NPA research exposed pharmacy deserts in parts of the country, making it hard for patients to access medicines, advice or emergency contraception, particularly at weekends, when pharmacies are often a lifeline and the only accessible healthcare provider available.

More than 280,000 people (the equivalent of a city the size of Newcastle upon Tyne) saw their local pharmacy close in the first eight months of this year, according to NHS data.

This is a crisis – so let’s be bold

The problem is not just inadequate funding – although it clearly is that – but a contract that no longer reflects what patients need from pharmacy or what the NHS needs pharmacy to deliver.

This is a crisis, so let us be bold about the reforms needed. We need better funding and a complete, patient-centred overhaul of the contract’s structure. Things cannot go on as they are. The NPA won’t shy away from saying so.