Demanding unused ARRS funds is not the way

It is easy to see unspent funds in one part of the NHS and think “if only we had that money we could …” but if pharmacy wants to engage effectively with the NHS, it must be needs led.

We need to identify a challenge that the NHS is facing and propose how we could contribute to overcoming it. We need to identify how the investment the NHS makes will yield the outcomes that it wants and how we would work collaboratively to achieve this.

Linked to this, we must not be confused by comparing the funding model for general practices with that of community pharmacies. General practices are primarily funded on a population basis and through performance at a practice and PCN level. Community pharmacies are funded primarily through piece work; paid for the items of work (dispensed prescriptions, services, vaccinations) undertaken, with some performance-related reimbursement (the PQS).

The idea of applying the ARRS model in community pharmacy does not make sense in the context of our contract. There is a bigger question regarding whether the community pharmacy contractual framework in England is fit for purpose for the role pharmacists could or should be undertaking within the NHS, but that’s for another time. Without fundamental changes to the contractual relationship between community pharmacy and the NHS, ARRS in community pharmacy simply doesn’t make sense.

Double payment

Using an ARRS funded pharmacist to undertake the DMS, NMS or CPCS would also amount to double payment. Pharmacy contractors get paid when they undertake one of these services. Why would the NHS provide extra funds for a service that is already being paid for?

The final flaw in logic is to think in terms of a pharmacist managing the dispensary. A pharmacist is a very expensive resource to be involved in the dispensing process and should really only intervene to provide a clinical check and to discuss a patient’s medicines with them.

With appropriate implementation of e-repeat dispensing and more use made of pharmacy technicians, community pharmacists would be able to be much more selective about their activity and the interventions they make in order to add value where it is needed for maximum impact.

If a pharmacist withdraws from certain dispensary activities, someone else will need to fill the gap – but this doesn’t have to be another pharmacist. Pharmacy technicians could be promoted to become dispensary managers and/or ACTs, dispensers could become pharmacy technicians and medicines counter assistants
could upskill to become dispensary assistants. 

Twenty hours of pharmacist time could be replaced with 20 hours of, say, medicines counter assistant time with some thoughtful reorganisation. How many services could a pharmacist provide in the 20 hours they have been given? Surely the income from these services will more than cover any investment in the pharmacy team.

We must add value

Looking forward, we need to think in a way that makes sense to the NHS and cuts our ties to old ways of working. We need to ask what problems the NHS has that we can help to solve and look for ways in which we can add value. And with developments in what is expected of us and also technology advancing rapidly, we need to seek out new operational models that deliver services effectively and efficiently.

Fundamentally, we need to look to the future and create a vision for what pharmacy could be, and start to develop community pharmacy in this vision. In doing so, we must not tie ourselves to old approaches and ways of working from the past.

Liam Stapleton is director of Metaphor Development Limited and an associate clinical lecturer at the University of Lincoln.