Jacques Gholam is a local community pharmacist.
The consequences of the Law of Unintended Consequences tend to expand exponentially when any action is poorly thought through. Equally, such events are only best seen with hindsight by which time either furious damage limitation takes place or sadly it is too late. This begs the question: where are the “grey heads in the corridors of power nowadays – those men and women of experience and sagacity whose counsel should be sought to consider such possibilities before any action is pushed through.?
The oxymoron is a fascinating construct in our language in which the use of two paradoxical words combine to provide a stronger emphasis – i.e: sit up and pretty ugly. As an independent community pharmacist, if I were to describe my role using an oxymoron, I would choose sticky lubricant. It is inelegant but no less effective because, quite simply, we are the glue that holds primary health care in the community together whilst simultaneously oiling those parts that get stuck together. This ensures that our customers or patients are properly and above all, safely, served.
Which brings me to the core concern of this article; has anyone seriously thought through the potential consequences of the recent Department of Health announcement to cut pharmacy funding by £170 million, equivalent to six per cent of pharmacies’ funding? It appears that no civil servant has been tasked with any form of regulatory impact assessment prior to this decision.
Consider the DoH reasoning provided for this announcement. Whilst it is officially recognised that community pharmacy has an important role in primary health care, nevertheless the Government does not wish to be seen to be providing support for one part of the retail sector over any other.
There’s the first paradox. Are we health care professionals or shopkeepers? The Government hasn’t clarified that point. The department actively exhorts the public to visit their local pharmacy instead of the GP or the hospital A & E departments, but express disappointment at the low uptake by the public of the digital tools now available in the retail sector. These include online transactions, click ‘n’ collect etc, which are difficult for the elderly, frail and vulnerable members of our society whom we serve, to use.
The DoH is determined that patients should have increased choice within the NHS network, which, by the way, includes community pharmacy (it has said so). At the same time, the same department acknowledges that up to 3000 pharmacies, possibly mostly independents, could close, thereby reducing that same patients’ choice even further. There’s paradox number two.
The Government perceives the number of pharmacies supported by practice funding to have grown unnecessarily over the years and to be an inefficient use of resources. Simultaneously, it is ignoring the “market forces” that are engendering this situation, notably that our population is both growing and ageing. Paradox number three.
I could go on ad nauseam, but let’s now consider the consequences if many pharmacies are forced to close. Where would the axe fall? Which pharmacies carry the heaviest burdens in terms of costs, overheads and debt management? The chances are more than likely that the axe would be totally indiscriminate in where and how it would fall. Isolated communities and urban centers would not be immune to sudden losses of pharmacies. Imagine going on the stump at the next election explaining why the local pharmacy was forced to close and how you, as the local MP, didn’t see it coming, let alone take action to prevent this happening.
There may be three thousand pharmacies closing down, rather as they did during the late 1960s and early 70s. This translates into pharmacies that no longer employ local residents as trained staff; no longer pay business rates into government coffers and no longer serve an essential (NHS word) pharmacy contract. Pharmaceutical wholesalers will cut back on their distribution networks because of less demand, thereby creating redundancies of drivers, delivery men and warehouse packers. That paltry sum of £170 million cut from basic pharmacy practice funding could no longer be described as a saving.
Please do think this through and then ask the DoH if cutting the funding in this manner is really and ultimately the best course of action. Remember the law of unintended consequences that heads this article, because it could affect you personally. And consider the oxymoronic nature of the DoH’s thinking in this situation – in which, sadly, the “oxy” is strangely silent.