As you know the Judicial Review regarding Community Pharmacy has been taking place in the High Court.  The national pharmacy press and the NPA have been reporting on the proceedings.  At the bottom of this mail are some links that you can use to follow and read what has been happening.
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One of the most disappointing moments seems to have occurred yesterday when it emerged that the Chancellor of the Exchequer Philip Hammond,  wrote to Theresa May in August to suggest that local pharmacies should be closed and give way to a system of warehouse dispensing.

Philip Hammond apparently wrote on 11 August, to Teresa May advising her that the sector was inefficient, subsidised and needed reforming and he would like to see us follow other retail markets with a shift away from the traditional bricks-and-mortar business model towards scaled up, innovative supply solutions employing digital technology.  

Aside from some of the factually incorrect statements the letter showed a lack of understanding of the pharmacy sector, it role in our communities and its vital roles in Primary Care.

The full letter can be read by clicking here. 

Responding, NPA Chairman Ian Strachan said:

“This is a smoking gun.  We have been warning for months that there are elements within Government that want to see the end of the community pharmacy network that has served so many patients so well for so long.  Now the proof is there for all to see.  The Treasury is clearly motivated by the notion that centralised medicines supply is cheaper, it is not in the slightest bit interested in the quality of patient care.
“From where I am standing – on the NHS front line – it looks like the funding cuts imposed on us this year are the first salvo in an effort to wipe local pharmacies off the map.  But the NPA and the millions of people who have supported our campaign to save local pharmacies will not let that happen.”
“Philip Hammond’s letter contains financial miscalculations and misleads the Prime Minister.  Above all it is remarkable for its total lack of appreciation that pharmacies do more than simply supply medicines. For many people they are a local lifeline.”


National Coverage of the proceedings

Chemist and Druggist
http://www.chemistanddruggist.co.uk/news/
Twitter:- @ChemistDruggist   and #CutsInCourt

P3  Pharmacy Magazine
http://www.p3pharmacy.co.uk
Twitter @p3pharmacy 

Pharmacy Network
http://www.pharmacymagazine.co.uk
Twitter @ThePharmNetwork 

NPA Summary of Proceedings

The Judicial Reviews relating to the changes imposed on community pharmacy on October 20th 2016 will be heard in the High Court this week.   The hearing will start today Tuesday 21st March, with an estimated hearing time of three days. The two cases being brought by PSNC and the NPA will be heard together.

PSNC was granted permission for the Judicial Review from the High Court in December last year. The PSNC case is that the Secretary of State failed to carry out a lawful consultation on the proposals for community pharmacy.

Click here to read more about PSNC’s application for leave for a Judicial Review.

The NPA’s case is focused on arguments that the Secretary of State failed to properly discharge his Public Sector Equality Duties and failed to appreciate community pharmacy’s wider healthcare role. The NPA will release their own information about their case.

The barristers representing the various parties are:

• Alison Foster QC (PSNC)
• David Locke QC (NPA)
• James Eadie (DH)

During the hearing the judge will explore the arguments from each party and consider the very substantial amount of information that has been disclosed through this process, particularly by the Department of Health.

The judge may reserve making a decision at the end of the hearing, and if this happens we may not know the outcome of the cases for several weeks. It is not helpful to speculate on what the outcome may be at this stage.

PSNC Chief Executive Sue Sharpe said:

“PSNC very much regrets that it became necessary to take this unprecedented step. We have always sought to work constructively and collaboratively with the NHS and Department of Health.  Over many years our negotiations were characterised by robust exchanges and a willingness on both sides to listen and consider each others’ views and analysis, and we were able to reach agreement.  

This changed last year and the Department would not engage with us constructively on the most important elements of the 17 December 2015 letter.  

PSNC’s focus this week will be on the hearing to ensure that our case is presented in the best way. We will issue a further statement after the proceedings.”

The NPA Chairman, Ian Strachan, has issued a video message to contractors from the NPA about the Judicial Review.   This can be view below.

PSNC is seeking a Judicial Review of the Secretary of State’s October decision to implement cuts to community pharmacy funding and other changes.

PSNC has sought permission from the High Court to apply for the Judicial Review on the grounds that it believes the Secretary of State failed to carry out a lawful consultation on the proposals for community pharmacy.

An ‘expedited hearing’ has been requested, so that if permission to seek Judicial Review is granted, the hearing will take place as soon as practicable.

PSNC accepts the need for the NHS to achieve efficiencies within the community pharmacy sector and is not challenging this principle, but it does not believe that the consultation process on the proposals that are now being implemented complied with the requirements of a lawful consultation.  PSNC believes that the Department of Health (DH) has used poor data which it did not disclose as a basis for its decision, rather than updating existing high quality data.

PSNC’s application raises a number of concerns about the consultation, including:

• The DH’s failure to disclose the fact that it had carried out an analysis of pharmacies’ profitability based on Companies House data as part of its Impact Assessment.
• The delay in providing this analysis to PSNC after the publication of the Impact Assessment.
• The validity of the DH analysis including the sample size and the use of accounting returns, rather than economic returns, as the basis for the assessment of pharmacies’ economic viability and how they might be affected by the changes.
• The DH’s failure to analyse what the levels of pharmacy closures may be.
• PSNC has been taking legal and other expert advice since the letter of December 17th 2015 and in recent weeks working closely with other pharmacy organisations also exploring legal options. The National Pharmacy Association is named as an interested party in PSNC’s application.

PSNC Chief Executive Sue Sharpe said:
“PSNC’s role is to represent community pharmacy contractors. We have always sought to do this by working positively with the NHS to ensure that community pharmacies can do their best to meet the needs of the NHS, patients and local communities, and that the NHS recognises and acknowledges the value they provide.
PSNC has spent the past twelve months trying to work constructively with the Department of Health and NHS England to enable community pharmacy to help the NHS to meet the increasing challenges that it faces. We have sought to avoid taking legal action and very much regret that the process the NHS has followed has made this impossible.”

Dave Carter, Gateshead & South Tyneside LPC Chair said:
"Pharmacy has always been willing to work constructively with the NHS however this year has been a tough year and it is really sad that it has come to this however I believe (and I am sure most contractors will believe) that  this is the right course of action since the department of health have not engaged with the PSNC and worse still not followed due process."

PSNC has launched a series of webinars (broadcast each Wednesday)  to help community pharmacy contractors to understand the imposition of funding and other changes recently made by the Government. 

You can access the webinars through the PSNC website where you can sign up to take part or alternatively listen on demand to missed webinars.

The series covers many aspects and is well worth watching live or listening again to help you gain an understand of the impact.  PSNC also tweet on the night using the  #pharmacychanges which you can follow to keep up with all that is going on.

The direct link to the webinars is
http://psnc.org.uk/psncs-work/our-events/register-your-interest-in-our-webinar/
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Statement from PSNC Chief Executive Sue SharpeToday’s news is extremely disappointing but does not come as a surprise; it became apparent some time ago that the Government was unshaken in its determination to make a massive cut to community pharmacy funding by reducing fees and allowances. Indeed, it has been clear in both the wording of the original letter sent on December 17th and in our discussions with the Government and NHS since then that there was to be no genuine consultation on the total funding sum. 
PSNC could not accept a funding offer which was damaging to the sector and which will adversely affect the ability of pharmacies to provide patient care. 
In response to the consultation on changes to community pharmacy, PSNC set out the need for the Government to make decisions about community pharmacy services based on a number of principles that put the needs of patients and communities, as well as evidence, at the heart of the process. 
Sadly, this has not been the case, and we are instead now seeing the implementation of a decision for which no evidence has been produced and which many people, including patient and GP groups, have warned will have a detrimental effect on patient care and lead to further pressure on other healthcare services. This is a short-sighted and ill-judged approach to take, particularly when alternative constructive proposals that would address the need for the NHS to make cash savings have been put forward by PSNC. 
It is a sad reflection on the NHS on which we all rely to see it taking such a rash decision with so little justification. But this is not the first time that we have seen decisions that do not seem to be in the best interest of patients or the NHS being made. NHS England’s decision to walk away from commissioning a Minor Ailments Advice Service last summer was damaging to the NHS and to patients. Such decisions call into question the judgement of those in control of community pharmacy policy. 
In the past PSNC was able to have constructive negotiations with the NHS based on a mutual desire for community pharmacy to be commissioned and funded to deliver the best possible service for patients and local communities. These conversations were based on trust and respect that we had built up with policy makers over many years. It is very sad that real consultation with us has now been abandoned, and the approach through the last six months has instead been of an entirely different character; “we can do it, so we will do it”, seems to be the mantra. The lack of real consultation and clarity has been a common theme throughout the consultation period. 
PSNC will study the Government’s decision carefully to inform our own decisions about next steps. 
The funding cut, combined with the previously announced reductions to Category M prices following a significant over-delivery of margin last year, will have a significant and negative impact on contractors’ businesses. We would strongly advise contractors to make whatever provisions they can for the funding reductions. These will be very challenging times. 
PSNC remains keen to work with the NHS on changes to the Community Pharmacy Contractual Framework that will allow the development of clinical community pharmacy services so that patients and the NHS can get the most benefit and best value from community pharmacy. 
Pharmacy closures 
Although we are unlikely to see pharmacies closing immediately, we expect that pharmacy owners will be forced to take steps to reduce costs. These are likely to include reducing opening hours and staffing, and stopping the provision of services which they are not obliged to provide, such as home delivery of medicines and the supply of medicines in compliance aids. We are very concerned about the impact that this will have on patients.  
We will encourage LPCs and contractors to get together to consider how they can ensure vital local services are maintained. They may need to approach local commissioners to seek funding for services where they are not able to cover their costs.  
Impact on patients 
Pharmacies have always met demands for help from their patients, particularly in the winter, acting to relieve pressure on other NHS providers. They have done this readily and willingly, but as they are forced to review their operating costs and consider staff cuts, patients may find that they have to wait longer to receive advice that would previously have been readily available. The NHS must recognise this as winter pressures set in and it turns as usual to pharmacy for help. 
The Pharmacy Integration Fund 
While we are pleased that NHS England has been able to find £42 million over the next two years to support integration, we strongly believe that this should be spent on supporting national community pharmacy services that will better help patients and reduce demand elsewhere on the NHS and will be seeking clarity about how it will be allocated. 
Impact on other NHS services 
Lots of big policies could be railroaded by these community pharmacy proposals, for instance if social care cannot cope with the increase in people left without support, there could for example, be a rise in hospital admissions. The removal of Establishment Payments will target for the greatest cuts the low dispensing volume pharmacies in areas with the highest health needs. They would see fee income reduced by around 20% next year, at a time when the NHS has said that efficiency targets of 4% are too high to be achievable, and has reduced targets to 2%.

Further Information for ContractorsFor more information on the Government’s announcement, please read the PSNC Briefings below which have been written to help contractors to understand and prepare for the imposition.
PSNC Briefing 057/16: Funding imposition for 2016/17 – Information for Contractors
PSNC Briefing 058/16: Funding imposition for 2016/17 – Frequently Asked Questions
PSNC Briefing 059/16: Funding imposition for 2016/17 – Indicative Income Tables
List of pharmacies included in the Pharmacy Access Scheme (Excel format with LPC, LA, CCG and NHS England local office data)
Contractors may also wish to read the Government’s own documents outlining the funding package.

An announcement was made in parliament today about Pharmacy Services.  You can watch it below.  If the player below is not working you can access it by clicking here.