The Housing Minister (one Matthew Pennycook MP) had to admit recently that hitting Labour’s target of building 1.5m more homes by 2030 is going to be ‘more difficult than we expected’.
Turns out Government - and bringing about the work of change - is quite a bit more complicated than it looks. Who knew?
The same will of course be true of NHS reform, and I am increasingly of the view (and sympathetic to it on some levels) that the fate of community pharmacy is inseparable from the Ten Year Plan.
There is no question, a ‘one system’ approach has plenty of logic behind it. Let me explain.
I said in my last column that I was closely involved in producing the last weighty tome while a Minister at DHSC; the “NHS Long Term Plan” was our ingenious title.
What I learnt then is how interlinked every moving part needs to be - and today is no different.
You can’t achieve the hospital to community ‘shift’ (rightly) craved by the Secretary of State without moving resources, workforce and a major emphasis of service delivery towards primary care.
You can’t move the dial for patients in primary care without pharmacy.
You can’t realise its’ potential without a step change in Pharmacy First and you can’t do that without coming back to Hub & Spoke to free up pharmacists to be the clinical professionals (more and more of which will be independent prescribers) they are.
The truth is however, pharmacy can’t wait until ‘late Spring’ (which in Whitehall speak means June/July) for the Ten Year Plan to be published and the second part of the spending review.
For one, closures continue at pace and estimations that a combination of the NICs rise and threshold changes announced in the Budget will hit pharmacies with a bill of some £12,000 each will hardly help.
Read more: CPE: ‘Financial rewards’ for high performance must include pharmacy
Secondly, the five year contract for community pharmacy in England expired in March and no new negotiation with CPE is underway at the time of writing.
And third, Pharmacy First is only funded until the end of March despite Ministers falling over themselves to speak of its potential. It even got a mention in the Budget speech.
Meanwhile Hub & Spoke is on ice even if I do understand that is more an issue of capacity in Parliament than a significant Ministerial wobble on the principle behind it all.
I said I have some sympathy for a ‘one system’ approach to reform, and I do, but in the same way as the NHS received a “down payment” in the Autumn Budget, pharmacy simply cannot wait until this Government has been in office for a full year.
I’ve been behind Stephen Kinnock’s desk and I know too well the advice he will have received when Hub & Spoke came up. It goes something like this…
“Minister, Number 10 doesn’t want us to proceed with this until we’ve considered the new pharmacy contract and the savings it can realise; and of course the ten year plan hasn’t even concluded its initial consultation.”
It will very likely be the same advice with the new (badly needed) pharmacy contract.
There is no question to my mind the Minister - and the tenacious Janet Morrison at Community Pharmacy England - will be arguing the toss, for the reasons I covered above, and I really hope they prevail.
Will they be backed up by NHS England in this endeavour? With the traditional Winter crisis looming, backlogs in elective care rising and the GPs in revolt, let’s see where pharmacy ranks.
Read more: Pharmacy collective action ‘will put immense pressure’ on GPs
If Matt Hancock’s evidence to the Covid-19 Inquiry last week is accurate, perhaps we shouldn’t hold our breath?
There’s also the vexed issue of dispensing practices.
Highly valued by the patients who have access to them but increasingly under pressure as surgeries struggling to make ends meet face a menu of unenviable choices. More on this in a future Political Pills column.
I don’t like industrial action, and of course neither GPs or community pharmacy can strike, but the news from the National Pharmacy Association (NPA) that pharmacy owners will take part in collective action next year unless funding is improved is understandable.
It’s also smart, unlike the BMA on behalf of GPs, to get the agreement now and give Ministers time to reflect - and act - before they start to limit pharmacy services in January.
Read more: Have your say on the state of community pharmacy
Sometimes in Government, the temptation - even the obvious thing to do - is to pause and consider the issue as a whole ahead of its various moving parts.
This time, when it comes to community pharmacy, is not one of them.
Sometimes in Government, Ministers need to walk and chew gum at the same time.
This time is one of those.