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Mail-order prescriptions: convenience, but at what cost?

A mail-order pharmacy model may be handy for patients, but it might spell the end of community pharmacy without adequately replacing the care they provide, cautions Leyla Hannbeck

It was inevitable that after Amazon registered itself as a pharmacy trademark in the UK, that another business seeking to make profits from the growth of online retailing would make its move.

Royal Mail has now teamed up with Pharmacy2U to provide same-day delivery of medicines, including prescriptions. This is the same Royal Mail that has joined the FTSE100 index of Britain’s largest publicly owned companies and has seen business boom during the pandemic as people order more from their homes.

What’s not clear is our sector’s response. Do community pharmacies sit back and watch as digital does to us what it’s already done to the rest of the high street? Or do we fight back, playing to our strengths, reminding everyone of how we also fulfilled a great need for face-to-face contact and advice during the COVID-19 pandemic and will continue to do so long after it is over?

Delivering medicines remotely may have its appeal but something profound and unique is lost. Gone will be the personal, one-to-one contact between pharmacist and patient. The Royal Mail worker or Amazon delivery driver knocking on doors may be carrying a package of medication but that’s all they are doing: transporting it. They’re not supplying vital advice and expertise to go with the parcel.

They’re not drawing on years of specialist training and knowledge to impart care; they are not local medical experts, easily accessible for professional advice, no appointment necessary. They are not familiar with local doctors like community pharmacists, who are in frequent contact with a patient’s surgery. They’re not able to ensure that a patient knows how to take their medicine correctly – something community pharmacists do regularly, helping reduce medicine wastage and saving the NHS money. They do not provide the reassurance that they’ve read the prescription and that yes, because they know the patient, what they are giving is the correct treatment in the right quantity.

In addition, patients come to us for things like vaccinations, the morning after pill, to stop smoking and for advice on minor ailments. Our door is always open; the online pharmacy’s contact with you ends when you close yours.

Robots are not infallible – they do exactly as they’re programmed to and don’t interpret and question. The number of pharmacists per patient in online prescription ‘factories’, compared to community pharmacies, is minimal.

Neither is it the case that online dispensing somehow saves the NHS vast quantities of money and is therefore to be encouraged, despite previous “unrealistic” claims by Pharmacy2U in its advertising that were challenged by the Advertising Standards Authority in 2018. This is a myth that must be laid to rest. All pharmacies are paid in the same way from the same pot, whether they are mail order or located on the high street. All that will happen is that because the mail order supplier has a lower cost base, the mail order supplier will make and retain more profit.

Delivering medicines remotely will reduce the amount of funding available to “bricks and mortar” pharmacies. They will be less able to employ as many trained, skilled staff and will not be able to supply the same levels of care and attention. Eventually, many will close completely. 

The Association of Independent Multiple pharmacies (AIMp) is not opposing technology – indeed many of our members have actively embraced it, recognising the need for convenience and innovative ways of working. But this is provided alongside their face-to-face operations. The government, the media and the public should ask themselves: if bricks-and-mortar pharmacies are no longer there, who will people turn to? Surely not to over-pressured A&E departments and strained GP surgeries that are all now struggling with post-pandemic workloads.

AIMp has been actively highlighting the value of local pharmacies in the national media and to decision makers and we will continue to do so as much as we can. For instance, AIMp drafted a paper on mail order pharmacies which we are actively engaging with regulators and decision-makers on. We must campaign to get the support we need while we adapt to change; we have no choice – for ourselves and for the public we serve.

Leyla Hannbeck is chief executive of the Association of Independent Multiple pharmacies (AIMp)


Pharmacy Manager
Newquay, Cornwall
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