Some home truths from abroad and a sense of despondency and defiance summed up proceedings at this year’s Sigma conference, writes Richard Thomas.

The Caribbean island of Jamaica, the location for the eighth annual Sigma conference, is nearly 5,000 miles and a world away from the troubles afflicting pharmacy in the UK. But it was events back home – the 6 per cent funding cut and threat of pharmacy closures in England in particular – that dominated the business programme and the conversations of delegates throughout the week.

The mood of the pharmacists present was subdued, even fearful about what the future might hold. Expressions of anger and frustration were mostly held in check; the prevailing feeling instead was one of uncertainty and concern.

A whole gamut of pharmacy leaders, speaking from the platform or via video link, struck a defiant tone. PSNC’s Sue Sharpe did nothing to talk down the threat. Calling the Government’s actions “ill-conceived and profoundly stupid”, she said the sector was facing probably its greatest ever threat.

The sector is facing probably its greatest ever threat

Promising “not to give up without a fight”, it was time for pharmacists to “rise up and speak out” about the value they offer patients and the NHS. Talk of withdrawing services in protest or even going on strike was not the answer. “Why would we risk losing the support of our greatest advocates and allies – patients?” she asked.

Outlining PSNC’s proposals for a more clinical role for community pharmacists, including support for asthma patients and independent prescribing, she nevertheless advised against contractors investing in new services until the situation became clearer. We need to see much more commitment to the pharmacy sector [from Government] before we can realistically tell people to start investing more.”

Legal challenge?

Pharmacy lawyer David Reissner of Charles Russell Speechlys suggested that legal action against the cuts was a possibility – a prospect that moved a step closer after delegates had returned to the UK when several pharmacy groups instructed the law firm to write to health minister Alistair Burt, challenging the legal basis of the Government’s plans.

Speaking at the conference, Mr Reissner pointed out that not only was any meaningful detail about the funding changes utterly lacking, it was a legal requirement of any Government consultation that ministers must be open to changing their minds. “Yet it is clear to me that the Government has already decided on its course of action.” The plans were legally flawed, he believed.

Other speakers took the view that resistance was futile. According to Warwick Smith, director general of the British Generic Manufacturers Association, the cuts were being driven by the Treasury as part of an austerity “philosophy” from chancellor George Osborne that the Government was determined to push through. It was enough to make you reach for the nearest rum punch. And then order about half a dozen more…

Public support vital

NPA chairman Ian Strachan described the imperative of mobilising the support of the public. The trade association has led an impressive campaign against the cuts, which includes a petition to the prime minister, campaign cards, window posters and a platform for patient stories.

To Mr Strachan, this was about more than just the cuts. The Government’s drive for so-called efficiencies through unproven mechanisms as hub and spoke dispensing and click and collect medicines collection – proposals put forward without proper prior consultation with the profession – felt more like “a grudge” against community pharmacy’s premises-based contractor model.

However, he was confident that the support of the general public would be a powerful asset in the fight ahead. “We need to get our political masters to think differently about pharmacy – and the way to do that is getting the public on our side. This won’t be the walk in the park that the Government imagined.”

Former chairman of the now defunct Independent Pharmacy Federation and pharmacy owner, Fin McCaul, warned contractors to put aside money now to deal with the impact of the cuts later in the year. He also reminded delegates that it wasn’t only pharmacy that was feeling the effects of NHS spending cuts. His local CCG, for instance, was underfunded to the tune of millions of pounds.

Pharmacists would have to maximise service income to make up their funding shortfall. So why do so many pharmacists still not meet their MUR quota, he wondered? “That’s not only leaving money on the table – it is letting our patients down.”

Plan for the worst

Day Lewis chief executive Kirit Patel agreed that contractors should “plan for the worst and hope for the best” as the Government was unlikely to go back on its imposed funding cut. He told delegates they needed to “skill their people up and harness technology” to prepare for a future based on clinical service provision. For some this would require a change of mindset to focus on service income streams. “The future is clinical, digital and remote.”

However, he didn’t pull his punches when considering the long-term prospects for the sector. “Pharmacy is in a pickle,” he said. Cumulative losses as a result of potential further Government cuts and efficiency drives could amount to anything up to £2 billion, possibly more, in the coming years, he believed. “You don’t destroy a pharmacy network for just £170 million.”

These are tough times for pharmacy, agreed Alliance Healthcare's Mike Smith, but moaning about the situation would not help. There is still a lack of understanding about what pharmacy can do, he claimed, even on the part of the Department of Health. “That's why we are in this position today. There has been a complete lack strategic thinking and planning.” 

He urged the profession to “step up its PR” to get public opinion on side. It has been “abysmal” in the past. “Get involved in the consultation process and make representations to your MP. Kick commissioners’ doors down if necessary and look at opportunities in public health. Find out what your patients actually want.” The sector had no choice other than to work with the DH going forward, he pointed out.

Pharmacy had to exploit its key asset – pharmacists and their teams – and to think outside the box and start charging for services. "And one more thing – we can't afford any more scandals. The profession must not shoot itself in the foot, especially at this difficult time.”

It was left to Pharmacy Voice and conference chair Claire Ward to issue a final rallying cry. The “arbitrary” cuts would “devastate the sector” and not achieve the better patient outcomes and efficiency gains that the Department of Health wants. “It is simply not acceptable and we will fight it,” she declared.

Pharmacy had undersold itself for years and Government didn’t see its value. “Now is the time for pharmacists to step up to the mark and show what they are capable of.”