The Pharmaceutical Journal
Vol 279 No 7481 p655
8 December 2007

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Letters to the Editor

The profession

No! Minister

From Mr G. Phillips, MRPharmS

Speaking at a public meeting of the All-Party Pharmacy Group last week, pharmacy minister, Dawn Primarolo, pronounced herself “perplexed” at the patchy, inconsistent or even total lack of co-operation with community pharmacy shown by most primary care trusts and GPs.

The cause is pretty obvious: it is almost entirely due to the Government’s own policy and can be summed up in one New-Labour word “contestability”. The political mantra of “competition and choice” in the NHS fails on two levels.

First, there is no evidence that it is what patients actually want. Indeed, what patients tell me they want is a good, local service and nothing more.

The second level on which it fails is that if the Government wants a market place then it must ensure that a true market operates with an even playing field, proper governance and an effective ringmaster. None of these is currently the case.

As the APPG report shows, GPs tend to see patients as “their patients” and all primary care funding as “their money”. This could not have been made more clear four weeks ago by Laurence Buckman, chairman of the British Medical Association’s general practitioners committee, when he also addressed the APPG.

He implied that co-operation with pharmacists was just fine, so long as none of the general practice funding went to pharmacy and so long as any “collaboration” was on doctors’ terms. As a senior figure in a powerful medical trade union that is exactly what he would be saying — it is his job.

So it is tempting to “scape goat” GPs when, in truth, it is the Government-devised dog-eat-dog funding system that is mainly at fault, not doctors. If you set up a system that forces professional groupings to compete, then that is exactly what they will do.

If you then give one grouping (GPs) every trump card, totally disempower the commissioners (PCTs) and put in place no proper governance structures (strategic health authorities) then the outcome is as predictable as night follows day. This has been pointed out time and again to the Government to which ministers reply “try harder” or “use your local contacts”.

Well, Minister, some of us have tried, tried and tried again. Pharmacists like me have invested everything we have (both professionally and financially) in the false dawn of the new pharmacy contract only to find ourselves thwarted at every turn by local GPs who dominate the commissioning process and have simply locked us (and patients) out. There is overwhelming evidence of this.

And, if that were not enough, we now find the investments we have already made to support the Government’s “Vision for pharmacy” undermined by the uncertainty of a massive clawback (Category-M) and our confidence to invest further destroyed by Lord Darzi’s consolidation agenda and the threat of 100-hour pharmacies.

All these are Government policies. All of them operate to frustrate their own professed aims. All of them are anathema to the promised “abolition of the language of the market place” that New Labour espoused before assuming power.

As one LPC representative put it, we are expected to behave as professionals while being treated like market-traders. I, for one, am sick of it.

We have suffered 10 long years of attrition. Let us hope that by the time the much-promised, much-delayed pharmacy White Paper is published there is something recognisable as a pharmacy network still standing to build upon.

Graham Phillips
Member of Council
Royal Pharmaceutical Society

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