Look how much money is being thrown at GPs while pharmacy funding is slashed, says LPC leader Hemant Patel. Community pharmacy may not be dead but is definitely on its knees...

Community pharmacy is being set up to fail and collapse. Simon Stevens, chief executive of the NHS, has a clear plan to separate provision of knowledge-based care from product supply, and make changes at a pace and scale never seen before in the NHS. The consequences for the community pharmacy network are grave.

When Keith Ridge sent his infamous letter to the PSNC and the community pharmacy sector in December 2015, it amounted to an undated P45 – a termination notice to the community pharmacy network. As the new financial year approaches, the odds are that it will be more of the same. Community pharmacy has seen a succession of yearly funding cuts amounting to £208m, while the Pharmacy Integration Fund has spent only a fraction of its allocation.

What a different story it is for doctors. Headline pledges in NHS England’s 2016 General Practice Forward View included:
• A further £2.4bn a year in general practice by 2020/21 and an additional £322m in primary care allocations in 2016/17
• A sustainability and transformation package of £500m over five years
• Proposals for reducing the costs of indemnity
• A practice resilience programme worth £40m.

There is financial investment from national and local sources, workforce development support, and measures to better manage workload by additional staff (such as 1,500 practice pharmacists) and modernise practice infrastructure, including premises and digital enablement. Finally (but crucially important for a long, secure future), there is the prospect of a central place in the redesign of primary care services as part of accountable care systems.

Workforce changes

It goes on. Measures to better manage workload include:
• An additional 5,000 doctors working in general practice by 2020/21, supplemented by GP training recruitment increasing to 3,250 a year
• Measures to improve the experience of returning to work and a new retainer scheme
• An additional 5,000 other staff in general practice by 2020/21
• An investment of £15m in general practice nurse development, together with those additional pharmacists, and 1,000 physician associates, who will take over many of the duties of GPs
• Finally, in case GPs are suffering from stress and burn-out, there will be a dedicated mental health service to support them.

Workload help

To manage the workload, there will be new measures to improve the interface between primary and secondary care, and an investment of £30m in a development programme to help release capacity within general practice.

There will also be a move to change intervals for Care Quality Commission (CQC) inspections to a maximum of five years and decreased regulatory burden for good and outstanding practices.

The NHS will launch a national programme to help practices support people living with long-term conditions to self-care, with a pilot already running at 50 sites.

Infrastructure

To modernise practice infra-structure, which includes premises and digital enablement, there will also be:
• £900m of capital investment by 2020/21
• New rules on premises costs that will enable NHS England to fund up to 100 per cent of the costs for premises development
• Support for other costs such as stamp duty, land tax and VAT
• An 18 per cent increase in allocations to CCGs for the provision of IT services was made in 2016/17 – and there is the likelihood of further local investment
• All practices to have wi-fi services for staff and patients
• A £45m programme to stimulate uptake of online consultation systems.

The DH is to set out how £3.5bn in additional capital funding will be spent by 2022-23, broken down into: £2.6bn to support local plans to transform estates and modernise facilities, as part of STPs, in addition to the £425m announced earlier this year.

There will also be £700m to help NHS estates which need urgent maintenance or upgrades, particularly in struggling trusts, and £200m to support specific programmes targeted at making savings and improving efficiency, allowing more time and money to be directed to patient care. Pharmacy, remember, will not get a single penny to update its premises.

Accountable care organisations

Investment has also been given to GPs to create federations, which will speak as partners in the increasingly important network of accountable care organisations (ACOs).

The three elements of an ACO are that:
• They involve a provider or, more usually, an alliance of providers that collaborate to meet the needs of a defined population
• These providers take responsibility for a budget allocated by a commissioner or alliance of commissioners to deliver a range of services to that population
• ACOs work under a contract that specifies the outcomes and other objectives they are required to achieve within the given budget, often extending over a number of years.

What about us?

The GP Forward View sets out a vision that starts with practical steps to free up GP time, improve efficiency and make better use of the skills available in the workforce. It recognises that general practice needs to be strong, healthy and sustainable to survive.

These are equally important things for community pharmacy, but where is the NHS’s action plan for us? All the enablers to make GPs successful are clearly laid out with adequate guarantees. In our case, no guarantees – just threats.

Simon Stevens’ strategy appears to be to bring all cognitive services under one roof, which GPs will govern. He seems almost to have an unwritten policy of discrimination on the grounds of location – and community pharmacy is bearing the brunt. His political masters are too weak to stop him and MPs are just go through the motions, uttering platitudes.

Community pharmacy has been excluded from helping to develop new models of care, left with no investment in infrastructure and shut out of the digital highway. With an increasing workload and reduced staffing, there is no respite from physical, mental and emotional exhaustion.

As dispensing gets devalued with little prospect of clinical roles nor support for becoming independent prescribers, the future is bleak. And let’s not forget the funding cuts. Bankruptcies are a real possibility.

Clearly, we cannot rely on Keith Ridge or Simon Stevens. Nor can they rely on the pharmacy minister, the Secretary of State, or the mealy-mouthed politicians in pharmacy and Parliament.

The only outcome, in the absence of new movement, new thought, new commitment and a new contract as part of the ACO set-up, is the sector being spun even further away into the periphery of product supply, where the mega-corporates like Amazon are ready to gobble up the weak and voiceless.

Amazon is ready to gobble up the weak and voiceless