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emptyshelvesJanuary 27 2016

A health minister has acknowledged that proposed cuts to pharmacy remuneration could lead to up to 3,000 pharmacies closing. Most at risk will be those pharmacies which are most reliant on prescription volume, he said.

Community and Social Care Minister Alistair Burt’s views are included in a summary of a parliamentary All Party Pharmacy Group meeting he attended where he was questioned about the proposals for the 2016-17 pharmacy contract in England. The APPG is looking into primary and community care, but the session was dominated by the letter the Department of Health had sent to PSNC on December 17 setting out how it proposed to change the pharmacy contract.

Asked about the view expressed by the Chief Pharmaceutical Officer last September that there were potentially 3,000 too many pharmacies, Mr Burt is reported to have said that that pharmacy numbers had increased by around 20% in the last ten years. “He could not be certain how many would close but suggested it could be between 1,000 and 3,000. Much would depend on the response of the multiple,” says the APPG report of the meeting.

Mr Burt had addressed the meeting saying that while community pharmacy funding will be cut from the £2.80 billion it is for 2015-16 to £2.63 billion in 2016-17, the community pharmacy sector is thriving, and that the sector can withstand some change.

The APPG records that Mr Burt said it is likely that not all ‘shops’ will be viable under the government’s plans. Instead he argued that multiples are more likely to be able to adapt, so the government will look at how to help small independents and those wishing to retire or exit. However, when asked whether there would be compensation arrangements, Mr Burt told the APPG that the government could not decide which pharmacies would close.

The APPG also heard that the government wants pharmacies to continue offering new and different services, but there are a number of efficiencies that can be made, especially in distribution arrangements. In addition, the sector would need to reduce its reliance on prescription income, as in future, those most reliant on dispensing income would feel the greatest financial squeeze, said Mr Burt.

The Deputy CPO, Jeanette Howe, confirmed that there would be further cuts in funding beyond 2016-17. She also agreed that while there were positive opportunities for pharmacists, the outlook was less positive for pharmacies.

Asked about how the government could speed up plans to increase services provided by community pharmacy, she said that the Pharmacy Integration Fund and local commissioning of services would assist. The PIF will be £20 million in the first year and will increase to £100 million by year five.

Commenting after the meeting, APPG Chair Sir Kevin Barron MP said the proposals to reform the community pharmacy contract “are not just about a 6% funding cut in the second half of the next financial year. Based on what we heard, that is not a one-off cut so there are implications for future years. We note from our meeting that phasing may be considered.

“But there is also much more to this picture than a cut in funding. There is a clear intention to reduce the number of pharmacies. We don’t yet know how that will be done but closures must not reduce access or quality. We also want to know whether there will be compensation for those who exit.”

Sir Kevin also said that the proposals for centralised dispensing processes, or ‘hub and spoke’, raised “questions around safety, quality and access. The supply of prescription medicines cannot be treated like buying clothes and DVDs. High quality, safe dispensing depends on the opportunity for a face-to-face discussion between the pharmacist and the patient. I don’t see how that can be done in a warehouse.”

Mr Burt has agreed to a further question and answer meeting with the APPG.
Following on from this, PSNC has updated pharmacy contractors on documents that have been issued since the initial letter from the Department in December. The DoH has issued more details on its proposals including a presentation with facts and figures it is taking into account in making its proposals.

A petition calling for the cuts to be stopped has passed the 10,000 signatures mark, prompting a response from the Government. In it, the Government says: “In some parts of the country there are more pharmacies than are necessary to maintain good access. 40% of pharmacies are in clusters of three or more meaning that two-fifths of pharmacies are within 10 minutes walk of two or more other pharmacies.

“We will ensure that those community pharmacies upon which people depend continue to thrive and so are consulting on the introduction of a Pharmacy Access Scheme, which will provide more NHS funds to certain pharmacies compared to others, considering factors such as location and the health needs of the local population.”

Commenting on the latest information, PSNC Chief Executive Sue Sharpe said: “Until this week communications have been silent on how the NHS intends to develop the clinically focussed service that it states as its aim. We have been clear that cuts to pharmacy funding that will force contractors to cut staffing is about the worst way to do it. We have made this point forcefully and are bringing forward our own proposals.

“The explanation given in response to the petition has no credibility in light of their position to date.”

Numark, the membership group for independent pharmacies, has continued to raise awareness of the need to lobby against the DoH proposals. Leaflets outlining the concerns, a letter template to write to MPs and a template press release for contacting local media about the cuts are available, and a poster is being finalised.

“The tools will expand in time to include advice on how to deal with the forthcoming cuts, but this initial phase is all about responding to the news and telling communities about the implications. Numark remains keen to be involved with any national campaign, but has produced these materials following feedback from members who want to do something now,” said a spokesperson.

The National Pharmacy Association has also commented on the Department’s briefing document distributed to stakeholders, which the DoH describes as “our vision for community pharmacy, and outline proposals for achieving that vision”.
NPA Chairman Ian Strachan commented: “There is a flat and glaring contradiction in the Department of Health’s position: it calls for community pharmacy to be at the heart of the NHS, then tells us how it plans to wrench the heart out of the sector.

“The promoters of this nonsense are either blind to the long term consequences, or they see it perfectly clear and just don’t care. Either way, we have to stand together and fight this every step of the way.”

Dr Mark Spencer, co-chair designate of New NHS Alliance, and a GP in Fleetwood, added: “This policy appears to be extremely short-sighted. The proposed £170m cut will save roughly 0.14% of the annual NHS budget, but the services and expertise we risk losing have the potential to save far greater NHS resource in the long run.

“While the exact number of pharmacies that will be forced to close as a result of the funding cut remains to be seen, it is quite astonishing to hear that the government seems to accept it could be as many as one in four. Jeremy Hunt has stressed on multiple occasions that the sustainability of the NHS lies in developing out of hospital care, and a focus on prevention. Cutting funding to vital primary care providers completely contradicts this approach.

“Closing high street pharmacies is likely to widen health inequalities in the most deprived areas of the country, but it will also have the knock on effect of increasing demand on general practice, at a time when GPs are already struggling with capacity and recruitment.”

Links:

APPG announcement

APPG report of meeting

PSNC announcement

DoH briefing document

Petition and Government response

Numark

NPA comment

NHS Alliance comment

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