Behind the counter: Penclawdd Pharmacy, Wales

You won’t find many views from behind a pharmacy counter as beautiful as the one from Penclawdd Pharmacy.

Just over the road that bends around the corner into the village centre, thick green marshy lands stand bare as the crisp wind hits the banks. There is a low tide from the Loughor Estuary, with boats moored on land and the town of Llanelli visible over the water.

Penclawdd is home to around 4,000 people and is known historically for its cockle industry. Its location on the Gower peninsula, west of Swansea on the south Wales coastline, means beauty is always in abundance.

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There are picturesque beaches, cliffs and woodlands all over, with the Worm’s Head on the stunning golden sands of Rhossili Bay a highlight. The natural landscape on this bright, clear, wintery day is one of the reasons why the Gower was the first place to be named a National Landscape in Wales.

It’s so beautiful that one of Penclawdd Pharmacy’s owners, Jonathan Rees, refused to install a potentially profitable automated dispensing collection machine just to savour the scenery.

“When we did the refit, we had plans to put one in, but we’d lose an entire window, and we really like the view!” he tells C+D. It doesn’t stop him longing for the views from the pharmacies looking over the beach further along the Welsh coastline in Tenby, which he thinks may even pip the view from Penclawdd.

Family

The Gower has always been home for Rees, and Penclawdd Pharmacy has been in the family since 1983.

His father Huw bought it and lived above the pharmacy on the two floors for four years before moving to a nearby village. Those floors are now rented out, and a basement is left unoccupied because of its liability to flood when the tide comes in from the estuary.

Rees remembers helping in the pharmacy at weekends and during holidays in his childhood. “I have memories at seven years old, just standing on the till. Some of the staff have worked here for 40 years and would babysit me as a kid, and pick you up from school.

“It becomes deeper than just the pharmacy.”

He admits he didn’t consider pharmacy as a career choice growing up, but his father recommended him looking into it as “you’re going to come out to a good job”.

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“It made a lot of sense and combines a lot of my interests in healthcare and helping people, and in business and how to make things profitable. It was a good combination for me.”

Huw still works now, almost as Penclawdd Pharmacy’s locum, as he covers when staff take holidays and enjoys “seeing faces he’s known for generations”.

Community

With his wife Stacey, also a pharmacist, Rees is gradually buying the pharmacy from his father as they feel happy staying in the area to continue the business.

“Penclawdd’s always been home, it’s comforting and you walk down the street, you know everybody.

“If I go to the petrol station, I get stopped and asked, ‘what’s wrong with my eye?’ or ‘I’ve got this thing on my hand’. It’s nice to feel part of a community that’s helping people.”

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Beyond healthcare, the pharmacy’s embedded in the community as it sponsors Penclawdd Rugby Club and South Gower Football Club in nearby Scurlage.

And during the visit, the pharmacy’s Christmas colouring competition already seems a hit as a handful of posters from children are on display around the pharmacy counter.

Two-pharmacist model

The decision not to install the automated dispensing collection machine also means there’s space for a Christmas tree and a wooden sleigh by the window, full of presents that will be donated as part of a Christmas charity appeal.

That was one of many decisions during the refit in 2021 that brought the biggest changes to Penclawdd Pharmacy.

Putting in two consultation rooms has been the “driver” for offering private services.

“Before I’d spend 80% of my time in the dispensary. Now, if I spend 20% of my day there, it’s a surprise.

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“The idea is that we’re in here all day and we’re trying to have a two-pharmacist model always providing services all day.

“That’s been our biggest change over the last five years.”

Services

The extent of services on offer is as comprehensive as possible for an independent community pharmacy.

Contraception services, hay fever injections and independent prescribing for minor conditions are all available, as well as undertaking anything under the common ailments service (CAS).

“If the staff realise something falls into common ailments, they refer to us quite quickly,” says Rees. “We do good numbers of that.

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“Last month, we were in the top five in Wales. Competing with Cardiff and Swansea, we were proud and didn’t realise we hit that level.”

While there has been calls over time to expand Pharmacy First in England, Rees is happy with 27 conditions the service covers.

“Per registration, it’s well remunerated and better than prescribing is. I wouldn’t look to expand it because are we going to encroach on what we do for an independent prescriber.

“We don’t have the ability to expand the independent prescriber scope within the NHS funding. It’s just a balance to be struck.”

Ear piercings are another popular service, as its one done alongside phlebotomy and ear micro-suction where Rees maximises the “revenue potential of each member of staff”.

But weight loss services are the most popular, with up to 40 bookings on a busy week; Rees even jumps out to complete two during C+D’s visit to Penclawdd.

But he’s been wary to stick strictly to offering it under the patient group direction (PGD).

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“Patients that have come in with a BMI of 26, we’ve turned them away in the nicest way possible. But then I’ve seen them a month or two later and in conversation they’ve dropped in that they’ve gone online and not told the actual truth of their weight.

“So other providers are being duped. As much as we’d love the revenue and to work with them, it’s not safe or appropriate for us to supply them. But that’s in a very small minority of patients that we see.”

All four pharmacists that work at Penclawdd do the weight loss services, while Rees’ wife Stacey leads on the aesthetics services that began in 2023.

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Botox, micro needling and lip fillers have been the most popular, and Rees says the popularity of all services has been down to good reviews spread by word of mouth rather than too much social media promotion.

Penclawdd Pharmacy offers free deliveries and can do up around 90 deliveries a day split between its two delivery drivers.

And despite the pharmacy’s decent size, the ACTs are in a separate room a short walk out of the back door into the flat’s garden where they complete the checking for the 160 monthly patients who have dosette boxes.

Previous roles

The savviness in maximising Penclawdd Pharmacy’s potential is owed to Rees’ experience working with the Welsh negotiator Community Pharmacy Wales (CPW) and the National Pharmacy Association (NPA).

Having completed his pre-reg in hospital before working for a couple of independent community pharmacies in Wales, he joined Penclawdd Pharmacy in 2017 part-time to complement his CPW position as associate director of contractor engagement.

“I saw the opportunity of having knowledge of what’s going on at a contractual level. The role was meeting contractors and trying to explain to them how you can maximise the contract. You’ll pick up tips from them to relate to others.”

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Just before covid started in 2020, Rees then switched to the NPA to become the Wales country manager.

“My NPA role was dominated by covid. It was basically crisis management and very similar to the work CPW were doing at that point.”

Despite the horrendous situation during the lockdowns, Rees found his work as a pharmacist and with the NPA as one of his “most satisfying periods of work I’ve ever encountered”.

“We were valued as a profession and by patients. We were the last ones standing and to double the workload efficiently to a wider area than we’d managed ever before was incredibly satisfying.

“I know people died in it – we can’t take it lightly – but it was as hard work we will ever do and to know we can come through that gives me great confidence.”

With the NPA, Rees worked on progressing the contract but was aware of the difficulties that came in pharmacy advocacy.

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“It’s still kind of true now but England’s pharmacy contract was so far behind what Wales and Scotland offer that it was difficult to advocate for more within Wales because they could look over to England and say ‘they haven’t even got x, y, z, and you’re asking for more again’.

“In Scotland, from the outside looking in, it’s much more harmonious between the negotiators and government trying to drive pharmacy as much as possible. There’s some of that relationship in Wales but nothing for what it could be.”

New locations

But as Rees time came to an end with his NPA role, it wasn’t long before he used all these roles to help him purchase a new pharmacy in the Gower with wife Stacey.

“We purchased Pontardawe Pharmacy from Lloyds in August 2023. The values were well below market value so if we could purchase it, stabilise it and then grow it, the value would outstrip quite quickly.

“It was an opportunity we couldn’t pass up and that’s grown exceptionally well.”

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It’s 25 minutes away from Penclawdd, in a small town north of Swansea outside of the Gower, and is their busiest pharmacy, dispensing around 20,000 items per month on average.

It’s separated over three floors as the stock room and deliveries are done above the shop floor. Pontardawe has an automated dispensing collection machine, installed to give a competitive advantage over a pharmacy opposite its premises.

“There’s a Home Bargains within 200 yards, so people don’t come in and buy items. Most people come in and collect a script. That’s five minutes of staff time we could leave with a robot to manage, so it makes sense to put one in there.”

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And rebuilding Pontardawe’s reputation was critical. “There was a predominant feeling in the area towards the pharmacy that was not pleasant.

“When we took over, they only had two or three members of staff which was inadequate for the volume of people they were seeing. But within two or three months, there’d be seven members of staff plus a pharmacist, and technology to help efficiency.”

The next purchase for Rees and his wife was to have more “control” of services in the Gower.

They bought the Well Pharmacy in Scurlage in August, which is the nearest pharmacy west to Penclawdd about 15 minutes in the car.

“It does a fifth of the volume of Penclawdd and about a sixth of the volume in Pontardawe. The purchase was more of a protection for Penclawdd and because the service being offered there wasn’t great for patients.

“They often couldn’t find pharmacists because it’s so rural. Patients would turn up on a Friday saying ‘they haven’t got a pharmacist, can you supply our meds?’ It’d be difficult for us to manage that whereas now we’re in control. It takes the pressure off here, we’re not in competition. We’re aiming for high level service from both.

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“Us going in there has been a very seamless experience because 80% of patients who go there we know from here because we see them sporadically.”

Rees, wife Stacey, and the other two pharmacists at Penclawdd all work in Scurlage Pharmacy, which only has three dispensary staff and shares one of Penclawdd’s delivery drivers.

But Rees argues running three pharmacies is a difficult number to manage. “Three might be the hardest number because once you get maybe five plus, you’re looking at having managers to help you and delegate. We’re still in that in between stage.”

Challenges

Sector difficulties mean Rees feels, and has to deal with them, in three different pharmacies.

Through his CPW and NPA work, he saw the tough reality of the negotiating the drug tariffs which Community Pharmacy England (CPE) leads on as part of the Welsh contract, with CPW not “really having a say in it”.

“Covid exacerbated it because of inflation of medicine prices. The tariff margin was moved to £900m this year but when that’s been costed, it should be £1.28 billion, so we’re a fair way short.”

Appropriate remuneration for dispensing is the “biggest issue” for Rees though.

“It’s almost derided to do prescriptions as though it’s archaic, but it’s the bread and butter. It’s what the communities need as the most essential service.

“Ensuring that it’s profitable enough that people are willing to do it and staff it safely because if you keep shrinking the amount you get for it, people are going to shrink the amount of staff that are doing it.

He adds that not compensating this properly may leads to greater costs for the NHS in the long run. “Providing that high level of care to patients will hopefully pay back to the NHS with less hospital admissions.”

Contract

Rees says a lot of the money for dispensing has been moved into services in Wales, which has improved the services on offer.

“Initially, people thought it was okay because it was a pathway into providing more services, but the money has not followed to reward the service delivery. They’ve stagnated over six years or so and the way inflation is, you’re doing a lot more work to get the same result.”

But he believes it’s hard for the blame to be put on CPW’s door. “As much as you are the negotiator, you haven’t got much of a hand to negotiate with if the government’s not going to pay you more money.”

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The day after C+D’s visit to Penclawdd Pharmacy in November, a 4% funding increase was announced for the 2025/26 Welsh contract, which meant the fees and allowances rose to £182m.

The Welsh health secretary Jeremy Miles hailed it a “record level of investment” as the funding uplift has contributed to a cash “increase of nearly 30% since 2016/17”.

But a week after the announcement, CPW chair Mark Griffiths revealed negotiations were “exceptionally challenging and at times deeply frustrating for all involved”.

Rees says the lack of no real terms increase in the contract was “disappointing” and the rise in minimum wage means “we are unlikely to see any extra capital with which to invest in our business for the benefit of patients”.

Action

He took part in NPA action last year as part of the #SaveOurPharmacies protest, but he is still unsure what the best way is to force real change in the sector and get the best contract possible.

“I don’t think many contractors are going to be happy with the result. Whether it’s dramatic enough to force an action across Wales, I’d be surprised if it does because we’re so scattered geographically.

“When you’re in a rural area, it’s much more personal to shut your door when you know those patients have nowhere else to go.

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“We’re lucky here patients understand what we’re trying to do. They realise the money’s not there for us to be able to do everything we’d like.”

Rees gave evidence at the UK Covid inquiry to share about the role community pharmacies played during the crisis. He believes the government has still not learnt from covid that appropriate funding will strengthen the sector.

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“It’s the stark reality of the amount of pharmacies closing. Underfunding the network means that if Covid does happen again, are we going to be in a position to respond as effectively as we did last time?

“I have serious reservations we are going to be in that position to do it next time.”

Learning and growing

But Rees is still persevering in developing not only his three pharmacies, but his personal brand too, through consultancy work.

“I thought there’s a gap in the market for contractors to be made aware of what’s available within the contract to maximise it, how to develop services, have a proper skill mix within the pharmacy.

“Scurlage has took up a lot of my time so I haven’t had time to do much for the last year. But I’ve had approaches from banks to do likewise with mortgages and loans they have offered to pharmacies that are struggling. So, you go and almost coach them so they can meet those fees. That’s quite rewarding.”

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With Penclawdd Pharmacy open seven days a week with steady footfall, he’s taking advantage of what his father has built to drive his own ambitions.

“My dad’s been here 40 years, built the business and reputation and patients have had a high level of service for a long time. That reputation counts for a lot, and it’s hard earned and easily lost, so we’re conscious of that.

“We’re trying to drive what we can offer to patients, so patients think ‘if we go to the pharmacy, they’ll solve it’. That desire to always develop is key for us, so we never stand still. We achieve one service, what’s the next one? The moment you get complacent, somebody else will develop something.

“It keeps us learning.”