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Opinion: When is a substitute not a substitute?

Once world-famous for the number of acronyms it had going on, pharmacy has started building an equally impressive collection of substitutes for existing things…

Some of the omnipresent substitute debates are ready for bed. Like substitutes to solve the medicine shortages. Just do it.

A more recent one came up this week courtesy of a new trade association – the IPA – which has replaced the AIMp. Unlike medicine, it's a simple substitution.

The AIMp acronym has been ditched, a decision met with relief by anyone who had to say it. It also tweaked the entry criteria for members, who can now run a single pharmacy, rather than multiple ones that the M in AIMp stood for.

Maybe it didn’t like AIP. No matter. Feeling fresh, the IPA wants everyone to know it’s stepping up to deliver what it believes are much needed improvements for indies. To this end, it’s hot on making substitutions elsewhere. Specifically, it wants to hook some CPE board members for some of its preferred candidates to correct what it perceives as an imbalance on the board in favour of big boys like Boots.

The CPE has brushed off the suggestion approximately as many times as it’s been raised, but this subs debate will continue to run and run, because as we have seen elsewhere this week, harmonious solutions to ideological pursuits of balance in boardrooms are hard to find – as the ‘appalling handpicked cronies’ on the new UK pharmacy professional leadership advisory board have experienced this week.

Whether you’re the biggest chain in the land supported by a vast corporate support network, or a plucky indie fighting off a methadone addict while you shop around for prescriptions you can’t fill, it’s hard to shake off the sense that the sector overall would benefit from a united front, not least in its political escapades.

People have called for the CPE to be subbed off the field of negotiation, but it’s lining up against the government, which isn’t playing fast and loose with cash right now. And, publicly at least, the pharmacy minister thinks the market is ‘thriving’.

Read more: Cuts, overdrafts and closures: Business becoming ‘impossible’ for contractors

As opinions go it’s an outlier pinged straight from leftfield, but it does lead us into the most concerning, and potentially existential, substitution of all. The ongoing closure of community pharmacies isn’t a problem, says the pharmacy minister, because the resulting vacuum is filled by buoyant online pharmacies.

This steaming hot ‘substitutable’ take was parroted by the CMA when it explained why it waved through Pharmacy2U’s purchase of LloydsDirect. Maybe it is simpler to pretend that an iPhone is a valid substitute. Online is the direction of travel for most things, so why not pharmacy?

Read more: CMA merger inquiry clears Pharmacy2U purchase of LloydsDirect

DSPs are not, as the CMA suggest, substitutable for community pharmacies. Relatively speaking, they are like those online substitutions you get when Tesco sends you frozen burgers instead of the fat ribeye steaks you ordered.  

Ask the MHRA, which tarred and feathered online pharmacy with the ire normally reserved for dunking witches this week. Maybe it was harsh, or maybe its concerns are legitimate, either way the appeal of DSPs to the government is obvious and immediate – they offer an efficient and comprehensive supply of medicine to patients without all the difficult stuff.

Stuff like offering a warm space for a vulnerable person to discuss their medical issues and receive treatment for them. The caring, healthcare, community stuff. Admittedly not the kind of stuff that the Conservative Party has built its reputation on. But community pharmacy has.





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