PJ Online | PJ Letters: Remuneration

The suggestion that the National Pharmaceutical Association board "acted with pique rather than the considered judgement required on this occasion", made by Barry Shooter (PJ, 8 December, p816) cannot go unchallenged.

Primly to suggest that the fee reduction "should have come as no surprise because we all should know that the dispensing fee is part of the global sum" I find astonishing, regardless of our respective opinions on whether the Government would even "be wrong not to do so" under the terms of our contract. The fee estimate was made on projections of likely volume, this was probably agreed genuinely by both sides, but then to hide behind the global sum ignoring all other considerations was a deliberate, calculated and, to my mind, unnecessarily provocative decision taken by the Department of Health.

In truth what comes as no surprise to me is that we have been sent another mixed message from a Department which is building an expectation of some pharmaceutical nirvana on the horizon, while systematically undermining the financial stability of the community pharmacy network. Mr Shooter and I are both optimists; I imagine neither of us would have continued on our respective paths were we not. But I cannot agree that I believe the Pharmaceutical Services Negotiating Committee will attain the remuneration results we need and deserve. I see every reason to believe that, regardless of the validity of any arguments we make, the Government is on a predetermined course to reduce average dispensing costs nearer to those of a pharmacy which it considers an "efficient" size, that is, larger contractors.

For the record, my understanding of the NPA meeting was that the board felt that continually to welcome the introduction of new, increased workload in the present fashion paid insufficient regard to the fact that the service will slowly grind to a halt under the weight of the current system. As such we have withdrawn from nothing — we were party to nothing in the first place. Nothing new there then. We have withdrawn NPA support from schemes and initiatives, and given our recent history with the Department I see little else that could be done. As to whether the action was taken "unilaterally", surely it is in the nature of representative bodies to make decisions. This was ours. After prolonged discussion it was felt that sanctions were an inappropriate response, although I note a tide is rising here as the recent survey in Chemist and Druggist and the letters page of The Journal show.

As to "negotiations carried out robustly and professionally to achieve the just result to enable us at least to recoup the additional costs associated with our increased productivity", have we not just done this? Did it not get us absolutely nowhere? Is not exactly the same thing likely to happen again next year as volume spirals?

Perhaps in this action the NPA has tried to send a clear message to contractors that we understand the pressures on them, and to recognise that the organisation has a responsibility not to sit quietly by as the service is damaged, randomly and irreparably. Instead it should provide a lead in asking for a more realistic dialogue over the future of the profession, which ultimately must be achieved by a consensus between all pharmacy bodies.

Peter Cattee
NPA Board Member, Chesterfield, Derbyshire

In business to make money

From Ms B. E. Scawn, MRPharmS

I cannot believe that our remuneration is being cut again (PJ, 24 November, p733). What other business would accept that the harder you work the less reward you will get?

Come on pharmacists! Surely we can find someone who can negotiate for us who realises that pharmacists are in business to make money like anyone else. Perhaps we should come out of the National Health Service and dispense only private prescriptions.

Barbara Scawn
Market Harborough, Leicestershire

NPA action will not compromise the profession

From Mr J. A. Schofield, MRPharmS

I am writing concerning Barry Shooter's criticism of the National Pharmaceutical Association's policy in response to the Government clawback of alleged overpayment (PJ, 8 December, p816).

Many times in the past the subject of industrial action has been discussed and quite rightly, few pharmacists have been prepared to withdraw services that would compromise patients. We are a caring profession and frequently demonstrate this to be the case. (And I write this mindful of the esteem the nursing profession still enjoys despite significant numbers of nurses striking and forming picket lines around hospitals during the 1970s and early 1980s.)

It is obvious that the Department of Health seeks to fund new services from the existing global sum — a sum that has increased by 4 per cent in real terms over the past 10 years despite a 40 per cent increase in workload.

In this scenario, we are supposed to motivate young pharmacists to come and work for us, and motivate staff to achieve higher qualifications and take on more and more responsibility. It does not take an economist to work out that a breaking point will be reached, or has been, that will probably put the public at risk in the forseeable future.

The NPA has drawn a line in the sand that does not compromise existing services. It will not harm patients but it does inform the Department of Health that we are sick of platitudes and patronising soothing words.

At a national level I cannot remember one positive development in the scrap that is the annual remuneration imposition in the past 10 years. I do not share Mr Shooter's view that the Pharmaceutical Services Negotiating Committee will achieve fair settlements for new or existing roles if we bend over for the DoH as eagerly as we have in the past. Remember that the "framework" under which negotiations take place is the scrapping of the "cost plus" contract and its replacement by something called "Recruitment retention and motivation"! At that point our discounts should have been removed from the discussion. They were not and when we went to court the following year to protest at the latest outrage we were informed by the judge that we should have said so at the time. Having allowed them on the table at that time meant that we were happy with the situation and we could not get it looked at retrospectively. Thanks a lot for that PSNC!

I have faith in the current PSNC. However, it cannot proceed unless it has the support of its members. History has shown (and Mr Shooter should be well aware of this) that we have insufficient clout to achieve anything like our aspirations. Thank God for John D'Arcy and the board of the NPA for digging in their heels and making a point that does not compromise our reputation as a caring profession.

J. A. Schofield
Jarrow, Tyne and Wear

Support called for

From Mr T. Reid, MRPharmS

I read with incredulity and some irritation the self-contradictory letter from Barry Shooter (PJ, 8 December, p8l6). He was making out that we should not be surprised that the dispensing fee is to be reduced by 10p and that it was all self-evident from figures in PSNC News. Yet he criticises the Pharmaceutical Services Negotiating Committee for not warning us about the inevitable! He sycophantically wrote: "I am an optimist and I do have every confidence that the PSNC under its new leadership will attain the remuneration results that we need and deserve." I hope that he is right, but experience would indicate that he may have to eat his words about the dispensing fee recovering lost ground.

Mr Shooter criticises the National Pharmaceutical Association for withdrawing its support from the repeat dispensing negotiations, until the Government allocates tangible resources.

When the fully loaded guns should be firing at the Department of Health he instead focuses on his own representatives.

To make matters worse, he believed that "the NPA board acted with pique rather than the considered judgement required on this occasion". What a ridiculous suggestion. Measured responses relating to future volume increases do not harm patients.

A panicky Mr Shooter, worried about leaving multiples alone at the negotiating table, says that "the last thing that independent community pharmacists need at this moment is ill-judged, emotive action". Well there is going to be no stocking-filler there.

He wonders "who gave the NPA the mandate to act unilaterally in this fashion". How naive. Surely the purpose of electing representatives is that they do just that — represent us?

So Mr Shooter, fire off at the Department of Health, give us all some new direction and new ideas on how to improve our lot and I will be among the first to join you. Otherwise let us support our two bodies that are ready to fight the DoH. Well done to the NPA and the PSNC for a bit of purposeful standing up.

Terry Reid
London N9

Try and try until success comes

From Mr H. R. Patel, FRPharmS

Pam Grant (PJ, 8 December, p817) attacks members of the Royal Pharmaceutical Society's Council for being "out of touch with the reality of community pharmacy" and accuses them of indifference. This is justified to a certain level but there is a need to look at the whole picture, local and national.

The fact is that the Government decides the remuneration of community pharmacy, not the Society. Secondly, the Government decides the global sum to pay for services provided by "chemist contractors", after consultation with the Pharmaceutical Services Negotiating Committee. Thirdly and crucially, the payment is made for what the Government wants done (ie, dispensing of prescriptions) at the lowest possible cost to the Exchequer. Fourthly, in England and Wales there are about 10,500 pharmacies making an investment of £100,000 each thus making the total investment £1,050m. It has to be assumed that this is the amount of money the Department has not got, otherwise it would pay contractors in full within 30 days, instead of 90 days. Fifthly, there are at least 22,000 pharmacists working in community when there are many unfilled vacancies in the hospital sector, which is Ms Grant's preferred option as far as salaried service is concerned.

The Government is good at delivering platitudes, and has consistently failed to reward quality or new roles both in the hospital and community sectors. How many successful pilots have the Government's health authorities run and how many are now nationally rolled out? None. Let us take emergency hormonal contraception pilots as an example. Does anyone have doubts about the value of pharmacy-based EHC service? Next, let us take smoking cessation services. Same story, but even worse news to share: many schemes are folding or about to fold due to lack of funds. It has failed to bring hospital and community pharmacy sectors to work together for patients' benefit. Even "Pharmacy in the Future" is yet to be resourced and that is why it is a pie in the sky for most pharmacists.

It amazes me that Ms Grant criticises her employers for doing a job that the Government and the public want done. She criticises the Council for neglect when that is blatantly untrue. It is the Government that is failing to bring about the speedy change that is required.

I can understand her sense of loss of control when good projects are sitting on the shelves. I have had the enormous joy of getting a medicines management project off the ground in Barking and Havering, where the health authority considers pharmacists to be important stakeholders. In contrast, I have had the most miserable experience dealing with the neighbouring Redbridge and Waltham Forest Health Authority, which consistently fails to include and involve bright and willing pharmacists.

The future is local. Monies are going to be devolved at the primary care trust level and there is a need to make frequent, well-thought-out proposals that meet identified needs. In negotiations there is also a need to not take a refusal as a snub but to go back with counter-proposals. Try and try until success comes!

Hemant Patel
Member of the Royal Pharmaceutical Society's Council
Brentwood, Essex

Meagre scraps

From Mr S. K. Bhatti, MRPharmS

It was good to read in the PJ of 1 December (p778) that there are other pharmacists who feel strongly that some form of direct action is needed to show our anger at the imposed remuneration settlement (PJ, 24 November, p733). However it is no good simply growling and showing our teeth. We must be prepared to bite.

I sincerely hope that this time the profession is not again going to be "full of sound and fury, signifying nothing" but indeed will send out the message that pharmacists are not the doormats of the National Health Service whom this Government can walk all over every time it needs to raise funds. This is exactly what has happened in the past with nurses, doctors and dentists getting the best settlements and pharmacists being used to "balance the books".

Our problem is that those who represent us do not seem to be aware of the serious crisis our profession is in. Why is it that our Royal Pharmaceutical Society is demanding such a huge rise in fees at a time when "grassroots pharmacists" are reeling from this Government's latest insult? Although I am aware that the Society has no direct involvement with remuneration issues, surely it can see the negative signals that this proposed hike in fees sends out to the profession.

Make no mistake, the imposed remuneration offer is indeed an insult to our profession and reveals quite clearly the low esteem in which we are regarded by Hazel Blears and her department.

So then , what is the Pharmaceutical Services Negotiating Committee going to do? Well, we are going to have a "public relations campaign". I am quite sure that Ms Blears is shaking in her boots, more likely with laughter than fear. It is time completely to overhaul the PSNC and only have people around the negotiating table who genuinely care about the profession and who will fight tooth and nail to get the very best deal for pharmacy.

We should refuse to take part in any new roles whether locally or nationally agreed until this Government comes to its senses. I believe that the pharmaceutical profession gives this Government the best value for its money yet it continues to demean us by throwing us these meagre scraps in return. As long as we continue to accept these scraps through the negotiating skills of the PSNC, then that is all we will ever be worth.

Sunil Bhatti
Bilston, West Midlands

The folly of hope

From Mr S. S. Kalsi, MRPharmS

Just as we pharmacists think we have an understanding minister and dare to raise our heads above the parapet we become aware of the folly of that hope.

At every public meeting we are patted on the head and told how indispensable we are and how our true potential is not realised. We even applaud this at the time. However, the words come straight out of the speaker's mouth only to disappear into thin air! The latest setback of the drop in dispensing fees is a case in point.

At a time when plumbers, among others, want £30 just to ring our doorbell, we are being told to tighten our belts another impossible inch.

When a public inquiry is held, we are told about the millions it costs. When a march is policed, we are informed of the millions it costs. When the public is told to shop benefit cheats, we learn of the millions it costs. When drivers are told not to drink and drive, we are told of the millions it costs.

Why does all this cost millions? Because the lawyers, the police, the printers and the advertisers all charge full (not discounted) professional rates for their part in the activities.

Why, then, do pharmacists, equal stakeholders in the professional stakes, not charge a fair and reasonable rate for an exercise performed?

The dispensing fee is not just a payment for counting tablets into a pot. It includes, in the absence of separate arrangements, a fee for the vigilance required in looking for contraindications in drug regimens, the counselling advocated and the ready access offered to the public at large. Until such time as these activities are funded, and adequately funded, we should not meekly accept our prescribed fate.

If general practitioners are asked to undertake any additional activity they first want additional staff — properly funded — because they have no time. We get 2p for policing exemptions — hardly a suitable amount to fund our staff's time. We sort and send prescriptions as a no-cost option. We incur telephone and other costs as a no-cost option. Enough is enough!

What is the Royal Pharmaceutical Society going to do to gain justice for its members?

S. S. Kalsi
Barking, Essex

Has the profession no pride?

From Dr P. Norton, MRPharmS

What are our colleagues on Merseyside thinking of (PJ, 1 December, p770)? The expertise of pharmacists should be used to advise patients and supply medicines but not at £1.25 for a consultation, prescribing and supply as they are in the "Care at the chemist" scheme! This is derisory and it is no wonder that the "Department of Health is interested". The cost savings against nurse prescribing in walk-in centres, or general practitioner surgeries must be enormous.

We should provide such a service but we should be paid for it. It is interesting to note that if a Merseyside pharmacist prescribed for 2,500 patients per year, which is comparable to the average GP who has 10 hours' patient contact per week, he would be paid £2,600 under the scheme, while the doctor receives £70,000.

If this is taken up nationally it is going to be yet another unpaid function of pharmacists like
multicompartment compliance aids (PJ, 1 December p784). When will pharmacists learn that if they provide a service for nothing, no one will ever pay them to do it? Has the profession no pride or financial sense?

Peter Norton
Aylsham, Norfolk

Let the Society take over the PSNC

From Mr M. G. J. Cooper, MRPharmS

Since 1990 senior officers of the Pharmaceutical Services Negotiating Committee have enjoyed index-linked increases to their salaries, while pharmacy contractors, however, have had their main source of income (dispensing fees) reduced. Pharmacy contractors should reduce their contributions to the PSNC for the coming year accordingly.

Since the Department of Health has dictated every reduction in the dispensing fee without any regard to the PSNC's negotiations, one questions whether the PSNC is worth retaining. It would be more sensible to close down the PSNC and for the Royal Pharmaceutical Society to take over its functions.

The Society, with its massive increase in fees, is not free from criticism. It could reduce its costs to members by closing its expensive headquarters in London and relocating to a provincial city, with all the consequential savings for members and staff.

M. G. J. Cooper
Manningtree, Essex

Pharmacy being taken for a ride

From Mr H. Khara, MRPharmS

Disgusted. That is how most pharmacists felt upon hearing of a 3.5 per cent increase in the global sum when the Pharmaceutical Services Negotiating Committee asked for 7.5 per cent. It smacks of contempt.

This month Chancellor Gordon Brown allocated an extra £1bn to be injected into the dying National Health Service and into private health care, pharmacy excluded. The profession was not even mentioned as a foot-note. The Government clearly does not regard pharmacy as an integral part of the NHS and has shown that it wishes it to wither.

Our reward for working harder and faster, and dispensing more items more efficiently than the Department of Health projected, has been an 11.5 per cent decrease of the dispensing fee from 97.5p to 87.4p due to an alleged overpayment of £8.1m. What exactly is the distribution of this overpayment and why are all contractors being punished? Projections are just that and may be tweaked at will. The Department of Health justifies the 43 per cent attrition of average payment per item from £1.42 to 99p in 10 years to stable pharmacy numbers, but the Government's own statistics show these are already starting to wane.

The second body blow is that clawback is set to increase to 11.28 per cent. With the loss of resale price maintenance and margins and fees at new lows, many pharmacies — already trying to recover money lost on dispensing by ordering parallel import stocks from several different wholesalers — will suffer again. The multiples are consolidating their positions by merging with or buying wholesalers, therefore making money from both the wholesale and supply side, and are less affected than the smaller independents.

So what of the saviours of pharmacy, our new services that we should be providing for free? Clearly a pat on the back is not sufficient. The present remuneration system means that the physical dispensing of prescriptions is our only useful function in the eyes of the Government, the mass media and the public.

The McDonaldisation of pharmacy is a reality and it is entirely conceivable that non-pharmacists will soon be in charge. The way forward professionally is for us to delineate the roles of dispensing knowledge and the physical act of dispensing by delegating the task to technicians, as in hospitals.

However, this will require funding and from what I understand, the Minister for Health Hazel Blears has made the Government's stance crystal clear: no additional money is to be be made available.

It was, therefore, with dumbfounded amusement that I heard that the Health Secretary Alan Milburn last week has ring-fenced £85m for NHS information technology and pledged that all consultants would have networked computers on their desks within a year. Along with golden handshakes of up to £10,000 for doctors to continue in deprived areas, and interest free house loans for nurses, I cannot help but feel that pharmacy is being taken for a ride.

There have been calls for industrial action last week (PJ, 8 December, p816) which may be the final resort if only it would make the profession's woes more public.

However, public sympathy lies squarely with underpaid nurses and overworked doctors. Any action will not succeed without unity and the DoH unfortunately also knows this all too well. All this time that we thought we were at the crossroads; now we know we are stuck on the roundabout.

Harpreet Khara
Coventry

We have faired better than MPs

From Mr C. Anton, MRPharmS

If Hazel Blears was correct in saying that community pharmacists had enjoyed a 4 per cent increase in real terms then P. H. Heyes (PJ, 8 December, p815) may be surprised to learn that they have done much better than Members of Parliament. In 1991 MPs' pay was £28,970. This had risen to £49,822 in 2001 (House of Commons Factsheets No 5). In the same time the retail prices index rose from 130.2 to 171.1 (Office for National Statistics). So in real terms MPs' pay rose 2.7 per cent per year over this period. It may also be sobering to realise that over a similar period (1994–2001) the pay of a grade D hospital pharmacist rose 0.9 per cent in real terms, an MTO3 pharmacy technician rose 0.6 per cent and senior pharmacy secretary/administrator rose 0.6 per cent.

Christopher Anton
City Hospital, Birmingham

Engage Cherie Booth!

From Mr N. T. Fitt, MRPharmS

Perhaps the Pharmaceutical Services Negotiating Committee should engage Cherie Booth to act for it if it proceeds with its application for judicial review (PJ, 8 December, p805).

N. T. Fitt
Manchester

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