|
Getty Images/Taxi
|
Community pharmacists are claiming that services they want to provide
under the new contract are being put on hold because of the £900m
NHS deficit expected at the end of this financial year. Pharmacists in
hospitals are also seeing a freeze on filling vacant posts as their trust
accountants try to balance the books by the end of March.
Community pharmacists’ leaders in Tower Hamlets in the east of
London this week complain that plans to offer emergency hormonal contraception
(EHC) under the community pharmacy contract have been halted because
of lack of money. In neighbouring Havering pharmacists have been told
to stop offering smoking cessation services because of lack of money,
the local pharmaceutical committee says.
Details of the cuts emerged as all primary care trusts in London have
been told that their budgets for next year will be top sliced by 3 per
cent to bring the NHS budget in the capital back into the black.
But it is not only London pharmacists who are feeling the squeeze on
spending. The picture is similar in the Home Counties. Steven Brill,
chairman of Hertfordshire LPC claims his PCT in St Albans and Harpenden,
facing a £3.7m deficit, has refused his request to provide a stop
smoking clinic as an enhanced service under the new contract. Other community
pharmacists have been reluctant to come forward with proposals for enhanced
services because they are pessimistic about being given the go-ahead,
he said.
Although St Albans and Harpenden PCT denies that any enhanced services
are being put on ice, pharmacists’ reluctance to come forward with
enhanced service proposals and the confusion over whether there is money
to fund them, is likely to damage the expansion of pharmacy services
under the new contract — whatever the true financial picture.
The package of pay reforms being brought in under Agenda for Change,
the new GP and community pharmacy contracts and a new contract for hospital
consultants are being attributed to the huge debt now hanging over hospital
and primary care trusts. It is a situation which, according to the president
of the Guild of Healthcare Pharmacists, Tony West, was entirely predictable.
He said: “All these changes cost money and at the same time the
drugs bill is going up. There is more money coming into the NHS but it’s
going straight into salaries. There are cost pressures in the system
and the Government will need to review how the money is being spent.
The bottom line is that there is more money going into the NHS but the
question is whether it’s getting best value for the money which
it is putting in.”
Mr West said the issue was not that Agenda for Change and the new contracts
were too generous: “People deserve the extra money created under
Agenda for Change — it’s whether or not the funds have been
managed to extract the benefits that there should be from that. The private
sector would have brought in extra targets and goals for that extra cash.”
Frozen hospital posts
Vacant posts in hospital pharmacies have been frozen as trusts strive
to balance their books, he revealed. “With more work and less
staff it becomes very difficult,” he admitted.
Hospital pharmacists also feel in financial limbo because the Department
of Health has yet to announce details of the national tariff for next
year which is at the heart of the Government’s payment-by-results
initiative which affects trusts’ budgets, Mr West said. He added: “The
Department a couple of weeks ago withheld details of the national tariff
so until we know what the value of the tariff is, it is not possible
to say what our financial situation will be next year.”
Pharmacists working in the community this week appeared to have a better
picture of the financial situation they will face in the next 12 months.
The financial outlook in London was especially clear as the NHS London
transition team, put in by the DoH to oversee proposals to restructure
strategic health authorities in the capital, announced at the beginning
of this month that all PCT budgets for 2006–07 would be cut by
3 per cent to bring the NHS budgets back into the black. The principle
underpinning this decision was that a pan-London reserve was needed to
bale out those trusts struggling financially.
John Bacon, transitional lead for London said in a statement: “The
NHS in London as a whole must balance its books and the work to ensure
that this happens across London starts now.” He said what was needed
was “rigorous” financial management over the next 12 months
and “greater efficiencies
in the delivery of health services” without compromising services
or standards.
But despite his hopes that services would not be compromised it became
clear this week that some primary care initiatives being adopted by pharmacists
were being halted because of the financial squeeze. North East London
LPC secretary Hemant Patel said that community pharmacists in Havering
have already been given notice to stop providing smoking cessation services
because of the pct deficit.
Mr Patel said: “Smoking cessation is a national target for the
health service and this decision by the pct has been demoralising for
community pharmacists just when they were expecting that their input
into health services was going to increase it has been taken away. It
has been immensely frustrating. It is also a crazy decision at a time
when the Government has announced that it wants to ban smoking in public
places from next year.”
Tower Hamlets PCT has also told him that plans for pharmacists to offer
emergency hormonal contraception as an enhanced service under the new
contract were being shelved because of lack of money. Mr Patel said: “We
have spent a long time trying to negotiate a suitable rate for pharmacists
to provide this service only to be told now that it will not be commissioning
it from us after all. Again, it is disappointing and demoralising, especially
for those who have stuck their necks out to be innovators. These decisions
are putting the government’s public health agenda in jeopardy.”
No one was available for comment from the PCT. Short-term issue?
The NHS Confederation, which represents 90 per cent of PCTs and other
trusts, is hopeful that any cuts or postponements in pharmacy services
will be short lived. Its deputy director of policy Jo Webber said trusts
at the moment were looking at what are their “core requirements” rather
than service development because of lack of funds. She said: “I
think this is a short-term issue. That is what the [DoH] is saying.
It’s about getting control back in the short term.”
She was confident that innovation in primary care, especially the role
that community pharmacists can play in delivering the government’s
white paper on outside of hospital care, was not going to be stifled.
She said: “Community pharmacists can play a big part [in the bill]
and that agenda is still where the Government sees the NHS going long
term.” |
The
Pharmaceutical Journal