CRISIS
aS thE goVErnmEnt annoUncES an Extra £8 mILLIon for gPS anD nI commUnItY PharmacY rEcEIVES YEt anothEr fInancIaL SnUB from thE DEPartmEnt of hEaLth, thE PErmanEnt SEcrEtarY, rIcharD PEngELLY, haS rEPLIED to a croSS-PartY LEttEr aSKIng for aSSIStancE: a rEPLY, WhIch hE hoPES WILL BE ‘hELPfUL’. PIf ISn’t So SUrE...
nI community pharmacy in ‘parallel universe’ W
hen, in march of this year, health spokespeople from each of the main political
parties expressed concern about the current funding crisis in community pharmacy, it appeared that, despite the current political stalemate at Stormont, nI’s mLas could work together for the good of their constituents.
the five health spokespeople: Paula Bradshaw (alliance), Pat Sheehan (Sinn féin), mark h Durkan (SDLP), roy Beggs (UUP) and health committee chair in the previous assembly, Paula Bradley (DUP), had taken action after being approached by a number of local pharmacy owners, who had informed them that they may have to close their doors as the direct result of the decisions taken by the Department of health with regard to issues such as funding cuts, lack of negotiation with community Pharmacy northern Ireland (cPnI) on a pharmacy contract, and the potential removal of rural access support funding.
In their letter of 20 march to mr Pengelly, the health spokespeople pointed out the fact that community pharmacy had, to date, received ‘universal support from all healthcare reviews, including transforming Your care and the Bengoa report’ – all of which, they said – ‘agree an enhanced role for community pharmacy would shift pressures from elsewhere in primary care’.
the health spokespeople then turned their attention to the subject of funding, pointing out that, while successive funding disputes had essentially centred on two opposing views on the quantum of the financial envelope for community pharmacy, the nI cost of Service Investigation (coSI) (2017), which is now complete, had supported the original position expressed by bodies including cPnI, ie, that community pharmacy is being underfunded by the Department of health by at least £20 million and that ‘this would seem an opportune time to use the evidence from the financial
14 - PharmacY In focUS
investigations to agree a settled position for each of the years 2011-18’.
‘We are somewhat concerned,’ the health spokespeople continued, ‘that you have recently embarked on a different course of action, so that rather than opening discussions with cPnI to reach a settled position, you have instead asked hSc Board to:
• carry out an analysis of the range for hSc services expected within a financial envelope for community pharmacy, and
• Provide the Department with a ‘formal’ view on the Pwc (2017) coSI report (even though they were members of the Expert group who advised and commented throughout the original process)’
the letter ended with the health spokespeople acknowledging the ‘tremendous challenge’ that mr Pengelly faces in the absence of a minister, but urged him to instruct his officials to ‘settle the community pharmacy funding dispute once and for all’.
‘In summary’, they concluded, ‘we would encourage the Department to act immediately to stabilise the community pharmacy network in the short term by: • opening further discussion with cPnI as the representative body
• Urgently introducing an interim rescue package
• re-introducing proprietary mitigation to address the issue of ‘dispensing at a loss’
• Ensuring sufficient funding is maintained in rural areas
• Delivering a new community pharmacy contract as a matter of urgency
given the fact that nI has been operating since february 2017 with no assembly and effectively in a political vacuum, this cross-party letter was a very positive move on several fronts. not only were five different parties working together, but they were working together for the good of community pharmacy, with an
acknowledgement – once again – of an enhanced role for community pharmacy, and a call to action that would settle this issue for once and for all.
gerard greene, chief Executive of cPnI, was quick to laud the cross- party letter. ‘We welcome the support from the main parties on the current issues facing community pharmacy,’ he said, ‘and their call for the Doh to act to immediately stabilise the network here. the healthcare system needs radical change and key to this is giving community pharmacy a more proactive role in public health and in the prevention and management of long-term conditions.
‘Scotland and Wales provide us with excellent examples of what this change looks like and the impact it can have on improving patient outcomes, shifting demand and delivering efficiencies.
‘through better understanding of its services, greater recognition of its value and with a flagship role at the heart of public health, our vital place- based network of community pharmacies can play a significant role in solving the crisis facing us.
‘the intervention from this group of mLas hasn’t come a moment too soon as the policy divergence between what has been agreed in terms of financial support and what is being realised is substantially different and simply can’t continue in this way.
‘this call from our elected representatives is vital in terms of ensuring that community pharmacy is recognised as a health service priority and resourced accordingly before it is too late.’
after such a positive move and an equally positive response, it was at this point that the wheels began to – well, not quite fall off – but to grind to a halt.
mr Pengelly’s response – which took almost two months to come – and which, he said, he hoped would be
‘helpful’, certainly started out on a positive note.
‘It has been the Department’s long- standing intention,’ he wrote, ‘that community pharmacy is fully engaged in supporting effective and efficient health care delivery within an affordable financial envelope’.
the letter then went on to assert that ‘it is vital that any financial envelope is based on the best possible information’.
Pharmacists across northern Ireland breathed a sigh of relief. after all, hadn’t they sweated blood and tears to submit the information required for the Doh’s 2017 coSI, which had not only produced a comprehensive report on the financial state of nI community pharmacy, but which had also reinforced the view of all involved in the profession that community pharmacy was, indeed, underfunded by between £20m and £30m per year?
apparently not…
In addition to the fact that the Department has now asked the hScB to provide them with a ‘formal’ view on the coSI report (even though they were members of the Expert group who advised and commented throughout the original process) – thereby delaying any progress in contract negotiations yet again - and switching the focus to the profits that pharmacists make on purchasing.
‘given the completion of the coSI exercise,’ mr Pengelly wrote on the subject of the 2017/18 cuts in funding, ‘together with the evidence of the level of profit on purchased medicines available to contractors, which will inform the determination of a financial envelope for community pharmacy, it is appropriate that payments were suspended.’
the Drug tariff was next on the list of issues to take centre stage.
recent months have seen unprecedented generic medicines shortages, which have left community
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