In an open letter addressed to the Secretary of State for Health (Mr Frank Dobson), the chairmen of two local pharmaceutical committees explain the problems and uncertainties facing community pharmacists in the continuing absence of any clear message from the Government about its future plans for the profession
Dear Secretary of State, — We write to you as experienced local pharmaceutical committee chairmen to present a wide spectrum of the views that we have encountered. The nation celebrated with exuberance and joy when your party swept into power in the spring of 1997. Following on from the gloomy days under the Tories, people expected that the New Labour Government would put values and people at the front of its policy-making — also that it would be a listening Government with a sense of fairness, equity and strong principles.
In such a climate, we read in The Pharmaceutical Journal that on the July 4, 1998, in the presence of HRH The Princess Royal, you had announced to a surprised and delighted audience your wish to write a strategy for community pharmacy and see it integrated more closely in the family of the NHS. In December, 1997, the White Paper “The new NHS — modern and dependable” had heralded not only a new, integrated and efficient NHS but also one that was patient-focused and as near the patient as possible. As there was no mention at all of pharmacy in your strategy, there was great disappointment among pharmacists everywhere and a certain amount of worry about the future.
Your strategy set the new health and social care objectives:
Despite our disappointment, we set out to find ways of working with the health and local authorities. There was much to think about, much more to organise, and many people to persuade. At our two LPCs we worked feverishly to consider new opportunities and challenges. We had monitored external changes and were responding appropriately. The pharmacy profession was witnessing a decline in the number of pharmacist-owned pharmacies, accompanied by a dramatic loss of confidence and morale. Despite this, your announcement gave pharmacists hope and succeeded in raising expectations.
Experts believe your government will serve for another term. If this turns out to be true, and, without intervention, we believe that, under the New Labour Government, we will observe a change in the make-up of pharmacy ownership from pharmacist-dominated to corporate-dominated ownership. More significantly, the number of owners will decrease dramatically, as fewer than one pharmacy in three will be pharmacist owned.
Following your announcement, many pharmacy representatives reminded the profession of previous empty promises of successive Secretaries of State and Ministers of Health. Many pharmacists at a local level poured scorn on suggestions of a strategy for pharmacy and new developments. They in fact preferred to close their pharmacies or sell them to vertically integrated corporate companies. Our two LPCs encouraged local pharmacists to respond positively to your call for ideas to develop community pharmacy. To sceptics, our secretary and the then President of the Society said, “Wait and see. In the future, people will compare Frank favourably with Nye Bevan. He is a reformer and he is sincere.”
But his words are at odds with reality. We have looked for a mention of pharmacy in every White Paper, Green Paper, Health Service Circular and speech you have delivered. There is enough paper to have killed a forest, but there is nothing substantial for pharmacy. Pharmacists locally feel that your latest White Paper, “Our healthier nation”, lets down not only you and your colleagues but also the six million people a day who visit this nation’s 10,500 pharmacies, many of which are located in the most deprived inner city areas or in rural areas.
This latest body-blow of ignoring community pharmacists’ contribution to the health of the nation, served on top of what is now a regular dose of ignoring our pleas, is bewildering and hurtful. What do we have to do to catch your eye, Frank? Some say militant action. We hope not.
Our profession has already produced Pharmacy in A New Age, which sets out pharmacists’ ambitions and a patient-focused pharmacy strategy which neatly fits into your main policy objectives. Our active and well-informed LPCs, in a spirit of co-operation and with a positive attitude and imagination, have worked hard to develop local solutions which are designed to provide improved services. These attempts have been received with interest, but no resources are available to start and sustain the services. For example, only recently we have seen a letter from a health authority which bluntly states that it has no money for developing pharmaceutical services and does not see itself obligated in any way to develop the pharmaceutical service because it is not resourced by your department for that purpose.
By this time we had already — with a great deal of enthusiasm and cost — tried to develop services that meet your policy objectives. We have organised meetings, training and focus groups, we have invited local and national speakers, and we have submitted our proposals to the Crown review group and to the Turnberg inquiry into London’s health care services. We have also produced a position paper on mental health, diabetes and hypertension. The LPCs and the pharmacists they represent now feel dispirited, tired, desperate, stressed out, let down, forsaken and undervalued, and many pharmacists are considering opportunities to serve the nation and support their families outside of pharmacy, at a time of a shortage of pharmacists. Pharmacists’ problems — with futures tied to property leases, declining margins, increasing costs, increasing supermarket competition and lack of recognition — are endemic and perpetual. Our advice to young people is to stay away from a career in community pharmacy.
In the past year we have seen three good, young and committed pharmacists in our area padlock their pharmacy for good and put up a “lease for sale” sign. They still have debts to clear. The other losers are the people on the surrounding council estates whose needs were recognised by the health authority but will not now be met.
Mr Dobson, we believe you will agree that this is not a way to successfully reduce health inequalities, which are a major plank of your policy. It seems that every investor and service provider has rights and expectations. The current pharmaceutical contract is based on an inequitable principle: if a pharmacist gains, the Government will claw the gain back; if he loses, it is his own fault. Without your interest and desire to act, Sir, this is the beginning of the end for many pharmacist-owned pharmacies. Many pharmacists believe that your Department has a secret agenda to cull them. Perhaps you may wish to clarify this. For a tree to bear fruit it requires a strong foundation and nurturing. We cannot identify with your promise at the LPCs’ conference to make community pharmacy a prosperous occupation.
Mr Dobson, we know that you would like to be known as a health improver, a service moderniser, a systems developer and a top manager of health service strategy and performance. You are also reputed to be a patient’s champion, a fair-minded person and a blunt speaker. So please, Sir, tell us why community pharmacists have no role to play in your action plan to tackle poor health. Tell us why pharmacists are not included in the “Saving lives” White Paper, which aims to prevent cancer, coronary heart disease and stroke, accidents (including unwanted pregnancies), and mental illness. Our colleagues are ready and willing to contribute with medicines management, concordance and making clinical governance arrangements more robust. We know this will meet patients’ approval. So, Mr Dobson, what is it that is delaying the green light?
We are pressed by colleagues to say that your and your Ministers’ words, just now, contain contradictions. So many good intentions have unintended consequences. Each solution you formulate for health care delivery carries a sting in the tail for pharmacists.
As active and intelligent LPCs, the more we know of the new NHS, the more confused we become about our role and relevance and about your intent. The more we try to influence health authorities, local authorities and GP-dominated primary care groups, the more powerless we become. The more sophisticated and resourced the NHS becomes, the more impotent and debilitated community pharmacy becomes. The more you invest in information technology and management, the more disfranchised and remote we become.
Please do not call this a paradox — it is simply total neglect on your part and on the part of your Ministers and their short sighted civil servants. It reflects a total lack of understanding of the demise of a mature independent profession, which has increasingly become heavily dependent upon the NHS for its survival.
Mr John Denham, the Minister responsible for pharmacy, recently said that primary care groups and trusts would control three-quarters of the NHS budget. He also reminded people that your Government wanted “to put family doctors and community nurses in the driving seat and so bring decision-making nearer to patients.” He went on to say: “PCTs will be able to use further powers in combination with greater freedoms, and make further innovations. They will be empowered to invest in general practice; in premises and information systems; to devise their own incentive arrangements; and to employ staff to support practices in delivering health care. They will also be able to deploy the flexibility offered by the Primary Care Act and develop clinical governance and continuing professional development. Those who work in the NHS will have tools to deliver the changes that benefit their patients, and the chance to develop new skills and build new partnerships with those whose contribution is most important to their patients’ needs.”
Your team responds to the medical profession because it is strong and it has a strong lobby. It gets resources and guarantees galore. Similarly, your team appears to respond positively to the corporate pharmacy owners’ lobby, for reasons we cannot understand.
And yet, when it comes to dealing with issues relating to pharmacy, especially those relating to the bottom 25 per cent of community pharmacy owners, there is a total disregard, as evidenced by lack of comment or positive action. Mr Dobson, please check the gross income of this bottom group and also check what proportion of pharmacy owners actually earn an average income. We are sure the results would surprise you. One-man bands are too busy and unable to afford public relations consultants, so are their rights and contributions going to be ignored under New Labour?
The Prime Minister in 1998 said that the Government’s aim was “to build a modern country equipped for the next century where every individual can ascend a ladder of opportunity and every family has the support of a strong community”. At about the same time the Chancellor of Exchequer firmly committed the Government to “promote opportunity for all and make Britain a fairer place.”
A fairer place? Your Department has a very long way to go before you will convince the community pharmacist to believe the Government. On behalf of the disillusioned local pharmacists we invite you and your senior officials to pay us a visit. Do not accept our words — please come and witness the damage to the human soul as a result of procrastination and policy vacuum. We are not expecting to hear from you, but you must know that each day’s delay kills something in the hearts of a previously committed and enthusiastic professional with local and intimate knowledge of people, places and other health care professionals.
Please, Mr Dobson, do not emulate your predecessors by going to your next pharmaceutical engagement empty handed and full of hot air. There is a danger that you will lose personal credibility with pharmacists and that your Government too will further lose support.
Nor, we hope, will you go with empty pockets. Community pharmacists have been your Department’s doormats for more than a decade. The cry from the frustrated grass-roots pharmacists is loud and clear: “You must not expect any improvement in quality or productivity without further investment of money and properly funded continued postgraduate training.”
For people to be responsible and enterprising they need, before words of wisdom and encouragement, a strong sense of belonging, trust and a sense of security. You have a great opportunity to put things in motion in your next address to pharmacists — not as a response to a “whinge”, but because it is right for your Government and for the people it represents, and also because it happens to be right for committed pharmacists. We are committed to developing your vision of the new NHS and are eager to play a role in developing primary care. What we need is a strong base to contribute effectively and consistently with appropriate recognition to make your vision a lasting reality in our local communities.
Yours sincerely,
Jayvant Patel
Barking and Havering LPC
Gary Boorman
Redbridge and Waltham Forest LPC