PSNC CEO Sue Sharpe speech to LPC Conference Final
Check against Delivery
Thank you Chris and good morning Conference. Chris has summarised some of the key strands of the new Coalition Government’s health policy that will, over the coming years, have implications for the future range and reach of community pharmacy services.
SLIDE – PROGRESS UNDER THE LABOUR GOVERNMENT
When I joined PSNC, over nine years ago, a Pharmacy Plan was in the offing. It had been promised by the government, which stated an ambition to reward quality at the expense of those who do the bare minimum. As I began to work with the then negotiators in the Department of Health, it became clear that their ambition was not, as was ours, to develop, implement and reward new services that would add value to the patient experience of pharmacy, and use better the skills of the pharmacist. Not a bit. The ambition was simply to move funding around – and out. There was a clear goal to remove all purchase margin from pharmacy. I do not want to dwell on that time and the threats community pharmacy faced then. But it is important to take stock of what community pharmacy did achieve in the latter half of the Labour administration.
We moved a long way. Nothing like far enough. But around 85% of pharmacies today have consulting rooms and are providing MURs. We know we have faced some negativity, both from GPs and PCTs. But patients have been overwhelmingly positive. They find them valuable. And in a patient led NHS, that should be what counts!
All pharmacies today contribute to supporting public health and healthy lifestyles – an area that has immensely high priority for the new government. Large numbers can provide NHS emergency hormonal contraception services. Customers and patients increasingly understand the help they can get from pharmacies. We have made a great deal of progress.
SLIDE – A PERIOD OF UNCERTAINTY
Right now, we are going backwards in service delivery as PCTs across the country face budget pressures. Service decommissioning is widespread. Some is staggeringly irrational. Cutting minor ailment services that will shift much of the demand to A+E, Walk-in Centres or GPs is an inexcusable waste of scarce NHS resources.
A year ago, we were just coming to the end of the Pandemic Panic. PCTs varied in their early recognition of community pharmacy as the resource that would help with antiviral distribution. Many learnt a lesson in the face of shambolic attempts to arrange supply systems that bypassed pharmacy. But community pharmacy, where given a chance, stepped in and sorted the problem. Afew years before we had the Oxygen fiasco. Again, where the new arrangements failed, pharmacy stepped in and sorted the problem.
What is the point of noting these events now? Well, I see a real risk of more chaos and threat ahead, in the period of migration from the old NHS structures to the new market-led arrangements. PCT staff are already moving on, leaving holes in those organisations, which still have a long time to go before they transfer their responsibilities to GP Consortia. We are seeing, as before, lamentable treatment of pharmacy by some – manifested in the decommissioning. So I forecast that the NHS will need us, once more, to step in and help sort the problems.
These changes introduced by Andrew Lansley are not welcomed by NHS Primary care administrators. No surprise there. Nor are GPs overwhelmed with enthusiasm, particularly when it comes to taking on rationing, or to adapting to competition for service provision. Chris has made this point already. If, as the government has promised, targets are to be abolished, and many are already not being met, can we provide some backstop? NHS primary care is changing from being a managed service to a demand-led market model. So, as Chris said, it is radical change, being delivered without any committed and powerful advocates (other than Andrew Lansley) on the ground.
Community pharmacy will need to adapt to this new environment and it will. Of course it will. In the period of transition we may have opportunities, not just to help in one, or two, or more crises, but also to set the foundations for how community pharmacy services fit in the future delivery systems. This is where you, the LPCs come into your own, vital, roles. And you will need to be fit for the job, and ready for it.
Chris has noted that, in future, pharmacies will probably be commissioned to provide services by local authorities and consortia, as well as nationally by the NHS Commissioning Board. So any opportunity, any, to set the right grounding for those relationships, is an opportunity that must not be missed. We will provide support and resources to help you. It is one of the major areas to emerge from our planning meeting last week. We know LPCs have many challenges, and we will do our best to help you meet them.
If the new government policy survives unscathed, there will be opportunity like never before for new service providers. And pharmacy can be at the forefront.
The mantra – no decision about me without me – is underpinned by plans for a whole new industry in Information provision, to help support patients in making decisions.
If the public health budgets are to be effectively ringfenced, pharmacy can bid for a significant amount of them, to offer services meeting local needs, that we can provide better and more conveniently than anyone else.
If Any Willing Provider is effectively implemented, the potential prize is huge. But none of it is given. Providers will need to assure delivery, quality, outcomes. We will be in competition with others, including the third sector- charities and Social Enterprises - providers way beyond the NHS contractor professions.
So, start doing the SWOT analysis.
At PSNC we are getting the evidence together. In the summer we recruited a researcher, Dr Johanna Honkvaara, to collate all the evidence, published or not, relating to pharmacy services. Alastair has asked you to contribute to this work, which will provide evidence for you all to use. With good data on outcomes, you will be in a strong position in your negotiations, so please – help us to help you.
SLIDE NEW GOVERNMENT PHARMACY POLICY
I mentioned the progress community pharmacy made under the last government. The Pharmacy White Paper was indeed progress in identifying policy for developing the role of pharmacy. Sadly, it did not get very far. Why not? I know I have spoken before of my frustration at the slow pace at which government works. Add to that changes of ministers, indecision of ministers and the paralysis at the beginning of the year caused by a difficult election in the offing, and you have some of the answer.
But what about the new government? When he spoke to the All Party Pharmacy Group in the early summer, the minister Earl Howe, made it clear that the coalition would not be chucking out all the last government’s policies. Where they made sense, they would be adopted. We hope that tonight he will speak positively about early expansion of community pharmacy services – in line with the Health White Paper published in July. We hope, specifically, to hear good news about the “First Prescription” service.
This would be a great step forward – a tangible increase in pharmacy’s role in medicines optimisation. Helping to cement the essential role of community pharmacy as the provider of adherence support. This role will help us to ensure we retain our medicines distribution function, and to continue to offer personalised advice to our patients.
Some people are talking about the need for a new contract. And I have no doubt that it will come. But when the NHS Commissioning Board is up and running, in roughly a year’s time, its first priority is most likely to be general practice. So we cannot hang around without making changes, before the Commissioning Board is ready. What we need to do is to implement new services where we can, and develop our credibility as providers of other services, in the meantime. We will also need to make some changes to the current funding delivery arrangements, to align funding where we can do so, to the policy of rewarding quality and outcomes.
In the next year PSNC must get the foundations settled within the government’s policy, that will serve community pharmacy well. We need to make a compelling case for a strong national contract that encompasses all the services that are needed by patients everywhere. To identify and get acceptance of what those services are. To extend them if at all possible beyond those in the current contractual framework. And we also need to secure a system that supports contracting for those services that will inevitably fall to be commissioned at local level.
In addition to our work to secure a strong future pharmacy role, we continue at present to work on a number of core roles. The Cost of Service Inquiry and negotiations related to it are far from finished. It is a long, detailed and intrinsically difficult task to measure the costs of providing the NHS community pharmacy service. Not only do we need to measure all sectors of pharmacy – independent, multiple, supermarket, neighbourhood, high volume, low volume, urban, rural. It also needs to isolate the costs properly not attributable to the NHS. And to identify the return on investment needed to provide fair funding for the business. PricewaterhouseCoopers are undertaking the work, but we are, as we need to be, closely involved with all elements of the work.
The annual margins survey is once more underway. By comparison with the Cos of Service Inquiry it seems simple. But it too demands painstaking attention to the detail of prices, volumes, the sample selected, grossing up to the market, and making adjustments to allow for the losses on brand purchases and the impact of branded generic prescribing.
This is not a comfortable time, and for pharmacy contractors there is a sense of a lack of stability. So there is, quite understandably, among some, little of the confidence they want, to persuade them to invest in the business and to prepare for future roles. However, to ensure pharmacy is ready to seize those opportunities I have mentioned, contractors will need to build the skills of team in the pharmacy and delegate roles to support staff. The demands are too greatto fall on the pharmacist alone.
Although it is difficult I do believe there will be great opportunities for those who gear up to realise them.The growing complexity of the business and imminent new services can only be met by good teamworking, and by developing the skills of the pharmacy team. Around the country there are inspiring examples of really good teams. And when they work well, the pharmacist can be energised, motivated, and released to focus on where his or her skills are best used.
Our funding and service negotiations next year will take place against a tough economic background. NHS budget constraints will not make it easy to negotiate for future funding. The settlement this year, although it led to heavy reductions in Category M reimbursement prices, was an extremely good outcome in such a difficult environment. And, for the pharmacy owner who is looking to develop a secure, service-based practice, it was a tangible affirmation of the minister’s commitment to pharmacy. Earl Howe has been involved in health and pharmacy policy for many years, and has made his support for pharmacy clear on several occasions. When we met him a couple of months ago, he was interested, genuinely interested, in what community pharmacy can do, and quite explicit that the GP Consortia would need to work effectively with pharmacy. Andrew Lansley, too, is positive about developing pharmacy’s role.
SLIDE – PRESSURES AFFECTING PHARMACY CONTRACTORS
Changes in the supply chain continue. I am sorry to report that problems with supply of a number of products have not lessened. The noise has abated but supply problems on the ground are getting worse. We continue to work with all parts of the supply chain – manufacturers, distributors, and with the Department of Health. We monitor the products that are difficult to secure, and communicate with manufacturers. We have lobbied hard, and with some success, to limit demands for faxed prescriptions as proof of need. It is nothing like enough success of course, and we do not stop seeking every avenue to improve the situation. We will continue to give this priority.
Pricing accuracy has improved. And much of that improvement, I believe, is the result of the pressure we put, through our audit work and regular meetings with the NHS BSA RxS to ensure they act on errors. Yes it has improved. But that is not good enough, and a system that cannot assure every contractor that every month every item will be properly priced, is a system that is not fit for purpose. This too is a major priority for us, and we are pressing for a fundamental review of how future pricing can best be done.
This year we have invested in a new Pricing Audit Support system, (PRISM) that will go live shortly. This will improve the checking capacity of our teams at Cockfosters (shortly moving to Enfield), and in Aylesbury and help us to continue to hold the BSA to account. It will help us to help contractors, and although it has been a substantial investment, this means it is worth it.
Following a review of all IT projects in the summer, the government decided to press ahead with the Electronic Prescription Service (EPS). Our problems do not lie with the concept, but the implementation. Will introduction prevent market distortion, ensuring pharmacies have equal opportunity to be EPS enabled in a locality before go-live? It must. Will there be a level playing field, which truly prevents doctor manipulation of patients’ choice of pharmacy? With the NHS mantra of Patient Choice there must be. Will electronic messages be reliably transferred for pricing and accurately priced? They must be. Will EPS be 100% proofed against disaster or system failure, or have swift and reliable back-up processes? It must. Lots that must be done.
PCTs, although they have been given notice to quit, are obliged to complete their Pharmaceutical Needs Assessments by February next year. PSNC has been working as part of the Regulations Advisory Group on draft regulations that will be issued for consultation shortly. The PNAs will be important, not just for the next two years, but to support future pharmacy commissioning decisions, so we have worked hard in our contribution to the work of the group, to represent the interests of contractors, and secure regulations that will work for our interests.
As you know, I am immensely proud of my team at PSNC and the work they do for you and for all contractors, in all these areas, and others I have not had time to mention. We think we have the most responsible job to do for contractors, and we try to do it excellently. We try, not just to react to events, but to be forward thinking, and to create the best opportunities for the profession.
Inevitably at times we do need to be reactive. Just recently we have had to deal with various problems connected with Specials, and with PCT and counter-fraud threats to breach confidentiality. We do not lead in work to reform supervision and the responsible pharmacist, but we try to ensure that we support contractor interests.
When contractors are landed with new and unnecessarily onerous, but unavoidable obligations like Information Governance, we do our best to minimise the bureaucratic burden and simplify the process.
Our goal is to use our expertise and skill to promote and further the interests of the contractors we represent, and who fund our work. Working against a background of more complexity, more bureaucracy and more challenges, we continually look to see where we can make the job of the contractor more simple, or create opportunities for future benefit.
SLIDE - PHARMABASE
At this point I want to introduce Pharmabase. Some of you will have seen it this morning, and when I have finished speaking we will give you a proper presentation on it. It is in its infancy, but it is the most immensely exciting initiative to support pharmacies in service provision, and in meeting contract requirements. A web based platform, created by pharmacy, for pharmacy offering a single reporting platform that all contractors can use, regardless of who provides their PMR system. That can report to anyone in the NHS. Not developed by a commercial provider looking at PCTs as the purchaser, but by us for us.
Its potential is massive, and after a lengthy process of planning, exploring market solutions, and rigorously considering the proposal and investment, PSNC members were unanimous in support of PSNC funding the development of the platform that you will see today. It was a very substantial investment. But this is just the beginning, and we now need to develop it further to support smart, speedy and simple recording across a range of needs, including the first prescription service when it is launched. This will need further funding, beyond our resources, and we will need to do this by raising a hypothecated levy next year. The size of this levy will translate to no more than £75 per annum per pharmacy, so the cost is modest, the value is anything but.