|  Contractors have two weeks to decide which way to vote in the
ballot on the new community
pharmacy contract in England and Wales.
Last week, they were sent a book that described the funding structure
and the service specifications for the new contract (PJ, 30 October,
p637). Now, the Pharmaceutical Services Negotiating Committee has embarked
on a programme of roadshows at which contractors have an opportunity
to ask questions and air their views.
At one of the first of these roadshows, in Maidstone on 31 October, two
major areas of concern emerged: consultation areas and repeat dispensing
(p669). But although practical issues such as these are dominating the
debate, the general feeling about the new contract appears to be positive.
In fact, when two organisations that together represent the majority
of both independent and multiple pharmacies — the National Pharmaceutical
Association and the Company Chemists’ Association — are both
supportive of the new contract, it is difficult not to feel optimistic
about pharmacy’s future.
“We think overall it is pretty good news,” says John D’Arcy,
the NPA’s chief executive. He says that new contract is strategically
important in giving pharmacists a more clinical role and establishing
them as NHS players. “This recognition of what pharmacists can
do is particularly important,” he comments.
Similarly, Colin Baldwin, chief executive of the CCA, says: “Our
view is that it is good news for contractors in so far as that it is
a start. But it does require them to seize the quality agenda and to
deliver advanced and enhanced services.”
Of course, under any contract, there will be some contractors who fare
less well than others. But Mr Baldwin says: “The vast majority
will do better under the new contract compared with the current one,
even if they just provide essential services.” This is not about
multiples faring better than independent pharmacies: he points out that
within each multiple chain, there is a huge diversity of individual pharmacies,
from small to large.
Striking a balance
It is impossible to make everyone happy so it is inevitable that the
new contract will be criticised. What is clear is that a balance has
to be struck between a contract that is so far-reaching that it puts
some pharmacists off and one that does not go far enough in developing
pharmacy’s role. Mr D’Arcy believes that the new contract
provides a structure that will allow the profession to evolve. “It
is a very significant and positive step in the right direction,” he
says.
“
A good compromise” sums up how Steve Dunn, group managing director
of AAH Pharmaceuticals, sees the new contract. “It does not go
as far as I think it should have,” he says. Mr Dunn would have
liked the new contract to do more to develop community pharmacy’s
role in providing high quality services and its integration into the
NHS. He explains that initially remuneration concentrates on dispensing
volume rather than service delivery, but adds: “In year two, we
expect the Government will start to shift the emphasis on to service
delivery by ratcheting up the focus on quality and ratcheting down the
focus on bulk dispensing. Pharmacists who are already displaying a willingness
to adapt and deliver additional services to their customers, truly embracing
their health care role, will be the ones who survive.”
Andy Murdock, Lloydspharmacy’s pharmacy director and superindendent
pharmacist, says: “It is a contract that is very workable across
a whole range of pharmacies.” But he adds that there will be an
enormous amount of change to go through. Contractors undoubtedly will
need support through this change. The NPA is currently working on a “new
contract survival kit” that it will be launching within the next
few weeks.
Perhaps one of the most difficult questions for contractors is working
out how they will fare financially under the new contract compared with
the existing arrangements. The problem is that it is hard for contractors
to work out exactly how much they make now from retained purchase profits,
explains Mr D’Arcy. “The current system is so convoluted
in terms of the way contractors source products and are remunerated for
them that it is difficult for them to say at one point where their business
is.” Contractors will also need to make additional investment in
their business, to fund consultation areas, increase staffing levels
and to train staff.
Kirit Patel, chief executive of the Day Lewis Group, says that from a
financial point of view the contract is good news. “The new contract
brings stability so contractors can make a proper projection and know
that the money will be there.” He points out that under the current
system, the Government recently sucked £300m out of purchase profits
by cutting the Drug Tariff price on just four generic medicines. “That
was £25,000 per contractor,” he says. “You can’t
invest in your infrastructure when someone can take money away like that.” But
Mr Patel says that it goes beyond this: “Because of the new contract,
we got Government help with the Office of Fair Trading and got a good
settlement on control of entry.”
Mr Dunn says that, in the first year of the new contract, most pharmacists
will receive roughly the same remuneration as they do now. But after
the first year, things might change. He explains that under the new contract
the Government is pharmacy’s paymaster and, now that it has agreed
that a certain return can be made from profits on drugs purchasing, if
profits were to go beyond this there is a strong possibility that the
Government would take this money away.
Hemant Patel, secretary of North East London Local Pharmaceutical Committee,
believes that the new contract is under-funded. “From the work
I have done in recent weeks, it appears that the money which is now being
included as profits for purchasing does not fully recognise the current
situation,” he says.
Moving away from the financial side, another key area of change is the
increased level of primary care trust involvement in community pharmacy
that the new contract will bring. “It is of fundamental importance
to have proper communication with PCTs in implementing the new contract,” Mr
Baldwin comments. Reassuringly, he says that CCA members will work with
their independent colleagues through local pharmaceutical committees. “It
is crucial that collaboration occurs at LPC level so that pharmacy provides
the services PCTs want,” he says.
An issue highlighted at the Maidstone PSNC roadshow is that PCTs are
negotiating funding for next year’s services now. The PSNC advice
is to negotiate funding for services under the current models rather
than waiting for the enhanced services to be available. Otherwise, PCTs
might get the impression that pharmacy is not interested and this could
influence future commissioning. Yes or no?
When it comes to the crunch will contractors vote “yes” or “no” in
the ballot? Mr D’Arcy thinks it will be a “yes”. “The
general mood from the people I have spoken to is that, although there
are concerns about how it will happen, underneath there is a feeling
that this is a reasonable starting point in the process of getting pharmacists
recognised for their role in health care,” he says. |
The
Pharmaceutical Journal