Underfunding has hit my community pharmacy hard, but we’re determined to provide new high-value services

I was surprised that so many pharmacy contractors voted in favour of industrial action in Northern Ireland, owing to chronic underfunding of our sector here. In conversations I’ve had in the past, colleagues have had very divided opinions on what should and shouldn’t be done to fix the problem.

But the vote on 25 February 2020 was an overwhelming surge in favour of doing something to try to improve the funding situation. There’s a continued feeling that the government doesn’t understand or appreciate what we’re doing on a daily basis and what good value community pharmacy is.

My pharmacy is run nearly at a financial standstill, with the payments that come in at the end of the month just about covering our outgoings. I would expect our bank balance to increase month after month, but that increase is very slight.

Our outgoings are high. Meanwhile, minimum wage and pension payments are continually increasing, while payments to community pharmacy remain the same. In terms of a wage, I’m drawing very little from one week to the next and it’s difficult to think about investing in the business when funding is so tight.

As a result, we have reduced staff levels on Saturdays — one of our busiest counter-days of the week.

I tend to avoid digging into our finances too much, because I see myself as a health professional — I should be focused on just trying to provide the best healthcare service I can. But I’m now finding it essential to make sure my team spends time trying to get medicines at more competitive prices. And even with this, there are many medicines that we are dispensing at a loss.

We’re just trying to do whatever we can to try to bring in some additional revenue.

We’re under pressure to provide valuable additional pharmacy services to increase our revenue, such as medicines use reviews. We love providing these and our patients benefit from them, but the funding for them has been provided by reducing our dispensing fee.

On a local pharmacy level, I’ve also set up a lifestyle programme for people with type 2 diabetes mellitus (T2DM), which brings in some extra money.

Through the programme, I take on ten people for a combination of group and one-on-one sessions to discuss nutrition, physical activity and stress management over 24 weeks.

T2DM is a condition that’s easy to fix by making the right changes. The person needs to be motivated, but they also need to know that there’s an option there for them, rather than just taking the medication, which, at the very best, just slows the progression down.

We’ve found that the lifestyle changes suggested in the programme can actually start to reverse the effect of T2DM, and in some cases it reduces their need for medication and improves their quality of life, their energy levels and even their emotional wellbeing.

In the first two years of the programme — 2018 and 2019 — at least half of each group had their HbA_1c down to, or below, 48 mmol/mol (6.5%) at 24 weeks. Reduction in medication has resulted in annual savings to the healthcare system of £1,100 in 2018 and £500 in 2019.

This programme has the potential to be an enhanced pharmacy service in an area that costs the health service so much, but the funding hasn’t always been available.

We have had some funding from the National Lottery to run the programme, but it was time intensive, so the funding covered only about half of what was really needed.

I’m now getting some more from the Health and Social Care Board and that’s been a bit of a help with our finances. But offering this service and getting funding is something I’ve sought out and taken on myself.

Community pharmacy has got such potential for other programmes like this; however, we get the feeling at times that this hasn’t been understood or appreciated from those who fund community pharmacy.

Until those making financial decisions for pharmacy start looking at value, rather than cost, we will remain at this impasse.