Wright Review next steps

17 Aug 2020

The PSNC held a webinar on the Wright Review on 10th August and this is available to view on demand here. They have issued four questions for consultation about the way forward. The NPA will be submitting a written response to the PSNC itself, and is encouraging independent community pharmacy owners to do likewise to ensure that all the voices of the independent sector are heard.

The NPA view on the Wright review is that:

  • There needs to be change and the NPA wants to be an active participant in influencing and supporting that process. We recognise this review is a sincere attempt to create a more coherent, end-to-end system of representation and support, connecting local and national leadership.
  • We can see merit in the vast majority of the recommendations made in the report, but we believe that key questions about the future of pharmacy representation & support in England remain unanswered by the Wright Review recommendations published in June.
  • At the outset of this process, the NPA set out a number of principles we wished to see applied to any future structure. Uppermost of these are continued investment in local leadership and improved accountability. We also emphasise the importance of equitable governance, to ensure that the voices both of independents and multiples are fairly represented in local and national leadership. Whatever structure emerges needs to allow the distinctive voice of independents to be heard, and must work for everyone, big and small (these principles are set out in more detail below).
  • The Wright Review recommendations address some of the principles we laid out, but the current level of detail is not enough to assure us on all the matters that concern independent contractors. We need to be clear how a vision and strategy for the sector will be developed.
  • If adopted, these recommendations will amount to a radical overhaul of how community pharmacy is represented and supported. We recognise the need for change, but the details must be properly thought through before embarking down this road. There must be ample opportunity to examine the implications and unintended consequences – but at the same time we must ensure that the sector does not become unduly focused on internal structures. We must also ensure that there is a suitable process for approving any changes that occur in a way that delivers legitimacy any new structures.Early in this process, we established eight principles that we intended to measure any proposal against in order to determine whether it meets the needs of our members:
  1. Increase the capacity for local service development and implementation; the system at local level must be skilful in representation, efficient and responsive to change
  2. Streamline the network of LPCs (ideally to reflect NHS structures), provided a thorough analysis shows that this would be cost-releasing, so that savings can be re- invested in local support and representation
  3. Reform the PSNC mandate and accountabilities, focusing PSNC more sharply on negotiation of the national contractual framework
  4. Invest in a local leadership development programme which includes PCN Pharmacy Leads; and potentially provides backfill funds to enable attendance at PCN meetings
  5. Redefine what ‘good looks like’ for a contractor in terms of what they get for their levy investment into PSNC and LPC; and improving transparency and accountability in relation to its expenditure
  6. Ensure that any forms of governance evenly and collectively serve all the contractor stakeholders in community pharmacy, i.e. independents and multiples
  7. Pilot any changes before full-scale implementation and learn from early pathfinders
  8. Consider how service development and innovation is handled by the sector. We think there could be merit in a new regionalised support structure, plus a national Community Pharmacy Service Development Unit. Both would serve, not direct, local pharmacy representatives. This idea requires further thought and we will be taking soundings from NPA members, LPCs and other stakeholders about its desirability and feasibility.

In relation to the four questions that the PSNC is consulting on, we would suggest that independents consider the following factors when drafting their own responses.

1. How do we fund the process – both to take work on the independent review forwards, and any longer-term changes to LPCs and PSNC?

  • We think that the transitional process should be funded through PSNC and LPCs rather than requesting further funds from contractors at this stage.
  • The proposed new structures have not been costed within the Wright review. In particular there is little detail on the scope and resources for any future LPCs. We are concerned that independent contractors might have to pay significantly more than today to benefit from the same services locally and nationally.
  • A key early step in this process needs to be testing the financial assumptions that have been made in the review and developing a full business case for the new models proposed in the Wright review – and any other proposals that may subsequently emerge.
  • Once there is consensus on the potential new structures, we believe that a supplementary report should be produced setting out the funding required to deliver the model.
  • The benefits of reform must outweigh the costs.

 

2. How will we explore the review’s findings and recommendations together, and consider any alternative proposals?

  • There needs to be change and the NPA wants to be an active participant in influencing and supporting that process. We recognise this review is a sincere attempt to create a more coherent, end-to-end system of representation and support, connecting local and national leadership.
  • The NPA can see merit in the vast majority of the recommendations made in the report, but we believe that key questions about the future of pharmacy representation & support in England remain unanswered by the Wright Review recommendations published in June.
  • PSNC should establish a shadow governance board external to their existing structures to take forward the proposals. Any independent expertise necessary to help facilitate the process of discussion should report to that shadow board not to the existing structures.
  • In order to develop the proposals to a point at which they could be ready for wider consideration, this governance board is required to :
  1. Clarify the scope and purpose of the proposed new national organisations and the scope of an LPC in the future
  2. Determine the financial implications of delivering any transformation programme and to understand any financial implications of any new structure
  3. Redefine what ‘good looks like ’for a contractor in terms of what they get for their levy investment into PSNC and LPC.
  4. Consider how service development and innovation is handled by the sector.
  5. Determine how the capacity for local service development and implementation can be increased
  6. Develop proposals for engagement with ICSs and PCNs. We are approaching, in 2021, a point of step change in relation to autonomy and expectations within local health systems. Pharmacy must be prepared to engage effectively in this new environment;
  7. Establish how to optimise the network of LPCs so that they can best deliver representation for contractors within the rapidly emerging NHS structures. There is a lack of detail in relation to the function and form of LPCs.
  8. Consider how legislation may affect any new structures
  • We must maintain momentum, we cannot afford to spend years looking inwards if this means failing to reach out to the world around us: including commissioners, fellow health care providers and patients. Introspection risks becoming the enemy of action.
  • Contractors and their representative bodies, both local and national, should be involved in discussions on the recommendations. The Wright review recommended the formation of a strategy and governance board and the proposed members of this Board should have a central role in these discussions.
  • It is difficult for all independent contractors to fully engage with the details and depth of these proposals. Over 2,500 member companies holding over 5,000 community pharmacy contracts in England are members of the NPA. These members expect the NPA to support and represent their interests. We have an extensive mandate to enable and engage on behalf of our members and contractors.

3. How will we manage this process and any future transformation from a governance perspective?

  • In the short-term a shadow governance board should be established to oversee the discussions and further thinking.
  • Independents and multiples share many common interests. Yet their distinctive voices must be heard, respected and reflected in governance locally and nationally going forward.
  • At PSNC, this implies a constitution that equitably balances independents and multiples – evenly and fairly serving all. Whatever structure emerges needs to allow the distinctive voice of independents to be heard, and must work for everyone – big and small.
  • The Wright Review recommended the formation of a strategy and governance board and the proposed members of this Board should have a central role in these discussions.

 

4. What do we need to do to ensure that contractors have ultimate oversight of this process?

  • Pharmacy contractors, and those that they have appointed to represent their interests nationally, should be central to the process of shaping proposals.
  • Once there are clear proposals on the table then all contractors should be formally consulted and asked to vote on whether to take these forward or not.
  • The radical reform proposed here cannot proceed without the explicit consent of pharmacy contractors who are in possession of the detailed final proposals for the new structures.
  • We need a process that will deliver a legitimate representative structure which will be recognised as such by both the NHS and the contractors.
  • Any decision-making mechanisms must therefore respect the requirements of different parts of the sector. Proposals should secure both the support of the sector as a whole, and its main constituent parts (the multiples and independents), in order to be adopted. This “triple lock” will require an absolute majority of each of a) all contractors, b) independents and c) multiples, to be approved. Significant change needs a significant and unequivocal mandate.
  • The Wright review has highlighted the challenges that we face and we remain committed to supporting a process of change. We believe that through collaborative working there will be a solution that meets the needs of all part of the contractor base.

 

We would encourage NPA members to submit their views on these four questions to us to help shape the final NPA position. This can be done by emailing independentsvoice@npa.co.uk before 24th August.

The deadline for making final submissions to the PSNC is 31st August.