I was listening to the Pharmacy Magazine weekly podcast - Talking Pharmacy (as I do most Saturdays) and heard a mention about Substance Misuse services. It made me reflect on whether pharmacy actually negotiates well when services are being commissioned. Perhaps, in good faith, we are too focused on activity based payments, akin to our traditional dispensing contracts rather than packages of care.
Richard Thomas editor of Pharmacy Magazine spoke of a local colleague - Martin Bennett of Wicker Pharmacy fame, who was writing an article for publication around the impact of the pandemic on pharmacy Substance Misuse services.
For those of you not in the know, the Wicker Pharmacy invested to a significant degree (as have many other pharmacies) to deliver a high quality and clinically safe service to such clients. But since the advent of Covid, the number of visits to the pharmacy per client have reduced.
Normally clients would initiate treatment by having daily supervised consumption of the medication supporting their particular journey through the service. Associated with the visit and consumption, the pharmacy would be paid a fee for that activity. I understand that Covid restrictions have resulted in a change in prescribing, with clients collecting a week’s worth of medication, and often alongside that a reduction in their supervised doses.
Now because the contract is based on activity around those touch points, there has been a crashing reduction in income, without I would argue, a crashing reduction in costs and initial investment by the pharmacy.
There is a whole separate argument about the risks of Covid verses the risks of large quantities of potent medicines in the community, with the potential of overdose of individuals in treatment and accidental overdose of household members such as children.
So perhaps we need to be a little smarter in our development of service agreements, and move away from activity payments (even though commissioners and providers like the simplicity and clarity) to a broader view of service delivery and reversion.
I look forward to the article and to hear the impacts that Martin and the Wicker are having to endure, along with the other pharmacies across England. I’m hoping he has a solution too, as I’m all ears.