When it comes to community pharmacy it really does seem that the Government has been trying to pull the wool over our eyes. In December 2015 Ministers announced that hundreds of millions of pounds would be taken from pharmacy budgets over several years. The sector, they said, should make its fair share of efficiency savings.
Government ministers assured us that they understood the true value to the community of such pharmacies and they were very keen to stress that the planned funding cuts would only lead to "a minimal number of closures". In fact in the House of Commons on 20 Oct 2016 Health Minister, David Mowat said: "It is possible that none will close."
However, revelations from the High Court judicial review brought jointly by the National Pharmacy Association and the Pharmaceutical Services Negotiating Committee tell a different story. It is now clear that an estimate of hundreds, if not thousands, of closures is a more accurate reflection of the outcome the Government expects.
Correspondence between the Prime Minister, the Health Secretary and the Chancellor reveals that ministers not only expected a high percentage of community pharmacies to close, but that they viewed this as a desirable outcome. The reassurances given by Ministers in Parliament just weren't accurate. It is shocking that the Government has tried to keep the truth from the public for so long.
No one should really be surprised though because it has been clear since the outset that the Government has little understanding of the true value of community pharmacies and even less inclination to assess the likely impact of their hasty actions.
Jeremy Hunt persists in viewing community pharmacies as nothing more than "high street retailers". The Chancellor argues that "the subsidy to community pharmacy" is too high.
Let's just be really clear here and now: community pharmacies are a key part of the primary care team and as such they do not receive any subsidy - they are paid for providing a service to the NHS and ultimately to the public.
Further it is a fact that the Government's own figures show that community pharmacies are at the top of the league when it comes to efficiency. It is true that the number of pharmacies has increased by 20% but this is a relatively modest increase considering that the volume of prescriptions has risen by over 50% in the same period and these pharmacies at the heart of the community deliver a wide range of additional services that go way beyond the dispensing of prescriptions and the sale of paracetamols.
Community pharmacies have for many years continually experienced increased workloads and reduced remuneration. They have been doing more for less and in spite of this they have offered to work with the Government to provide more services to achieve further savings for the NHS.
It is clear though that the Government is just not listening. They apparently have other plans for the service going forward. The Chancellor refers to the cuts as a "the first step to reforming the over subsidised and inefficient market." He then goes on to suggest that the long term plan may be a move away from the traditional 'bricks and mortar' community pharmacy to "scaled up innovative supply solutions using digital technology."
Is this Amazon style alternative what the public really want? The fact that Internet pharmacies have been around for 20 years and have still only attracted a tiny amount of the business would seem to suggest not.
Let's stay focused and remember though, that the object of these changes is not to provide better patient outcomes. In all the evidence that has emerged there is not even the slightest suggestion that patient needs are being considered.
Does the Chancellor really expect elderly patients to get their prescriptions via an online service? Who is going to support these patients with their medication? Will we be relying on the courier to show a child asthmatic how to use an inhaler? It seems that the Government doesn't know or care, because their sole aim is to save money.
On the money, Ministers are misguided. The advice, service and supervisory role performed by highly qualified, extremely accessible community pharmacists saves the NHS billions of pounds every year. Is the Government so short sighted that it cannot see that forcing the the closure of community pharmacies will place even greater pressures on already overstretched GP surgeries and Emergency Departments?
In an attempt to reassure the sector, the Government has promised to offer some protection to pharmacies that are not within a mile of another pharmacy by means of a new 'Pharmacy access scheme'.
However scandalously few pharmacies serving the most deprived communities will qualify for any protection. Instead they will be saddled with even greater cuts to pay to for a scheme that protects pharmacies in more isolated, more affluent locations. Amazingly only three community pharmacies in the whole of London will qualify for the scheme and Boots the Chemist at Heathrow airport will be one of these! This entire programme of changes has been ill thought through and the plans have been left in chaos.
The results of the Judicial Review brought by the pharmacy representatives is due to be known within the next week. Hopefully the outcome will give the Government pause for thought. Ministers need to go back to the drawing board and come up with a long term package of help for community pharmacists which recognises the critical role they play in providing face to face, accessible healthcare to patients right across the country.