Behind the counter: Humberston Pharmacy, Grimsby

It’s a sleepy Thursday morning in Humberston, a village next to the north-eastern seaside towns Grimsby and Cleethorpes.

Grimsby isn’t in the national headlines too much. The North Sea cargo ship crash was the closest it’s come to significant national attention in recent times.

There’s always interest around election time as the Conservatives (and maybe Reform soon) had managed to transform the town from being one of the Red Wall heartlands when they were last elected in.

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It’s known as a fishing town, but with the decline of the industry since the 1970s it has changed and become one of the UK’s most important offshore wind farms, providing 3% of our electricity needs. Cleethorpes used to be a booming seaside destination too, though that has dwindled overtime.

But there’s no smell of fish, or holidaymakers in sight, on this midweek visit to Humberston Pharmacy. It’s just over a mile away from the beach but nestled in a quiet neighbourhood of families and retirees.

First-time buyer

Just down the road from two pubs, the spacious premises stands next to a couple of hairdressers, takeaways, and a beauty salon in a small shopping parade.

Having been the premises of a former Lloydspharmacy, 32-year-old Ruckaiya Karim got her hands on the keys in August 2023. She owns the pharmacy with fellow pharmacist Wais Asefi who she met working in Grimsby, with her father as a silent business partner.

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The pharmacy greets you with a coffee machine upon entry. Two large sofas spread out in view of the dispensary, where three staff members hustle around, with a special offers section featuring discounted teddy bears, soaps and body wash products next to the counter.

The phone rings a couple of times with patients asking for their prescriptions, with staff politely informing them that they cannot do same day prescriptions and to return the next day.

A patient pops in and out of one of the two consultation rooms for a Covid jab, with another settling into position to use the blood pressure monitor machine in the waiting area.

The pharmacy’s running steady, but it took time for Karim to get things on the right path. After a “nightmare” process buying from Lloyds, Karim had to win the trust of locals back after the upheaval caused by the sale of the Lloyds across England.

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“It was just uncertainty,” she tells C+D. “For the staff it wasn’t nice. They were told to stop dispensing, and that had a knock-on effect to patients, because medication was not ready on time.

“In the first six months, it was building back up our reputation. That’s the whole point of an independent, you want to build that relationship with the community and we’ve managed to do that in just under two years we’ve been here.”

Community is “dog-eat-dog”

Karim was born-and-raised in Bradford and completed her MPharm there before splitting her pre-reg between hospital and a Boots.

She moved to Grimsby to work at the Diana, Princess of Wales hospital, but felt she still wanted to do more with her career.

Karim moved to London and spent 18 months during the pandemic setting up a Covid rehab unit before deciding to move up to Middlesbrough to work as a clinical teams manager in the local hospital.

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“I loved my job, but I was at that point in my career where I didn’t want to work for someone, but for myself,” she says.

“Coming into a business, it’s dog-eat-dog and that’s what shocked me the most. The NHS has its downsides, but I felt more teamwork there.”

New team

Since Karim and Asefi opened Humberston Pharmacy nearly two years ago, they have brought in new staff.

A trainee pharmacist will finish in September, with another joining the team later in the summer too.

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Karim says it’s been hard to recruit the right staff, but she speaks highly of the accuracy checking technician (ACT) she brought in who she had worked with in hospitals. The ACT is now the pharmacy manager.

“She’s really good and it helps having an ACT because she just manages the dispensary,” Karim says. “That’s what I wanted to bring from hospital pharmacy, as there’s a lot the community sector can learn.

“In hospital, a lot of the checking is done by the technicians, so I wanted the pharmacist role here to be that clinical service-led role.

“I hardly do any checking as I’ll be doing the services. That’s the expectation here.

“We will follow her lead with whatever she wants to implement and do whatever is best for the dispensary because she’s very experienced. There’s a lot of stress she takes away from me.”

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Karim understands some of the concerns the proposed changes from the supervision consultation allowing pharmacy technicians to take on more responsibilities in preparing medication and dispensing, but she backs the good it can do.

“There’s scope for the technician role to be expanded and if it’s done correctly, I think it’s fantastic. Our ACT does the initial blood pressure checking and monitoring, it’s all technician-led and then it gets referred to the pharmacist.”

GP collaboration poor

Most of Humberston Pharmacy’s patients are over 60, but it does get seasonal footfall from tourists who stay at the nearby holiday park the Fitties by the beach.

Karim has kept free deliveries for patients but started charging for dosette trays at £10 a month considering the time it takes for a staff member to check the pills.

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“That’s one person less on the shop floor, so we made the decision to charge for trays. We thought we would lose a lot of patients, but the majority stayed. And we’ve got some new patients.”

When Karim took over, the store dispensed 6,000 – 7,000 items per month on average but this has increased to 8,000 – 9,000.

But she hasn’t relied solely on more scripts coming through, partly because she’s found it surprising how difficult it’s been to build good relationships with GPs.

She had “very friendly” collaboration with them when she worked in hospital. In community though, it’s led to “hardly any” referrals through them for Pharmacy First conditions, with the pharmacy relying on word of mouth and proactively spotting opportunities to complete a referral.

“If anyone comes in with a sore throat, these guys know it’s a straight pharmacy referral and they wouldn’t even interact with the patient so we can have a consultation and increase our numbers up a little bit,” she says.

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“We only just meet the targets; we’ve hit the 30 which is good. There’s definitely scope to expand the Pharmacy First service, but a lot of that is GPs referring. They have people calling with UTIs nearly every day that should be directed to a pharmacy.”

Karim is on the independent prescriber pathfinder programme too, offering services in CVD prevention. She adds that their recent investment in a new blood pressure monitor machine has been “really helpful for the amount of time we save”.

Weight-loss

And Humberston Pharmacy offers weight loss services, with most patients on Mounjaro. “The service has definitely picked up and generates a revenue for private services, but those patients don’t necessarily bring us their scripts,” Karim says.

“But we’re a small pharmacy, we don’t want to bite off more than we can chew. One thing having my own pharmacy taught me is that there is no easy way to make money!

“It’s not easy and yes, weight loss services generate an income, but there’s still a patient in that consultation. If they’re in two minds about doing it, it’s not something we would push them to start.”

No incentive for new scripts

Karim finds one of the biggest challenges is meeting patient expectations and wants them to be in the habit of booking appointments online or ringing like they do with GP surgeries.

“A lot of patients expect to be seen there and then. If patients are willing to go to a GP practice and wait 10 minutes before being seen, the expectation needs to be the same for pharmacists. Nine times out of ten we’re checking a script for another patient and it’s not something we can break off from.”

But she laments the eye-opening financial challenges she has taken on with her first pharmacy.

“We shouldn’t be dispensing at a loss. It’s unfair. It’s something I thought the new pharmacy contract might have looked at, but it’s not great.

“The bare minimum is speaking up about not dispensing at a loss. We don’t get funded or treated the same way that GP surgeries are. It’s absolutely appalling.”

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She highlights how the government have given money in some places, but have taken away in others, such as with the decrease in hypertension consultation fees but increases in ambulatory blood pressure monitoring fees.

“The funding stayed the same and if anything, they’ve probably taken a bit away. How can we sustain a business when we’re making a loss?

“It’d be unfair of me to not provide diabetes medication because we’re making a loss on it. That’s where the services come in because the loss from the medication, we break even a little bit with the services.”

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If the government “pumped that investment into pharmacy”, Karim says she would have been able to consider more about offering more jobs in the pharmacy.

“But I can’t afford it,” she says. “There’s no incentive for me to take a new script for a new patient. I’d rather have increased footfall in weight loss, ear wax and Pharmacy First because that is genuine income and helps to pay everyone’s wages.

“I’d rather not get a new script and get 10 Pharmacy First referrals instead. I don’t want to be a 20,000-item dispensing pharmacy.”

Tech-led dispensaries

Nearly two years into her five-year plan for Humberston Pharmacy, Karim has planned out what she and Asefi will do to improve it. “The long-term plan is to reduce the floor space and add two consultation rooms, but to do that I need some investment into the pharmacy.”

She wants a paperless dispensary and everything to be electronic, but she also wants to build closer relationships with GPs. “There’s so much we can offer them to take their workload off. Just work with one and if that goes well, then we could expand.”

Karim is unsure if it’s viable to open another pharmacy yet because of the NHS reimbursement, including dispensing at a loss, and finding another good team. But she believes Humberston Pharmacy is set up in the best way possible to make the business work.

“I’d really like to have a model set up in community pharmacy where others look at it and see that Humberston have got a good model and want to implement that.

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“Having a dispensary not led by your pharmacist but technician-led is the way forward. The pharmacist is majority of the time in a consultation or speaking to patients.

“Move away from the old school and do it through Pharmacy First. At the end of the day, we need to make money and do it in a way that benefits everybody.”