Those responsible for pharmacy at NHS England tell Alice Harrold why the future looks positive for the sector

With government funding cuts hitting community pharmacy to the tune of £208m between December 2016 and March 2018, many independent businesses are fearful of their future. While many are afraid that they will be forced to shut their doors, the Government argues the cuts will reduce the number of ‘cluster’ pharmacies supported by the NHS and bring the sector into a time of greater efficiency.

The Government is also insistent that the Pharmacy Integration Fund (PhIF), a £42m sum confirmed in October and earmarked to develop clinical pharmacy, will help soften the blow and integrate the sector into the rest of the NHS.

The announcement of the fund was met with some scepticism from the sector that it could truly impact pharmacy’s place in the NHS – not to mention that pharmacists were being asked to invest and adapt at all in a time when they may be at risk of closure.

With these concerns in mind, reporter Alice Harrold met the heads of pharmacy at NHS England in November to discuss the PhIF, which they are calling a ‘fantastic opportunity’ for the sector that pharmacists should now focus on.

At the time of the interview, questions still hung in the air about whether the fund was meant to be a sweetener to help pharmacies to swallow the cuts, or if it was meant as a genuine move towards change.

The Pharmacist’s questions about the cuts were met with a call to focus instead on the integration fund, on what turned out to be two days before the funding package was announced.

The interviewees
Keith Ridge (KR) Chief pharmaceutical officer, NHS England
Anne Joshua (AJ) Head of community pharmacy strategy, NHS England
Bruce Warner (BW) Deputy pharmaceutical officer, NHS England

How can you guarantee that the fund will directly benefit independent pharmacies?

KR Well if we are funding the urgent repeat medication service first [using the PhIF], and then linking it with NHS 111, there’s no difference there between which type of pharmacy you’re linking it to, so I think pharmacy generally is going to benefit from the integration fund.

BW If you look at what the integration fund is there to do – to bring community pharmacy into the NHS properly, that in itself will generate a range of opportunities in a lot of different care settings that are going to benefit community pharmacy and most importantly, benefit patients. How is NHS England going to involve pharmacy groups such as PSNC and the NPA in the implementation of the fund?

KR We have an oversight group, which I chair and which has a range of organisations on it, including internally from NHS England, patients, CCGs etc. We’re also going to form a reference group, which will have a broader membership including the organisations you’ve mentioned, in terms of the pharmacy sector more broadly.

AJ There are also task and finish groups sitting underneath the oversight group. Already, one of them is focusing on urgent care, one of them is on care homes an actually another one is linking with the out-of-hospital urgent care programme. And all of those have representatives from the Royal Pharmaceutical Society, Pharmacy Voice, the Pharmaceutical Services Negotiating Committee, the Association of Pharmacy Technicians UK, and in fact the care homes, one of which I co-chair with Sandra Gidley, so there is certainly that involvement.

KR Not just from an NHS England point of view, but from a personal level, I think we do need to move on from the somewhat acrimonious things that are happening around us at the moment, and have happened over the last little while. We need to move into a period of collaboration, positivity, around the opportunity that the integration fund is generating. I think it won’t do the patients and the public any good if we don’t move into that period.

How do you hope to mend the fractured relationship between the pharmacy sector and the Government following the new funding package?

KR From an NHS England point of view, we need to reassure the public that actually community pharmacy will still be there and will still deliver the services it’s required to deliver as a commissioner. We need to make sure that happens, that those services are safe, they’re available, and the patient has a good experience of those – that’s our role.

Gaining more access and developing the clinical skills of the community pharmacy workforce, is perhaps what we should be discussing now. Otherwise I think there’s a real risk of not being able to deliver those benefits that we’ve described around the integration fund, which would obviously be a great shame for you and me and other people that visit pharmacies every day. So we have to work with the sector to collaborate and get this right, and focus on the future.

So would your message for the public and for the rest of the sector be to get behind this and focus on collaboration?

BW Absolutely, as Keith has just said. We have a window of opportunity here, we need to make the most of it. There are signs that we do understand how hard this has been for people – it hasn’t gone unnoticed, we need to understand that.

But we do need to move on. We have a window of opportunity now that we really have to make the most of, and we want to do that with the sector. It’s up to the sector to really build on those opportunities, grasp them and to shake things and do things differently as a result of that. That doesn’t mean it’s not been difficult for people, of course it has been. But we need to make the most of those opportunities.

Why don’t you take this money and lessen the effects of the cuts that are potentially going to force some pharmacies to close or have to reduce their hours, staff or services?

KR I think we still have to face some facts. There’s nothing in here, as far as I’m concerned at least, around closures – so that’s not what this is about. With 40% of community pharmacies in clusters of three or more within 10 minutes of each other, and all receiving NHS funding, the Government has decided to make this system more efficient.

I think we can’t also get away from the fact that community pharmacies of any nature – independent or otherwise – are businesses and I guess we would expect them now to make those efficiencies and to deliver the services which the public expect.

After all, we are all taxpayers and in order to make the most of what is not an infinite pot of money from the NHS, we need to ensure that money is used effectively and efficiently. What we’re offering in terms of the integration fund however, is a rather different future for community pharmacy. It’s not about doing more. It’s about doing things differently – clinical services, which we want community pharmacy to deliver.

BW I think if we were to use the money that’s been put into the integration fund to mitigate the cuts without changing anything, that would be a very short-term view of things, if we don’t change anything for the long term, we’re going to be faced with the same thing in a few years’ time. What we really want to do is use that money to fundamentally change the direction of travel to a more clinical future so that long term, the future of community pharmacy is secured. Because if we carry on as we are, then that’s going to be more difficult.

AJ I think we need to add that the sustainability and transformation planning process is an opportunity for pharmacy, and the PhIF can help make that connection. At the moment we have community pharmacy with its national contract – but how does that relate to sustainability and transformation planning, which is localised over those 44 footprints? So for me, it’s trying to facilitate that.

Will the pharmacy cuts mean the beginning of the end of some independent pharmacists?

KR No. The pharmacy access scheme is in place. NHS England will manage that, people are already understandably applying for that. My personal view is if community pharmacy of whatever nature, but particularly independent, embrace the opportunity in the integration fund, then sure, there are some efficiencies to be made, but that’s across the NHS – not just pharmacy. But the opportunities are here and they’re coming more [often]. Actually the future is positive. I [hope] we can get over this period so that we can all work together to deliver that future.