In the first two articles of this trilogy about community pharmacy contractual arrangements in England, I articulated why I believe the current contract is irredeemably broken.
In this final piece, I’m highlighting that failure is not inevitable. There are credible alternatives to the status quo – arrangements that are already working well in parts of the UK and abroad, as well as fruitful approaches being taken locally in England.
Read more: It's time to level the playing field for independent community pharmacies
The Scottish contract has its basis in a 2017 plan called achieving excellence in pharmaceutical care. The plan devotes at least as much space to enabling transformation as it does to describing service developments.
It recognises the centrality of developing the pharmacy workforce and improving digital infrastructure. This focus on practical delivery, along with a collaborative leadership culture in Scotland, has significantly benefited patients, the NHS and pharmacy contractors.
The contract in Wales ensures continued investment in the community pharmacy sector, conditional on providing a greater range of clinically focused services. It incentivises and rewards pharmacies that do more of the things the NHS needs.
But Wales’s success relative to England is not only about funding. There is also a surrounding policy framework based on six principles. As well as continuity, community, and connectivity, these are: capacity – making time for pharmacies to deliver outstanding care; capability – developing the workforce; and collaboration – integrating community pharmacy within the NHS and other primary care providers.
Further afield, there is much to be admired about the approach taken in parts of Canada, which has led to such innovations as a Pharmacy Plus scheme in Prince Edward Island.
Read more: Has the NHS long-term plan delivered for community pharmacy so far?
There is no good reason to think that England is incapable of taking a similar clinically-focused journey. The success of a walk-in minor ailments service in Cornwall is just the latest example of progress at a local level. Patients are able to visit the pharmacy without an appointment or referral for a consultation with the pharmacist that takes place in a consultation room and receive NHS treatment if appropriate.
A record of the service is sent electronically to the patient’s GP for completeness. In its first year, community pharmacists in Cornwall delivered over 8,000 of these minor ailment consultations, saving over 6,000 GP appointments.
We can’t wait until England's current funding framework comes to an end in 2024 before giving serious thought to what should replace it. For many months, the National Pharmacy Association (NPA) has been considering this matter, together with our members. Obviously, we’re not alone in giving the medium- and longer-term future serious thought.
The Pharmaceutical Services Negotiating Committee (PSNC) has published some sensible pillars and is currently working through a new vision, which will lay the ground for future negotiations. Meanwhile, the Company Chemists’ Association (CCA) recently published its prospectus for the future.
Read more: Increased use of community pharmacy ‘essential’ to NHSE 2023/24 priorities
By and large, we all agree on the need to take a clinically-focused journey, building on the medicines supply function and integrated with the NHS. But I believe that NPA members – as natural innovators and skilled healthcare professionals – are particularly open to the idea of an ambitious, transformative change.
We’re ready to go with our members to new places, fully deploying the skills of our brilliant pharmacy teams and reaching further into public health, medicines optimisation and urgent care, increasing access and dramatically improving patient outcomes.
Andrew Lane is chair of the NPA
