How much longer can community pharmacists push linctus up the hill?

The Grouchy Pharmacist

 

You know when enough is enough. Someone has to say something.

 

Well here we go.

 

When I qualified as a pharmacist I was sold a dream. Basically said dream went a little like the following.

 

  1. Get on the register.
  2. Get experience, probably with a multiple community pharmacy chain.
  3. Buy a community pharmacy.

 

Sorted.

 

Mmmmm maybe not…

 

I saw a notification the other day on Facebook and it guided me to a post within which yet another talented community pharmacist was set to jump ship to work in a primary care pharmacy role. This pharmacist was standing, leaving gifts in hand, trying to look sad. The reality was nothing of the sort. A polite facade hid a great degree of relief behind the eyes.

 

And who can blame the ambitious community pharmacists calling time on pushing linctus up the hill?

 

Low pay, targets, performance management and no lunch break. Some complain of feeling guilty for taking a toilet break. The miserable conditions many community pharmacists have to put up with have been well documented in pharmacy circles. That said, really very little has changed in community pharmacy in the last 30 years.

 

And as usual, it’s about how the money flows through that system. The odds are stacked against the conscientious community pharmacist with ambition. There’s basically no money in delivering excellent pharmaceutical care.

 

And you may as well forget about becoming a prescriber.

 

There has been an element of window dressing to attempt to add depth to the role in certain quarters. The ubiquitous community pharmacy pilot. The trouble with this attempt to deliver ‘clinical services’ through community pharmacy is quite frankly the money rarely follows. To deliver complex services in community pharmacy would require investment in pharmacist training and medical supervision. The streams of money running into community pharmacy mean that this grand ambition will always just be that unless there is a huge shift in policy.

 

I have wondered recently if we have ever delivered pharmaceutical care in community pharmacy to the level that the people who access the service deserve? And this I think is probably the root of the problem, the symptoms of which we are seeing played out on the myriad of millenial inhabited social media groups. These youngsters have no reason to believe in community pharmacy. Those that stay have a life of considerable responsibility, commercial pressure and long hours standing on their feet to look forward to.

 

Are they just being snowflakes?

 

Largely I think it would be unfair to say they are. But they are aware that it doesn’t have to be that way. The profession of pharmacy provides many exciting opportunities for career development. The trouble is with the acute lack of investment in community pharmacy these opportunities sit elsewhere. The lure of working in general practice is proving too tempting for many.

 

The perfect storm for community pharmacy becomes starker when you consider the rise of ‘health tech’. The Government have already put multiple markers down saying that the community pharmacy network is too expensive when we consider the supply function. The Amazonisation of pharmacy is coming. This will lead to fewer, more centralised jobs which will largely be robotic.

 

And robots are accurate and fast.

 

Centralised prescribing and remote consultations are well on their way to the mainstream. Again community pharmacy will find it harder to compete as the digital natives coming through want to access healthcare immediately. Sure some community pharmacies these days have impressively long opening hours but I think expectations have gone through the roof in this regard.

 

So where does this ranty analysis leave us?

 

Well, it has resulted in an incredibly disillusioned workforce. This ill-feeling is overflowing in public and private forums online. And who can blame them?

 

At the risk of hopping up on to my moral high horse, I do feel sad when I see foul language and direct criticism of patient behaviour. People accessing community pharmacy services will often exhibit complex health-seeking behaviours. For pharmacists to criticise or mock this in public or private groups where they feel disinhibited is a big problem and a step too.

 

This is a sign that the professional wheels are coming off.

 

Again on one hand who can blame these pharmacists for trying to express their frustrations?

 

So we arrive where we are today. Low community pharmacy wages across the UK, considerable responsibility on the shoulders of responsible pharmacists and poor working conditions.

 

Am I being too negative?

 

Realistic more like.

 

The Grouchy Pharmacist is everyone and no-one.

Five year deal for community pharmacy in England worth almost £13bn

Following negotiations between PSNC, DHSC and NHSE&I, HM Government has agreed to make a five-year investment in community pharmacies. The deal secures funding of £2.592bn per year for community pharmacies. The agreement also sets out a vision for the expansion of clinical service delivery through pharmacies over the next five years, in line with the NHS Long
Term Plan.

 

The deal is in line with the GP contract, providing 5-year stability and reassurance to community pharmacy. The Government have said that this should allow businesses to make long term business decisions and to discuss investment with banks and suppliers.

 

The Government have said that this deal confirms community pharmacy’s future as an integral part of the NHS, delivering clinical services as a full partner in local Primary Care Networks.

 

There have been a number of new pharmacy services announced as part of the deal. Amongst the new services is the new national NHS Community Pharmacist Consultation Service, connecting patients who have a minor illness with a community pharmacy which should rightly be their first port of call.

 

The deal seeks to recognise that an expanded service role is dependent on action to release pharmacist capacity from existing work. It seeks to rationalise existing services and commits all parties to action which will maximise the opportunities of automation and developments in information technology and skill mix, to deliver efficiencies in dispensing and services that release pharmacist time. The deal also aims to continue to prioritise quality in community pharmacy and to promote medicines safety and optimisation.

 

Matt Hancock Secretary of State for Health and Social Care commented:

 

“Soon after becoming the Secretary of State for Health and Social Care, I set out my ambition to unlock the huge potential within community pharmacy. I outlined that I wanted to see the clinical skills of the teams that work in pharmacies better utilised and to make best use of the accessibility of the 11,500 pharmacies throughout England. I am now delighted to set out this landmark 5-year settlement for the Community Pharmacy Contractual Framework (CPCF) which, from October 2019, will expand and transform the role of community pharmacies and embed them as the first port of call for minor illness and health advice in England.

 

“Community pharmacies are a vital and trusted part of our NHS. We need to draw on your expertise, your experience, and the invaluable human connection you have with your communities. Through this deal I expect to see community pharmacies further integrated within local primary care networks, doing more to protect public health and taking on an expanded role in urgent care and medicines safety.

 

“This deal sets out a clear future vision for community pharmacy, a vision which NHS England & NHS Improvement and the Pharmaceutical Services Negotiating Committee fully support and are committed to delivering in partnership with us. I invite and encourage community pharmacy and other primary care contractors to work with me to deliver integrated and accessible community health services for all and to help people live happier, healthier lives for longer.”

 

Claire Anderson, Chair of RPS in England, said:

 

A shift to a major clinical future is encouraging and is absolutely the right direction for community pharmacy. We have long called for pharmacists in the community to play an expanded clinical role and there is much to welcome in the new contract with focus areas on urgent care, prevention, medicines optimisation and safety. The exploration of innovative and new services will showcase the enhanced roles that community pharmacy can play, such as enabling earlier detection of cardiovascular disease, Hepatitis C testing and supporting public health.

 

“Referring patients with minor illnesses who would have otherwise required an appointment with their GP to community pharmacists will be game-changing for our primary care systems. If successful, the Community Pharmacy Consultation Service will support the delivery of the NHS Long-Term Plan and make the best use of the clinical skills of community pharmacists through better integration. It will also have a positive impact on relationships within the multidisciplinary primary care team and in educating patients about the types of support and expertise that pharmacists provide.

 

“Medicines optimisation across the health service should be central to patient safety. As Medicines Use Reviews (MURs) are phased out, it will be vital that pharmacists in all settings, including within Primary Care Networks, are enabled to help people get the most from their medicines.”

 

“A five-year settlement will offer some certainty for contractors who want to plan for the future, although with funding remaining flat and contractors potentially facing rising costs, the sector will no doubt be keenly watching how further details on services and payments are negotiated each year.

 

“It will be vital for pharmacy leaders to engage with new NHS structures to co-create the design and delivery of local services, and so we welcome transitional payments to help meet costs associated with changes such as integration into Primary Care Networks.”

 

Mark Lyonette, Chief Executive at the National Pharmacy Association (NPA) said:

 

“We strongly support the emphasis on clinical services and the recognition that pharmacies can play a significantly greater role in urgent care and public health. What’s more, the five-year term of this settlement gives us the long view we asked for.

 

“But static funding year on year means it will be very difficult to deliver the transformational improvements we all want to see.  The government must be prepared to direct more money into community pharmacy if it becomes clear that funding is insufficient to maintain current core services and invest in positive new developments like the Community Pharmacist Consultation Service.

 

“We note the proposed annual review each October. To ensure the service levels required for patients, we suspect the £2.59bn needs to be a floor not a ceiling.”

 

Commenting on the agreement, Malcolm Harrison, Chief Executive of the Company Chemists Association (CCA), said:

 

“The CCA is supportive of a five-year settlement for community pharmacy. While we recognise that a further five years of flat funding will present significant challenges to what is already a financially strained sector, we are encouraged by the direction of travel set out by the agreement.

 

“The CCA and its members have been calling for a more clinically focused contract framework in recent years. We hope that the Community Pharmacist Consultation Service will allow community pharmacists and their teams to continue to refocus the sector on the delivery of care.

 

“We believe it is now critical that all community pharmacies embrace the new urgent care services and engage with Primary Care Networks so that the sector is more integrated within the NHS. We are also pleased to see the use of the Pharmacy Quality Scheme to support the sector-wide agenda for patient safety improvement.

 

“There is much still to be agreed within this settlement. We look forward to working with our colleagues from across the sector, through the PSNC, to help develop what the new framework will mean for contractors.”

 

You can view the PSNC summary of the new funding arrangements here.

 

£300,000 investment in Scottish Community Pharmacist Practitioner Champions to continue

Scottish Government has announced its intention to continue funding for Community Pharmacist Practitioner Champions in 2019-20.

 

The Practitioner Champions are set to be tasked with supporting all community pharmacists and the whole pharmacy team to undertake Quality Improvement activities as well as supporting the implementation of the refreshed Minor Ailment and Common Conditions Service.

 

You can read about the original role and remit of the Practitioner Champions here.

 

The funding breaks down as follows;

 

NHS Board Investment
Ayrshire & Arran £21,420
Borders £6,099
Dumfries & Galloway £8,610
Fife £19,734
Forth Valley £15,728
Grampian £28,670
Greater Glasgow & Clyde £64,544
Highland £18,671
Lanarkshire £35,747
Lothian £43,033
Orkney £5,000
Shetland £5,000
Tayside £22,743
Western Isles £5,000
£300,000

 

You can read the full circular here.

Andre Yeung on being on a mission to make things better in pharmacy

Andre Yeung

 

Andre Yeung is a pharmacist, NHS England Network Chair and architect of the Digital Minor Ailments Referral service. By his own admission, he is on a mission to make stuff better for patients.

 

He was recently elected to the Royal Pharmaceutical Society English Pharmacy Board. He topped the poll in England with 941 member votes.

 

We caught up recently to talk all things pharmacy.

 

What have you learnt from your career progress so far?

 

“I qualified ion 2000. I started as a community pharmacy business. My father was a community pharmacy owner. I grew up with the expectation that I would work in the family business but that came to an end when my father sold the business in 2006 when the market was riding high. I began working for one of the multiples, became an area manager. I then got an opportunity at Celesio to do a business development role across a number of settings across England and into Scotland too. I worked with some fantastic people. After three years of that, I took time out and did an MBA at Durham. I came out of that MBA thinking differently and started my own consultancy. A few years later I a am carrying out a number of functions. I’ve worked with the NHS, Pharmacy Voice the PSNC and others.”

 

How did you find the election process and what were the top line findings in your survey?

 

“I think it’s your job to understand how members are feeling. My role will be to represent the views of the members. I will be accountable to members. I found myself in a position where I started to run but realised how little I knew about what pharmacists think about various topics.

 

“It was a practical thing to do to find out what others are thinking. I wanted to seek to understand and then move forward and have an influence. It was a very positive experience. Some of the other people were gracious enough to give me a pat on his back too.”

 

There were no hustings so was this the easiest year ever to get elected?

 

“I genuinely don’t know. I don’t know why that was but to be honest I wasn’t sure if that would have been beneficial for me because understanding what pharmacists are thinking rather than broadcast. I hope to contribute by helping my board colleagues set the tone for the organisation and hopefully influence positive change in pharmacy. I’m looking forward to working with fellow board members and the executive team”

 

What is your key objective for your time on the board?

 

“I have always been outward looking. Many pharmacists, ourselves included are in business and the market is constantly changing. I’m slightly obsessed with making sure I serve members as best as I can. I hope to be an outward-looking board member who can stay in touch with members. I hope this will give me a mandate and empower me to some really great stuff for members and the profession and the RPS.”

 

Is there a dearth of leadership in pharmacy at the moment and does this drive negative narratives in the media?

 

“I think it would be remiss not to recognise the fact that in community pharmacy especially things have been tough for a long time now. As someone speaking to community pharmacies on a daily basis we have to recognise the last few years have been difficult for everyone. Therefore it is a trend and I do observe it offline too. Like all humans we affected by the environment we operate in especially for business owners. It doesn’t give a lot of opportunity for positivity int he wider profession.

 

“In terms of vision and strategy over the last five years, people inside and outside community ask me ‘what is the vision?’ so I agree there is an issue there. Maybe the narrative is changing due to recent changes.”

 

Do we need to imagine community pharmacy in a post-NHS era?

 

“I think I have a different opinion to you. In England community pharmacy I am seeing green shoots. Im seeing signs of things that give me reasons for hope. The tone of the conversation is changing behind the scenes. I definitely see, through projects I’m involved in, opportunities for the future. The Long-term plan is critical and community pharmacy are mobilising to take advantage of these

 

What is the digital minor ailments referral service?

 

“This is a service that I’m involved in that was developed through help from NHS England in the North East of England. We were lucky enough to get an opportunity in the North East around an idea to refer patients from NHS 11 to community pharmacy. I think to date we have had 25,000 patients referred through that channel. It is a service around which enthusiasm has grown around it. It is something that community pharmacy is offering that no-one else can.

 

“We have similar projects starting elsewhere in the country and I think this is great. The vast majority of community pharmacists are deeply enthusiastic about this type of clinical role. The digital minor ailments service already involves lots of things community pharmacists are doing already.

 

“If you take the digital minor ailments referral service you get patients referred to community pharmacy to have a proper consultation. Medicine is a really important tool in our armoury, you want training and some equipment. I think independent prescribing is part of our future but I think we need to work out how we get there. I think it’s an evolution. It is a huge investment.”

 

Have you got any outcomes to report from this service?

 

“We’ve got lots of information. The service is safe. The pharmacists are doing a great job. Patients love it. And we have been able to scale activity. It is important that the service joins up activity with other areas of the system like NHS 111. It is shifting the patient expectations of what a community pharmacist should be doing and how community pharmacists are perceived.”

 

Andre also joined us recently on the podcast. Click here to listen to the full conversation.

 

 

 

Community pharmacy prescribing in Scotland

Sam Falconer is a community pharmacist. His current role is that of pharmacy manager at Kilwinning’s Townhead Pharmacy.

 

Sam and his team are carving out a reputation for innovation and excellence in the delivery of pharmaceutical care a the heart of their community. Sam is an independent prescriber and he has been using this qualification to deliver a common clinical conditions service.

 

This service involves him assessing and prescribing for conditions like tonsilitis, ear problems, chest complaints and other ailments not covered by the Scottish Minor Ailment Service. He is already making an impact locally and the people that use his services are extremely satisfied with the work he does for them.

 

He was good enough to join me on the podcast to talk through how he has achieved this but also some of the challenges along the way.

 

If you want to understand how to run a well thought through independent prescriber led community pharmacy common clinical conditions service then this podcast is for you.

 

 

If you prefer to never miss an episode you can subscribe on your preferred podcast platform. Just click on the links below to get going.

 

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Eight reasons I’m glad pharmacy apprenticeships have come and gone

Charles Odiase

 

Apprenticeships come into existence driven by certain factors, I will comment using the below headings;

 

Demand vs supply

 

Presently the demand for pharmacists is way less than the supply, especially as we have a lot of schools of pharmacy. Therefore a new workforce or route to becoming a pharmacist will only be a negative, as this would further compound the issue increasing the risk of unemployment and/or very low wages and poor employment conditions as we have often seen in community pharmacies in particular.

 

Insufficient workforce via conventional routes

 

As previously mentioned we have more pharmacists in the labour market than we have jobs, so how would a non – conventional route make the profession better? It would create frustration and drive further poor wages which is simple economics; more supply to demand equals lesser financial value attributed.

 

Void in workforce/skill required

 

We already have apprenticeships like the buttercup apprenticeships for dispensary workforce, we have pharm techs so where is the room for further apprenticeship in pharmacy; where was the need identified? This can only lead to further confusion and debates over roles and competences which could harm the already fragile public confidence in the pharmacy profession. Further conflicts within the profession; presently the profession is managing the conflict between Pharm Techs and Pharmacists, and this would only lead to further divide and frustration.

 

Government interference to take more control

 

As funding for pharmacy continues to be cut, giving the government room to boycott the profession only strengthens its position over the profession, leaving the profession helpless as there would no longer be a reason for employers and the government to feel obliged to meet the profession’s needs, disapproval and/or demand, as the conventional professionals become less relevant and the apprentices are loyal to their sponsors who are their employers, to the demise of the conventional pharmacist.

 

Precedence

 

There is no precedence for this idea I am aware of from anywhere else in the world, however, we have precedence for those who want to study a medical related professional degree which is simply applying for a transfer or conversion. Surely setting such precedence can only signify the downgrade of the perception of the pharmacist profession not just to our medical related colleagues but to the public as a whole. This isn’t simply a threat on employment or wages but on our colleague and public perception of the pharmacist professional status. It will no longer be a course viewed on par with medicine and the likes, the ever-struggling profession would simply lose its standing position in the room where others have sitting down positions, we will be sent out to stand outdoors in the cold and fringes for good. This could damage the pharmacist brand and this isn’t an exaggeration, we see this already with community pharmacists fighting the perception of simply being box checkers who pharm tech can replace.

 

Level 7 courses and apprenticeships

 

The uniqueness of medical related level 7 courses is they make emphasis on the combination of technical and non – technical skills = functional skills training. This takes time and experience 12months doesn’t provide, it is why the nurses are moving towards a degree pathway, it’s why we have advanced practice postgrad courses etc. To suggest that 12months is sufficient regardless of the individual having a first degree is simply an insult to the profession, I can only assume those in support probably never did an MPharm degree and to their defence don’t realise the MPharm degree is not the diploma or BSc degree they completed. Apprenticeships are often used in the social sciences and mechanical courses/fields as these fields depend more on technical skills and less on non – technical skills at their baseline postgrad level. However, in the medical related field I am yet to see this become common place for very obvious reasons such as the need to develop much needed non – technical skills which could be the difference between causing harm or preventing of harm to service users. Apprenticeship is good for less fluid crafts and skills, as often what is learnt is reproducibility not versatility.

 

Regulation

 

Regulation exists to provide uniformed standardisation which is much needed especially in medical related professions to assure public confidence in the profession. Apprenticeship regardless of guidelines put in place will further increase variation, as it offers more regulating powers to employers and other stakeholders whose drives aren’t fundamentally quality but labour acquisition cost. What we would see develop is similar regulatory flaws and loopholes observed during the time of the RPSGB leading to its enforced split. This will further compound the challenge faced by the GPhC which could lead to a further increase in GPhC fees.

 

Setting wages

 

How would wages be set as paying the post apprentice the same or more will surely create friction with conventional pharmacists whose training has cost a lot more and been more intense. It would affect the present poor wage structure more negatively.

 

I do hope for once pharmacists can rally together to wave off this threat to our profession, livelihood, public confidence and further professional divide.

 

Charles Odiase is an advanced clinical practitioner and specialist pharmacist in obesity and diabetes.