The Pharmaceutical Journal Vol 267 No 7160 p190
11 August 2001

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Who represents local pharmacists in the new National Health Service?

By Joy Wingfield and Stephen Garner

In the space of 10 years, our local pharmacists have dealt with two family practitioner committees, two family health services authorities, a merged health authority (HA) and there is now the prospect of a much larger and remote strategic health authority (SHA). We have responded to fundholding practices, commissioning groups, local purchasing co-operatives, six primary care groups, now four primary care trusts, with the possibility of further mergers to reflect our slice of the projected 300 or so PCTs in England by next year. We have exhorted all local pharmacists, whether hospital, GP practice or community based, to participate in the Nottingham-wide pharmacy development group (PDG). But this is now as challenged as the local pharmaceutical committee in knowing which way to turn — outwards to an SHA or inwards to individual PCTs? Not forgetting, of course, the Nottingham branch of the Royal Pharmaceutical Society, whose boundary (so far unchanged) encloses some of these geographical constituencies but reflects none of them fully.

We wonder where is the debate on how we should cope with these constantly shifting sands of National Health Service policy and structures?

Let us look at the numbers.

There are 100 LPCs in England. Most have 15 members; some have as few as nine. So roughly 120 to 130 community contractors or their employees currently carry the flag for their cause. If we eventually have around 300 PCTS, predicted for 2003 at the latest, then with only one pharmacist to carry the local flag, we would need at least twice as many willing activists as now, operating without the support of 14 colleagues. One LPC per PCT, as currently constituted, is patently not feasible. Should we consider a PCT-based local coalition instead — as is the model in Scotland? Would England’s community pharmacists identify and work with their colleagues in such a relatively small geographical area? PCTs are in the ascendant: 75 per cent of primary care funding will be in their hands by 2004 (or even 2003 as the second term starts to wane) and they will assume responsibility for local pharmaceutical, optical and dental services.

What about strategic health authorities? They will “cover whole-system performance and networks, supporting and monitoring primary care trusts and NHS trusts, driving forward the modernisation agenda and brokering strategic solutions where problems have been identified”.¹

So what is the “whole system network” for pharmacy? Will the SHA deal with a variable number of existing LPCs, a collection of “LPC-ette” coalitions reflecting the boundaries of PCTs or with a new “super-LPC” mirroring the size and geography of the SHA? Surely participation in the latter body would need to be a paid-for, normal working hours activity, with clearly defined competencies and skills. And do we know what such a super-LPC would be negotiating for?

But we should not forget pharmacy development groups and Society branches. Both are inclusive organisations; most have active representation from hospital and community practice at least and many are supported by pharmaceutical advisers, industry pharmacists, academics and political activists. Both are eligible for financial support from the Society. Both usually have a common desire to develop local pharmacy although actual involvement varies widely around the country. Society branches generally have three roles: social, educational and political. The social role is a hard furrow to plough given the multiplicity of alternative ways for our cash-rich (?) time-poor professionals to spend their free time. Nevertheless, it remains an important arena in which to sink differences and interact as individuals, rather than pharmacists.

Monthly continuing education meetings are the mainstay of many branch programmes but there is a growing need to make these more consistent with continuing professional development and more in tune with the needs of accreditation and personal development plans. And, finally, politics. Local politics needs local movers and shakers. And you find them in the branch, on the LPC and in the PDG. Usually the same people! As the burden of local policy driving becomes more onerous, there just are not enough willing pharmacist bodies to go round.

So can we rationalise the load? Could locally inclusive bodies such as PDGs and branches merge, particularly for financial support and administrative efficiency, albeit retaining three separate strands of activity as set out above? Will there still be a regional as opposed to a very local role for pharmacy contract negotiators? Who is best placed to deliver this role and how will they be selected? And will local pharmacists rally to the PCT banner and become individually involved in their own future? They will need to be more articulate, more persuasive and less isolationist than now. Local independents and small multiples have a built-in advantage in terms of local relationships and knowledge; national groups can field individuals with national vision and presentation skills to secure proper recognition and of the potential still locked up in community pharmacy contractors. But both may have to recognise that the NHS is about local services for local people, and that means more hands on the pump than is currently apparent.

In addition, what about the Society’s branches and regions? We are aware of the review of function currently under way, but should not the concept of self-governance be extended at local level, with the branches having a local role in developing and maintaining professional standards. Could regional committees be reconstituted to be co-terminous with the new SHAs and formal NHS recognition sought for a body representing the totality of pharmacy interests in the area?

Management-speak states that “form follows function”. In other words, decide what you are trying to achieve first and then design the system to deliver it. We need to debate and clarify what our local representational needs are — if any. What can reasonably be expected of our existing local bodies and how can they handle these major changes? We need some serious thinking and answers to these fundamental questions before redrawing the structures. But we need to do this fairly soon, because there will soon be too many bodies and not enough people.

Joy Wingfield is a member of the Nottingham local pharmaceutical committee and the Nottingham pharmacy development group. Stephen Garner is chairman of Nottingham PDG and of the Nottingham branch of the Royal Pharmaceutical Society