It’s been almost a week since the outcome of the Smith Commission was unveiled. The mixture of sunny and stormy reactions it has received has been well and truly heard and it remains a hot debate within Scottish politics at this moment in time. Although much has been made of “the vow” in the Daily Record before the referendum on Scottish independence and that being apparently redeemed, it is important to note that legislation has still got to be put forward through Westminster to devolve those proposed powers. But how will new powers affect the pharmacy profession north of the border?
To a minor extent, it can be argued that it won’t make a difference at all. After all, health was already devolved to the Scottish Parliament in 1999 – well before the whole debate over Scotland’s future commenced with regard to September’s independence referendum. The real issue I think that could emerge from a debate in the context set within this blog entry is funding of the NHS in Scotland and how that will affect pharmacists in all sectors, particularly community and hospital.
Since I have never had experience of other sectors of pharmacy other than community as a pharmacist specifically, let’s take a look at community pharmacy. If you are a hospital pharmacist, industrial pharmacist or a pharmacist from another sector in Scotland or elsewhere who has a view on the issues discussed within this article are more than welcome to comment and I look forward to reading your contribution.
Whilst there is a commitment from the Scottish Government to protect the health budget, the main concern for pharmacy contractors at this current time will be renumeration for dispensing and provision of other services such as the minor ailment service, chronic medication service and smoking cessation. For the future, much of the focus will be on the plans for the provision of pharmaceutical care as highlighted within the Scottish Government’s document, Prescription For Excellence (September 2013).
The figures outlined in this next paragraph come from the ISD Scotland’s prescription cost analysis from 2014. In 2013/14, the net cost for medicines dispensed in Scotland was approximately £1.15 billion which represents an increase of over 22% since 2004/05 (where the figure at that time was approximately £939 million). When you consider the fact that the annual NHS Scotland budget was £11.9 billion in 2012/13, we are only talking about approximately one tenth of that overall budget that is spent on dispensing of medicine in Scotland. In 2011, the Scottish Government axed prescription charges for patients in Scotland and the main question here is whether taxation alone is sufficient enough to cover the costs.
That leads on to the headlined point made last Friday – the devolution of income tax (rates and bands only) to Holyrood. How will that affect the amount of money that the Scottish Government will have to spend on the National Health Service in Scotland? It has to be noted that the money received from the Barnett Formula will probably be affected if the proposals in the Smith Commission report are legislated for next year as planned. MP’s from outside Scotland, within the rest of the United Kingdom, will raise eyebrows if a cut is not made in the amount of money that Scotland receives whilst at the same time having control over the rates and bands of income tax, if the proposals for more powers are to go ahead. So as a result, it is yet to be finally seen what the final effect will be if the planned proposals from the Smith Commission become implemented.
It also has to be noted that according to reports in The Scotsman, that £125m of extra funding is due to head to the NHS in Scotland, because of the additional investment commitment by the UK Government for the NHS in England with the Autumn Statement that took place earlier today. This is very much welcome, but the real question is as to where this money is actually going to go? Will it be used to prioritise improvements in GP services? Will it go to Accident and Emergency services? Or will it go elsewhere within NHS Scotland? It is key that the Scottish Government make their intentions clear as soon as they have a substantial plan of action and response to provide.
As far as the viability of community pharmacy business’ are concerned, I can only imagine that the key for them is to ensure that they continue to pay an affordable rate of the relevant taxes that they have to pay. But one of the key disappointments from critics of the Smith Commission’s report was no commitment to devolving corporation tax to Scotland. It is likely that if plans stay on track that Northern Ireland will benefit from having the power to alter the rate of corporation tax in the future. That is an understandable change that should be made for them as their neighbours in the Republic of Ireland already have a low corporation tax rate of 12.5% for trading income.
But Scotland could also benefit from having the same power in future as well. The argument can be made for that tax to be cut to a lower level in comparison with the rest of the UK in order to make Scotland a more competitive place to do business. There is no way that Scotland can compete with cities like London on the same level of corporation tax simply because London is a global economic centre. Business’ in Scotland don’t just depend on a competitive rate of corporation tax, but so do many people who want to fulfil their career ambitions in Scotland. I would fiercely argue that Scotland is a world class country to do business in, but we need an enhanced level of autonomy to take the decisions required to appeal more to investors to come to our country and put their money here.
And this point links strongly to my next major point. The future for newly qualified pharmacists and pharmacists who want to develop their long term career north of the border. Regrettably, many more pharmacy students than ever before are really struggling to secure a pre-registration placement which is an important step in the journey towards the final destination becoming a pharmacist officially. Students in Scotland who miss out on a placement north of the border have no realistic choice but to leave for elsewhere in the UK to achieve their overall objective – and even that is proving difficult today. Much has been made of the idea of a cap on student numbers, but it’s frankly uncertain whether it’s going to have any immediate effect on the numbers in the short to medium term.
Rather than try and reverse the current situation with the number of students studying pharmacy, what needs to happen is that more of an urgent approach will have to be undertaken in order to stop pharmacy graduates from either heading towards unemployment/underemployment or heading towards the exit door from pharmacy and into another career path. Ideas have without doubt been exchanged about how to fulfil the career needs of many pharmacy graduates in future, but there is no firm action plan at this stage. Prescription For Excellence was not necessarily a set of firm proposals to initiate a major change in the framework of community pharmacy through legislation. Sure there were many ideas within it and painted a positive vision for the future as far as the provision of pharmaceutical care within Scotland is concerned. But the challenge now for the Scottish Government and the profession is to give those future graduates a viable career path to undertake within healthcare in Scotland for the benefit of the NHS.
On another note, it could be worth increasing the number of placements available through the Scottish Government’s NHS Pre-Registration Pharmacist Scheme. Introduced by the then Scottish Executive nearly ten years ago, it has been a centralised yet effective way in sustaining a strong quality of pre-registration training for pharmacy graduates north of the border. But what about the number of applicants entering the scheme and how many placements are actually available?
According to this link from the NHS Education for Scotland website which contains FAQ’s for potential applicants to the scheme, one of the frequently asked questions listed explores the issue of how many placements are available on the scheme – it is anticipated that there will be 170 for 2015/16. Not all of those placements will be in community, but a vast majority of them will. There were 1,246 community pharmacies within Scotland in 2013/14 (link from ISD Scotland), so how about increasing the number of placements available within community pharmacy and reaching out to contractors in getting them to take part within the scheme?
By encouraging and helping any community pharmacy contractor who would be willing to comply with the required standards for participation within the scheme in order to take part, we can improve the number of placements available. And it will also require funding – why not spend a portion of that £125m mentioned earlier on increasing the number of pre-registration placements in Scotland?
Pharmacy in Scotland, particularly in the community sector, is envied by our friends and neighbours worldwide. I would go even further and state that we are a world leader when it comes to what the profession does and how we contribute towards the overall provision of healthcare. That reputation must be protected and is something that the nation can be immensely proud of. But it is important to understand that the initiative will have to be taken primarily by pharmacy in Scotland. Whilst there are many important stakeholders in terms of groups, individual pharmacists and technicians plus other people connected to pharmacy in some way or another can play their part too by blogging, writing to their local political representative or contributing ideas. I have even included a poll at the start of this article to see whether you think pharmacy will benefit from the proposed new powers for the Scottish Parliament – please have your say in that. The poll closes next week and the results should be known by then.
And engaging with the political process is mandatory if positive things are going to continue to happen. The Scottish Government will not turn round and continue to enhance the autonomy given to pharmacists within the community if we run out of ideas and lack creativity in bringing ideas forward in what our elected politicians can do in Edinburgh for the whole of Scotland. Albeit many people like me were disappointed with the outcome of the referendum in September, Scotland could yet still have a lot to gain as far as devolution is concerned.