Junior doctors and a scrap about Jeremy Hunt’s focus on seven-day services have rightly grabbed a lot of attention recently. What has escaped much of the media’s attention, however, is that at the same time the government is pulling the rug from under the most accessible, seven-day NHS service we have. The government’s plans for community pharmacy could have as great an impact on patient wellbeing as anything regarding doctors’ contracts.
Only last week I heard about an emergency in Chelmsford. A customer in a sandwich shop had an allergic reaction to a jalapeno chilli and stumbled into a pharmacy for an antihistamine. The pharmacist, recognising the severity of man’s anaphylactic shock, administered an epi-pen and called an ambulance. Our ambulance services are so overstretched that paramedics did not arrive for half an hour.
In England, people make 1.6 million visits to community pharmacies every day. Community pharmacies are at the coalface of delivering care to improve health and wellbeing, whether that is through the provision of medicines advice, smoking cessation or obesity management services. Of course, this advice and support comes on top of their important role of dispensing medicines – pharmacies dispense around one billion prescription items every year.
Community pharmacies offer easy access to highly skilled healthcare professionals, and could play a much greater role within the NHS. At the moment, it is estimated that the NHS spends £2bn per year on GP consultations for conditions which pharmacy teams could treat. Providing a national community pharmacy minor ailments service could save most of that through reduced GP appointments. There are clear arguments in support of investing in community pharmacies in order to save the NHS money, and to provide convenient and expert advice within easy reach of patients – 96 per cent of the population can reach a pharmacy within 20 minutes by walking or using public transport.
Out of the blue, just as parliament rose for its Christmas recess on 17 December, the government announced proposals for community pharmacy which would severely constrain its ability to deliver health services and lead to increased costs elsewhere in the system. The government insists on a cut in funding. This is at least six per cent for next year and unspecified amounts for future years. But what is much more worrying is the proposals for how those funding cuts will be achieved.
The care minister, Alistair Burt, has conceded that as many as 3,000 pharmacies – around one in four – may close. NHS officials have repeatedly said that there are ‘too many pharmacies’. Key payments for pharmacies will be phased out, and there will be a drive towards a commoditised medicines supply service with an increased focus on warehouse dispensing and online services. In practice, this means that we risk losing the advice and services people rely on.
Last Tuesday MPs from across the House took part in a Westminster Hall debate on the future of community pharmacies. The level of political concern about the potential for closures was palpable. It was telling that not only Labour MPs, but Conservative and even Scottish National party representatives highlighted their concerns about the impact that the government’s planned funding changes could have on the quality of patient care and access to health services in England. It is unusual to see such a level of consensus, and the reason for this is that the plans could affect every English constituency, urban and rural, affluent or deprived.
The government’s consultation process has only just begun, and we are now at a moment when politicians could help to shape the outcome of that for the better. The government must provide a clear evidence base for how the changes will protect patient care. Disruption to services must be minimised, and the government’s focus must be on changes which help to get care right, not simply a reduction on the balance sheet. Community pharmacies can help reduce overall NHS spending if they themselves are properly funded.
Finally, the government must enter constructive discussions with community pharmacies about how to improve the overall pharmacy service in the best interests of patients. For this to work the government must be far more open about its plans and how it intends to deliver a clinically focused community pharmacy service, optimising the use of medicines to ensure that they meet the best interests of patients.
Community pharmacy has a plan to save the NHS money through better use of medicines but the NHS is not listening. At a time when budgets are under unprecedented strain and there are queues outside GP surgeries, why would the government want to close the accessible, seven-day source of NHS services on our high streets?
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Sue Sharpe is chief executive officer of the Pharmaceutical Services Negotiating Committee, the body which promotes and supports the interests of all NHS community pharmacies in England
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Support for the NHS Bill on March 11th would improve Labour credibility with the young and NHS staff – why the deafening silence? Do the right wingers who gave us the PFI disaster and marketisation still have too much influence ?