December
council meeting
Council decides to take action alongside PSNC over remuneration
settlement
At its meeting in London on 4 and 5 December, the Council
of the Royal Pharmaceutical Society agreed to take concerted action alongside
the Pharmaceutical Services Negotiating Committee in its efforts to secure
a better remuneration settlement for community pharmacy contractors in
England and Wales (see also p879).
The Council made its decision after debating a motion
put by PETER CURPHEY, who proposed that the President should seek immediate
discussion with the chief executive and chairman of the PSNC with a view
to a supportive, professionally based, joint approach to the Secretary
of State for Health to ensure that the profession's views are taken account
of. He also proposed that the President should seek a separate meeting
with the Secretary of State "to make clear the profession's incredulity
at the continued reality gap between workload demands on prescription
volume and the advances described in 'Pharmacy in the future' ".
Mr Curphey said that those within Government departments
who read reports of Council meetings understand how deep-seated the resentment
had grown, and how low morale is in community pharmacy. He added that
that he had no vested interest in the matter because he was regarded as
essentially a small pharmacy recipient who was not paid therefore on volume.
Some six years previously the Council had mapped
out the threats and the opportunities for pharmacy in "Pharmacy in a New
Age". It had made clear the magnitude of change that would be necessary.
Mr Curphey believed that the Society had won that battle and that pharmacy's
time was now. They had an NHS national plan in England and equivalent
plans in the other home countries. But somehow the Government had lost
the plot. It was failing to make a connection between what it was doing
to contractor remuneration and the aspirations of the profession and of
the Government in delivering its targets.
In his view, the ministers in the Department of
Health were being advised by an unhelpful, unsupportive group of people
who appeared to have little interest in the survival or the potential
of pharmacy. The Government had made considerable changes to the medical
profession by giving money to it. Now it was trying to change the pharmacy
profession by taking money away from it. There was something inherently
unfair in that.
One document in support of his motion was the letter
to pharmacy contractors in England from Hazel Blears (Parliamentary Under-Secretary
of State for Health). She had clearly been badly advised to write that
sort of letter. It was an insult to contractors' professional pride. It
took some beating to tell the profession that, having done 52 per cent
more work over 10 years they should be pleased to be 4 per cent better
off.
Mr Curphey said that he was not suggesting that
the Society should impose itself on the PSNC but should offer support
based not on commercial imperative but on the way in which the profession
wished to advance. He was not advocating a direct head-to-head with the
Government. But he wanted the Council to support the motion and he wanted
Council members to speak — and their Journal reports were read
in government — so that the incredulity, the disappointment and the anger
was clear.
WALLY DOVE seconded the motion.
HASSAN ARGOMANDKHAH said that if the Company Chemists
Association and the National Pharmaceutical Association were also consulted
and four different responses went to the Department it would be more fruitful
than a single message signed by the four bodies. There should be regular
meetings of these pharmacy bodies, and when they wished to give a message
to the Department on which they agreed, they should try to do it in their
own ways from different sides so that the message was reinforced.
KIRIT PATEL said that the PSNC was the mandated
body to discuss remuneration, but the Society had a strong voice and stronger
public relations with Westminster and the decision-makers. It was already
involved in helping the Government deliver the NHS plan. Whatever the
PSNC decided to do, the Society had to be willing to support it.
Mr DOVE said that members of Council, and certainly
contractors, would be surprised that he had seconded a motion from Mr
Peter Curphey, because some five or six years ago they had found themselves
on different sides of an argument. But times had changed, and the Society
had to back the PSNC. What the Government had done was unbelievable.
The profession had to focus its message. Mr Curphey
was right that, if the Government continued to take money out of the profession
as practised in the community, then there would not be a profession. There
would be pharmacy closures, and it would not just be the small businesses.
Multiples would be affected as much as independents. So the profession
was facing an extremely difficult situation and the Society had a clear
obligation to ensure that there was a profession in the future.
Mr Dove accepted that public interest was important
for the Society. But it was a step too far to say that anything in the
interest of pharmacists was against the interest of patients. The present
situation would affect patients and destroy the profession.
HEMANT PATEL said that the situation in community
pharmacy reminded him of the method for boiling a live frog: if the temperature
was raised half a degree at a time, the frog would tolerate the rising
temperature until it became too debilitated to jump out. That was exactly
what was being done to community pharmacy.
The fee had been dropping since 1987, when it was
adjusted for inflation and volume increases. After taking legal advice,
the PSNC was to challenge the Minister's decision. But that was not all.
The NHS was a bad payer. It recommended that everybody should settle their
bills within 30 days yet it was itself taking 90 days to complete the
settlement. That compounded the issue for community pharmacy owners.
Many pharmacists were losing money dispensing proprietary
medicines. If they stopped dispensing proprietary medicines and concentrated
on supplying generics, the Government would be in difficulty with patients.
There was also a lack of trust of the Government,
and community pharmacists were not willing to accept the Government's
word that it would fund new services. Mr Patel said he was finding difficulty
in trying to get pharmacists to take on new roles.
Mr Curphey had made the point that money had been
found for GPs. In London alone £400m had been given to GPs to improve
their premises and the quality of services. Nothing went to the community
pharmacist.
Community pharmacists were being penalised for dispensing
increased volumes of prescriptions. But pharmacists were not responsible
for the prescription increase. The Government wanted the National Service
Framework for Coronary Health Disease implemented. That resulted in more
prescriptions being generated. The Government had continued to abuse the
goodwill of community pharmacists, and sooner or later that had to come
to an end.
DIGBY EMSON, supporting the motion, said that the
issue was a serious one. It would the affect the whole spectrum of community
pharmacy. The Society could send an important signal from its professional
perspective regarding concern about the effect on patients.
Community pharmacy had been held up as a good example
of public/private partnership. But a partnership like that required trust
on both sides. Mr Curphey was right that that trust had broken down as
result of some the signals that the Department had been sending in recent
months. Rightly or wrongly, intentionally or unintentionally, that had
created a significant degree of uncertainty. The public/private partnership
issue made it difficult for people to decide whether to invest further
capital. There was a serious public safety issue too. By implication,
the productivity increases that the Department was demanding as a result
of its action seemed directly in conflict with some of the principles
of clinical governance that it sought to be established. Mr Emson had
a serious concern that the productivity increases produced so far, and
demanded by the Government's action now, would pose a serious risk to
public safety in the area of community pharmacy.
ANDREW BURR said that the message the Government
was sending to community pharmacies was: "Do not bother with your aspirations.
You are never going to achieve them because we are never going to give
you enough money to do that". Frankly, all the services that Ministers
praised were funded out of the pocket of pharmacists and were not funded
by the NHS. Mr Burr hoped that one day the public would recognise that.
There was an expectation that they were funded by the NHS.
Dr EVANS suggested that, in part, the sorry story
was pharmacy reaping where it had sowed. It was the fruits of the parallel
imports story. There should be a lesson there somewhere. He also commented
on the ambivalence of a regulatory body, acting in the public interest,
taking up that sort of discussion. Could one imagine the General Medical
Council having such a discussion? The British Medical Association could,
but not the GMC.
Mr Curphey had spoken about the destruction of the
network. But there was no pharmacy network: there was a non-random clustering
of pharmacies, with aggregations particularly in the high streets. The
Audit Commission had said in effect that there was too much clustering
and too much public subsidy of pharmacies cheek by jowl in the high street.
The support for that was not in the public interest. The public interest
was to maintain some kind of presence of pharmacy countrywide.
If the Society wanted to do something constructive
about the issue it should apply itself to constructive thinking about
how to maintain the reality of pharmacy care throughout the country without
improperly subsidising commercial aggregations in the most profitable
places.
The VICE-PRESIDENT said that the issues at stake
were the destabilisation of the existing network and the undermining of
the financial basis of community pharmacy. There was a risk that current
philosophy was working counter to the public interest by reducing the
availability and accessibility that the community pharmacy network provided.
There were implications not just for a continuation of pharmacy's existing
role but also for its development in the areas set out in "Pharmacy in
the future".
Answering a question from the PRESIDENT, Mr CURPHEY
said that his motion recognised that the PNSC, while it might like the
support of the Society, would not want to travel with the Society to the
Department. That was why he proposed a separate meeting with the Secretary
of State.
The PRESIDENT said that, on the whole, the Secretary
of State had not met the health professions in recent times. The Society
did, however, have a meeting arranged with Hazel Blears in the next week
and could point out the inhibiting factors that had emerged which prevented
the profession from achieving the objectives which it believed it should
achieve.
Mr CURPHEY replied that he did not know what was
on the agenda of the meeting with Hazel Blears. If the meeting did not
take account of the strength of feeling expressed by Council members then
it would be a waste of time.
The PRESIDENT said he would act as the Council wished.
He recognised the feelings expressed. The position was that they had a
clear view of where the profession should be moving in the public interest.
That had support and was entirely in keeping with the Government's policy.
Professor SCHOFIELD supported the point made by
Dr Evans about the importance of the Society carefully considering its
position. Dr Evans had raised the issue of the appropriateness of the
Society taking the stance that it was about to take. If it was a question
of the quality of service to patients and safety, then there were important
issues that it would be appropriate for the Society to address, and he
was fully behind that. But commercial considerations were for the PSNC.
The Society should be careful about the basis on which it was taking up
the issue, and the basis on which it supported the work of the PSNC.
The PRESIDENT said that that point was entirely
valid. The Council needed to have cognisance of the advice and guidance
of a Privy Council member on such matters.
PAT HOARE said that she wished to speak on the issue
of safety. Pharmacies had difficulty filling staff vacancies when staff
could earn much more by stacking shelves in supermarkets without being
expected to train. As a result she had experienced this year greater stress
than ever before in her work as a locum. It compromised her ability to
give the best standard of pharmaceutical care in her practice. When pharmacists
were overburdened there was the risk of error through stress.
As a locum going to different sized community pharmacies
she was dismayed to see the small independents losing heart. They provided
a valuable service to a local community but they were struggling. The
smaller companies had to compete in a world where there was a shortage
of pharmacists and they could not attract them on a salary basis.
Mr CURPHEY, summing up, said that he first wanted
to correct some inaccuracy. He challenged Dr Evans's comment on parallel
imports. They were not the fault of pharmacy. Pharmacists had been forced
to use them because that was the way that money was being taken away.
Mr Curphey said he wanted to pick up on something
that Mrs Hoare had said. Stress levels were high in most pharmacies —
in multiples as well as small independents. The reason was volume pressure,
which pharmacists could not resolve simply by employing more staff because
there was not enough money in the volume payment.
What was needed from the Government was an understanding
of the disconnection between the current contracts and where they all
wanted to get to and helping and supporting that process of change. He
was not talking about millions of pounds for the profession, but help
was needed.
Mr Argomandkhah had talked about unanimity but suggested
that pharmacy bodies went to the Government separately. Mr Curphey had
a suspicion that the best way to give a message of unanimity was to go
to the Government together. They would then make sure that everybody was
singing from the same hymn sheet.
The message that Mr Curphey wanted to give was that
the Society supported the Government's objectives in "Pharmacy in the
future". They fitted neatly within the way that the profession wished
to go. But if the Government wanted community pharmacy to be part of the
delivery of that ambition, then it had to make sure that pharmacies were
still in existence.
The PRESIDENT then put the motion to the Council
and it was agreed. Professor Schofield and Dr Evans abstained.
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