By Nick Kaye
Chair, National Pharmacy Association (NPA)
The Government’s decision to abolish NHS England (NHSE) and put the administration of the health service under political control is a bold, decisive move by health secretary Wes Streeting.
Unravelling the last element of the reforms introduced by then secretary of state Andrew Lansley was a shock to many – not least those who work in NHSE – but not really unexpected for a government that has staked its reputation – and political fortunes – on its ability to reform and improve our NHS.
Frankly, community pharmacy has not fared well under NHSE because of high level decisions around funding (both by NHSE and the Treasury) which put our network on a path to long term decline through real terms cuts when so many other parts of the NHS family were protected from austerity.
And while many of those working with us within NHSE are very committed to the community pharmacy service and have fought hard to realise its potential, the leadership of this arm’s length body has not always appreciated the power of a very local health service, which is far, far more powerful than simply dispensing medication.
On a personal level, my heart goes out to colleagues in NHSE who really care about community pharmacy and are affected by unsettling reorganisation.
I hope good people who have championed our cause within government are still there to share their expertise and knowledge. And I hope that the two-year process of merging the health service apparatus into the department of health and social care (DHSE) does not slow down reform.
But let’s be honest. Streeting’s move has opened up a lot of opportunities to think differently, move more quickly and transform health services for our millions of patients and their communities.
Wes Streeting outlines ambitious NHS reform plansPic credit: Getty images
The National Pharmacy Association (NPA) will work with whatever structures the government establishes to secure and improve the vital pharmacy services upon which millions of patients rely.
Ministers have inherited a crisis in pharmacy and need to do everything they can to prevent further damage to pharmacy services.
Much has been made about our campaign for better funding for pharmacy. But we’ve always been clear that the government has inherited a mountain to climb if they are to bring pharmacies up to a sustainable level. We hope a deal emerges that gives pharmacies some comfort and paves the way to a better future.
That settlement when it comes, will have been negotiated between NHSE and the DHSC, before going to Treasury, Number 10 and elsewhere in Whitehall.
Having Ministers directly accountable for our settlement without an arm’s length NHSE is potentially very desirable, not least because they have made it clear that they want to invest in community pharmacy.
But we’ve also been clear that we agree wholeheartedly with the vision Streeting has laid out. He’s right to want a digital revolution. He’s right to want care to move closer to communities and he’s absolutely right to want the health service to move from treatment to prevention.
All these things are at the core of what we do.
Pharmacies have closer, more regular contact with patients than perhaps any other part of the NHS, so are ideally placed to work on prevention. By their nature, pharmacies are in the centre of communities – on high streets, in shopping arcades, on street corners, in towns, villages and cities.
They are entrepreneurial and ambitious, able to change rapidly and innovate – just look at what they achieved during Covid – so are perfectly placed to adapt.
Pharmacies played a critical role during the pandemicPic credit: Hollie Adams/Getty Images
The possibilities are huge. Medicines optimisation, a greater urgent health care service, as operates in Scotland and Wales, deprescribing to improve outcomes – and save the Exchequer billions – prevention, weight loss, lifestyle change. All could be possible through a reformed pharmacy service and pharmacy contract.
Speaking to NHS Providers last year, Streeting spoke about devolving power through the NHS, saying: “We need more doers and fewer checkers”. As someone who represents an amazing network of “doers” in community pharmacy I couldn’t agree more.
Reforms of the order being discussed are essentially political, not technocratic. It’s in the interests of our patients and our sector to have political leadership that can implement a bold vision for the future and use their political capital to make things happen.
We want to move at speed to make reform happen and realise Wes Streeting’s vision, so I hope an NHS administration with clear political direction can make change happen without delay.
