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and more JRs than Dallas Lack of leadership

A lack of leadership in community pharmacy might seem fair comment at the moment given progress on absolutely nothing, writes Terry Maguire.


f course such a claim would be utter nonsense. Community pharmacy has more leaders

than a G20 summit and good leaders they are too.

Good in the sense they know how; to rally their troops, spin their visions of reality and progress their narrow agendas.

Lack of leadership is not the problem, rather it's a lack of an agreed vision for community pharmacy and that fault lies with us, the myopic sheep who are led in this direction and that, agreeing to any place that vaguely looks like a promised land.

If you don't know where you're going how do you know you have arrived?

Health +Pharmacy (H+P) is a case in point. A great idea and golden opportunity to put community pharmacy at the heart of public health.

We are reaching the end of the accreditation part of this project and soon we will have the first batch of H+P accredited pharmacies with their shiny stickers and enthusiastic health advisors. We have built H+P but we have no plans to do anything with it.

The "doing bit" of H+P needed clarified at the start but that was left unclear and those of us who asked were told it would be fine.

There was a suggestion that simply creating a quality framework of standards and training pharmacists


and staff would in itself be enough. This is the architecture of folly.

It is worrying that so many pharmacies are signing up to the scheme yet most haven't the foggiest what they will do when the accolade of H+P accreditation is foist upon them.

This frustration came across strongly at each of the training events and for those attending I could only give my personal vision for the scheme and it is as follows:

Level 1. Participation in 6 PHA campaigns per year, (Flu vaccine, bowel cancer, sun safety etc). All pharmacies will participate, H+P accreditation not needed and this is part of core contract and paid.

Level 2. Accredited H+P undertaking 1,200 Brief Advice Interventions annually using Motivational Intervention skills (additional payments for service level agreement).

Level 3. Public Health Services; Smoking Cessation, Weight Management, Sexual Health. Only accredited H+E pharmacies (except grandfather clause of Smoking Cessation).

H+P must be the vehicle by which community pharmacy actively supports public health locally. Brief Advice using motivational interviewing (MI) skills is the "doing bit".

Of course CPNI, in exercising its leadership is off in a totally different direction when it comes to H+P vowing to save the profession by collapsing the scheme if we cannot

continue to sell; Mars Bars, Coke, and SFP factors 2-12.

For me at least, CPNI's vision for community pharmacy remains an enigma as it views any progress beyond a supply function a step too far. Another JR shows strong leadership sadly it’s totally in the wrong direction.

JR 3 is really unfinished business from JRs 1 and 2. JR 1, you might remember repaid monies extracted, DHSSPS appreciated its mistakes and changed its processes so that money could be extracted again, legally; back to square one.

This led to JR 2 which did not reach court as a compromise was reached; DHSSPS would undertake; a margins survey, a Cost of Service Inquiry (CoSI) and a pharmaceutical needs assessment (PNA).

The JR2 agreement was to pay £6 million annually into the system until the CoSI would be completed (actually it only stated 2 years). CoSI hasn't been completed and no payment was made in Sept 2014.

JR 3 will be heard in June and

September with a reserved judgement no doubt and given the leisurely pace of our judicial system we are likely to learn our fate in winter 2015 after the results of CoSI.

CPNI's accountant gave a very clear overview of the CoSI processes at a Contractors' meeting. She delivered a

three paragraph answer to the simple question; what is "fair and reasonable return"?

When she finished and our small brains tried to absorb the accounting technicalities she was asked the killer question and she agreed that "fair and reasonable" was "whatever you can make it out to be".

Given this fuzziness CPNI will always win this argument and will always be successful.

Recently I attended a meeting called to discuss a business case to support frail elderly patients taking medicines in their own homes.

Medicines support is key to keeping these patients out of hospital and community pharmacy is the right place to provide this support through a commissioned service.

It was all too telling that HSCB have little appetite to do business with pharmacy contractors, seeking out any other solution.

Under CPNI's leadership we might win the JR 3 battle but we are already losing the war. If you don't believe me consider the 300 pharmacists to be employed in primary care but not within the contactor network. 

These views are entirely those of the author and do not necessarily reflect the opinions of either Profile Publishing & Design Ltd or the Ulster Chemists' Association.

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