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Should pharmacists go on strike?

The case for taking a militant stance against the 6% funding cut

On Tuesday September 30, 2014, French pharmacies closed their doors to the public. It was an act of protest. Faced with the government’s threat to allow medicines into general retailers, the profession felt compelled to make its voice heard. The message was simple: we will not go down without a fight. If the government doesn’t appreciate our value, then we will demonstrate just how vital we are. The strike was widely deemed a success – only 10% of the country’s pharmacies opened and the economy minister Emmanuel Macron started to back down from the proposals on the same day.

Here on the other side of the channel, pharmacists tend to be less militant. The profession has got used to doing more for less, all while taking it on the chin. The typically diplomatic Pharmaceutical Services Negotiating Committee (PSNC) has branded recent funding settlements “fair” given the financial squeeze across the NHS.

But the decision to cut pharmacy funding in England by 6% in October – announced by the government just before Christmas – has heralded a sea change in attitude. PSNC slammed the “unprecedented” funding cuts as a “clear threat” to the sector. And for the first time, pharmacists decided to take collective action against the government squeeze. One pharmacist started a petition against the funding cut, which, at the time C+D went to press, had more than 10,500 signatures – passing the threshold that demands a government response. Others are calling for even more drastic action in the form of a strike. So is it time for the sector to down its tools and become more militant?

‘One small step’ for pharmacy

It was on Christmas Eve that Paul Mason, chair of Barnsley LPC, decided to set up a petition against the funding cuts. He was speaking to colleagues about the announcement – “generally moaning and groaning” – and conversation turned to potential forms of action. They wanted a way to harness the widespread discontent with the government’s decision and communicate a clear message: enough is enough. A petition seemed the best way forward and, five days later, Mr Mason posted one on the UK government website.

The move clearly highlighted the depth of feeling in the sector. The petition rose to become one of the most popular on the website within the “first three or four days”, Mr Mason remembers. In less than two weeks, it passed the 10,000-signature mark, which leaves the government no other option than to respond.


It is obvious that senior pharmacists in government just do not understand how community pharmacy works"

Mark Koziol, chair, Pharmacists' Defence Association


Mr Mason hopes the sheer volume of support will make a difference. “If nothing else, I would like to think it will open the eyes of pharmacists and staff to the threats the cuts pose,” he says. “It will provide a mandate for [lobbying group] Pharmacy Voice and the like to be quite robust with the government.”

But he acknowledges the petition is just “one small step” towards making the government listen to pharmacy. Mr Mason believes the sector needs a wholesale change in attitude to be considered on a par with nurses and doctors. “We see from other professional groups in the NHS [that] the ones who seem to get a better deal are the more militant ones,” he says.

Action, not words

So do pharmacists need to follow in the footsteps of junior doctors and go on strike? Numerous C+D readers mooted the idea when the funding cuts were first announced. And Hassan Khan, owner of Cullimore Chemist in Edgware, can see why. At the age of 28, he is already looking to get out of pharmacy due to the financial pressures.

Mr Khan believes a strike is the only way to raise awareness of these pressures, which the public are largely “not aware of”. It is undeniable that, while the proposed junior doctor contract strike regularly makes the headlines, the cuts to pharmacy funding have been absent from the national media. Strike action would make pharmacy’s voice heard and galvanise support from the public, who would realise the sector’s value, he says.

Mr Khan worries the profession is seen as “weak” compared to others in the NHS. “What I don’t understand is why the doctors can stand together and call for strike action and we can’t,” Mr Khan says. Part of the blame, he feels, lies with the fragmented nature of the sector. If independent contractors decided to go on strike, he asks, would the “corporates” agree to shut their doors as well?

But mostly, Mr Khan attributes the blame to a lack of united leadership. The sector needs a body such as the British Medical Association (BMA) “with a bit of a backbone”, he argues. Instead, he feels there are too many pharmacy associations that have, as yet, failed to challenge the government with one united voice. “We need someone to stand up with a bit of leadership and say, ‘enough is enough’, and call for strike action,” he argues.

One voice

Mr Khan’s point will undoubtedly resonate with many pharmacists. Pharmacy bodies have faced their fair share of criticism in the past for being fragmented and failing to work collaboratively. But it seems things are changing, if their response to the funding cut is anything to go by. Pharmacy Voice – a representative of both independents and multiples – will be working with the Royal Pharmaceutical Society (RPS), the Association of Pharmacy Technicians UK and the General Pharmaceutical Council, among others, to consult with the government on the proposals.

All of these organisations appear to be in favour of talking tough with the government, rather than proposing strike action. Pharmacy Voice is “confident” it can influence the government to see its point of view, while the RPS will join it in making the case for “improved patient access to high-quality care, advice and medicines” through an increase in funding.


Management mentality in the NHS always seems to be, if they're coping, let them get on with it"

Bill Beeby, deputy chair, BMA clinical and prescribing committee


The typically more militant Pharmacists’ Defence Association (PDA) is also in favour of dialogue at this stage. Chair Mark Koziol says the government “just doesn’t understand how community pharmacy works” and still struggles to see beyond the supply function. But he believes that “far and away” the best way to address this misconception is to present pharmacy as a solution to the “dire shortage of GPs” rather than shutting up shop. “I believe that, with strong leadership, both independents and group practices of individual pharmacists will be able to deliver this vision within a relatively short period of time,” he says.

Another way

To some, this emphasis on dialogue may feel like something of a cop-out. After all, doctors seem to take industrial action much more readily. Just four years ago, the BMA led a strike over cuts to GP pensions. The strike proved ineffective in swaying the government on this particular issue – prompting the profession to criticise the BMA for “failing as a trade union” – but may have established GPs as a force to be reckoned with. At the time when pharmacists received the news of funding cuts, GP practices were promised a 4% funding boost every year until 2021.

Bill Beeby, deputy chair of the BMA's clinical and prescribing committee, says strike action is sometimes necessary. “When it gets to the point where there’s an impact on patient care, you do have to take a tough stance,” he says. “Otherwise management mentality in the NHS always seems to be, if they’re coping, let them get on with it and give them more work.” But Dr Beeby points out that industrial action isn’t the only – or necessarily the best – way of taking a stand. He stresses that there are alternative measures available to show the NHS that you won’t be walked over.

One of these measures could be withdrawing free services, suggests Jay Badenhorst, managing director of Whitworth Chemist – although he is keen to stress that he is not speaking on behalf of his employer. The cuts could push some pharmacies into closure and services such as free delivery of prescriptions, which has resulted in many “life-saving interventions”, may no longer be viable, Mr Badenhorst explains.

Refusing to provide these services could be a “much more powerful” starting point for negotiations with the government than a strike, he says. Plus, it would avoid the risk of breeding resentment among patients. “If pharmacy decides to go on strike and closes its doors, the impact on patients would be massive and pharmacy would be seen as contributing to patients being worse off,” he warns. But whatever action pharmacy decides to take, his crucial point is this: “We need to be very united and strong and have one message.”

This appears to be the crux of the matter. Pharmacy can no longer afford to be split between the independents and multiples, or the service-ready versus the service-reluctant. Perhaps English pharmacies can learn something from French counterparts: not necessarily by going on strike, but by forming one united voice to demonstrate its value. The apparent collaboration between the pharmacy bodies suggests this vision may well be on its way to becoming a reality. And, as a collective, the sector should command the attention it rightly deserves from the government. Vive la révolution.

Should pharmacists go on strike?

Yes - Hassan Khan, owner, Cullimore Chemist, Edgware

“We need a body to stand up with a bit of leadership
and 
say, ‘enough is enough’, and call for strike action.
A 6% cut is ridiculous. What other profession would allow
that to happen? Unless someone stands up [against it], it’s a
slippery slope.”

No - Jay Badenhorst, managing director, Whitworth Chemist

“I think going on strike would possibly be the worst
thing for us to do. Instead, we need to come up with
a counterargument [to the proposed funding cut].
We need to be very united and strong and have one message.”

 

More funding cut news...

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Labour MP vows to draw attention to pharmacy funding cuts

Half of readers will reduce staff to counter funding cuts 

63 Comments

Leon The Apothecary, Student

Why not both? Strike - whilst providing the alternative the the cuts.

Imran Tailor, Locum pharmacist

yes strike.

Owner of the chain stores obviously will say no to strike because all they gonna do is reduce the staff pay after funding and hey they need to maintain NHS contractual requirements for the pharmacy.

I think this is the time where individual pharmacist should take action and go on strike, not for anyone else but for themselves. its better to lose some pay than getting less paid for rest of your life. 

Strike worked for junior doctors... clear message, do something or suffer.

Brian Conn, Community pharmacist

I would be against strike action as it would only "punish" the communities we serve. My community is like my extended family and wouldn't want to hurt them in any way. We need them with us and not against us!

I see two options to get our point out there. The first could be where we refer ALL the minor queries to our beloved GP colleagues on a agreed day and see how that massive increased workload feels like. They then may also be on our side as it may make them realise how much work their local pharmacy saves them from. When you write a referal note there would be an obligation on their part to at least look at it! It will increase the GP workload for a day .....well they have had a 4% payrise!.

Or alternatively we have a day of documentation where we document and collate all we do in a day and let the public really know how much goes on in a day in a community pharmacy.

I suspect ultimately that the best and the fittest will survive the coming years.

Sadly having just used "Amazon Now" which delivered free within two hours, I see community pharmacy in the medium to long term little likelihood of retaining distribution of medicines, and those pharmacists that do survive need to be upskilling themselves NOW in readiness for new roles.

Shalim Salam,

We need to demonstrate the value in our communities by withdrawing supplementary hours.  We are obligated to provide 40 hours as core. I am sure that most contractors open 50 hours plus.  We need to give notice to the NHS of removal of our weekend and see how the multiples cope.  Badly I would suggest.  We can start by not opening Bank holidays the NHS depend on our goodwill to open Easter Sunday and Xmas day.  No multiples open then... Thoughts?

Adam Foster, Community pharmacist

There is more than one way to strike.  Instead of closing our doors, and not performing our core responsibilities why don't we show the DoH what they get for their money.  All minor ailment queries should be referred to 111 or GP's surgeries or even A&E.  No emergency supplies for patient medications - refer back to GP surgeries.  If we do this for a day, then threaten a week and then a month I'm sure the government would realise how much we actually do for free to ease the burden on the NHS and realise they're actually getting a bargain with the current funding deal.  I'm not a contractor but I work for a wonderful Independent who treat their staff fairly and I'm worried about cuts to my staff, and my salary obviously.  Everyone is in the same boat regardless of if you're a locum, manager or owner. Infighting does not help anyone and it's about time everyone worked together for the greater good. Surely somebody can unite the profession and make this stand together.

Paul Speakman, Community pharmacist

I'm not sure there would be a consented effort to withdraw free services across the whole pharmacy network.The pharmacy chains that make larger profits would be prepared to carry on providing free delivery to attract more patient business at the expense of smaller contractors.If the long term government proposal is the continually reduce the global sum and phase out practice allowance all pharmacy staff should be concerned about our futures in the profession as we are in business not charity.I work in an 'in-house' pharmacy in a health centre and i firmly believe a lot of the public think we are funded by a bottomless pit of NHS money.We definitely need to get on the campaign trail and raise public awareness of the dire cosequencies of funding cuts to our profession and take a unified approach across the whole community network

Suleman Malik, Non healthcare professional

Yes!! It needs to be organised sooner rather than later!

Farshid Azar, Dispensing assistant

Independent and small Pharmacies would not have their Pharmacists going on strike.

Pharmacy is an essential service and RPS and GPhC should take action instead of individual Pharmacists.

Pharmacists going on strike may have an adverse effect on patient care and undermines the principles of the profession.

We cannot let down our patients whose loyalty we need just because we are not happy with the government.

 

London Locum, Locum pharmacist

Why would I strike for the benefit of another party that has little or no care for me. If I'm going to strike I would have to see tangible benefits for myself. In the same way I don't think Boots would consider Closing all their branches in a campaign for their relief staff. Simple

shafaq mehdi, Pharmacy technician

I think pharmacy technician  are also forgotten in all this. A lot of registered technicians are doing sooo much work and underpaid. Pharmacist can earn a lot of money abroad aswell as in this country.  However we get paid same as a counter assistant I think more respect should also be given to us as well we stand  shoulder to shoulder. With the pharmacist 

London Locum, Locum pharmacist

No one is listening I'm afraid. Locums, ACTs are but mere flies in the ointment. Only certain voices matter in the big scheme of things. I don't think Boots, Lloyds, Kirit etc... need your assistance in fighting their battles. I doubt they would take even the slightest interest in yours.  

Mark Boland, Pharmaceutical Adviser

Absolutely right

Ghaus Ghulam, Community pharmacist

Yes, strike! enough is enough time for an action!!!

Ghaus Ghulam, Community pharmacist

Yes, strike! enough is enough time for an action!!!

Gerry Diamond, Primary care pharmacist

Won't happen unfortunately. No point talking about it and consider other means, petition, lobbying and having one voice for the profession rather than a dozen odd,,,,,it's like the life of Brian to the massess........the peoples liberation front of judea, the judean peoples liberation front and the liberatiom front for jusean people and so on....

Gerry Diamond, Primary care pharmacist

not to forget the popular judean people liberation front and its fraternal societies

SydBashford Sold&Retired&DeRegistered, Community pharmacist

DOH will just shrug their shoulders and say "well you will have double the Rx's to do tomorrow then, wont you" !

Peed Off Superintendent, Superintendent Pharmacist

The fact is that EVERY pharmacy loses 17k plus whilst the big multiples lose millions. It is the multiples who should be leading us into strike action...

Milan Patel, Community pharmacist

If junior doctors can go on strike then what stopping us pharmacists from not going on strike. Do you think anything will change with NHS funding getting tighter and tighter year by year. 

On the other hand does anyone value the importance of pharmacists and in particular community pharmacists.........if you turn up 15mins late at work there is a queue of scripts waiting to be checked and substance misusers waiting at the door.

Finally, I personally think now is the time to tell the government to cap the number of students wanting to pursue pharmacy course or else your value will be equivalent to a dispenser or shop assistant as salary cuts will start.

Meera Sharma, Community pharmacist

JUNAID ASLAM,

Let's get real here.... Nothing is going to happen.... We are going to discuss... Many will agree and in the end... No one is going to strike ...

Shaun Steren, Pharmaceutical Adviser

Sorry, but I have to disagree with much of what is being said. The representation provided by the RPSGB over the last few decades was appalling, it made pharmacists, as a collective group, invisible to the publics and governments eyes. It happened over such a sustained period that the damage has been made irreparable. Pharmacists themselves have treated each other as appallingly. In my twenty five years I have observed self-interest, protectionism and schadenfreude as the essence of pharmacist-pharmacist interaction. If, in my professional life, I was in my hour of need, the last people that would enter my mind as a source of support and help, would be fellow pharmacists. Of all the things in my career I am most sure of, the thing that I know to be most true, is that as a pharmacist, another pharmacist is the last person to trust. The very idea that we could go on strike is absurd, in fact delusional. How can a group of people unite, when they have been so repellent to each other for decades? A strike will NEVER happen, how could it when instead of collective action, individual pharmacists will now be sat at home calculating how to out-maneuver other pharmacists in this current climate of cuts. In this vacuum the corporate giants have moved in to occupy the space permanently. This is why I feel somewhat indifferent to what happens, we are all to blame for this. I don't belong to a profession, looking back, I don't think I ever did.

London Locum, Locum pharmacist

Your're right. We're too far gone to suddenly come together in an instant for the greater good. It's every man/woman for themselves now and it should be purely an individual decision. A strike would not garner any sortof sympathy from the general public as they simply have no care or respect for pharmacists. A situation brought about by the collective 'door mat' 'please sir' behaviour over many years and the non work of the RPSGB and now RPS. It's simply too late guys. Strike or no strike.

Asqua Din, Community pharmacist

Yes, strike. Time we stand together as a profession. It's a shame it has to be like this.

M Yang, Community pharmacist

Some of the comments I'm seeing talk about how we're betraying the public by shutting our doors. I for one think this attitude is holding us back. If we always cling to "doing our duty" then the smallest steps of progress will always be beyond the reach of our profession. By all means we should do what we can for our communities, so we should give advance warning to our patients, local care homes and have deliveries dispatched ahead of the strike(s). Daily supervised medication should be given out in advance, and so on. The medical profession gets their way, partly because they kick up a lot of fuss. When you kick up a fuss the public will then sit up and take notice, asking why their essential service has been disrupted. Will the bigger multiples ever join a strike? It seems doubtful but even the mutiples can't cover every single one of their pharmacies if enough locums decide to decline work. In the French example, they managed 90% of pharmacies. It's safe to say 90% is a massive disruption. If the vast majority of independents are willing to take action, it's still a significant number of closed pharmacies. Some parts of the UK will see a higher number of pharmacies on strike.

James Spiral, Community pharmacist

Just a thought. how legal would a strike be bearing in mind contractors are under obligation within their contracts to stay open for 40 hours per week (in most cases). Wouldn't this be playing into the hands of the government who have stated they want to close pharmacies

Simon MEDLEY, Community pharmacist

they didn't close pharmacy2u the most blatant breach of contract since that apple was eaten in the garden of eden !

James Spiral, Community pharmacist

True, but pharmacy2u appears to have special government protection as it is integral to it's vision of the future. Wait until amazon buys up one of these internet phamacies similar to it's rumoured interest in ocado for expanion of it's grocery deliveries. then it's game over for many.

Amal England, Public Relations

Everybody has a contract at the end of the day. Junior doctors had a contract, GPs have contracts and they are talking of mass resignations, nurses have contracts and they have taken action before, civil servants have contracts etc. Your profession is being starved of funding and you want to look at your contract. How about you tell Jeremy Hunt to look at the contracts many independent pharmacists signed with the NHS say a few years ago, which that pharmacist believed to be a reasonable basis on which to open a pharmacy and since then that contract has been and is being changed, sometimes many times a year. ..... Legal obligation? , what legal obligation!

James Spiral, Community pharmacist

Those are employment contracts protected by employment laws and GPs are not so much mass resignations as mass early retirement as their pension pots are now limited to £1,000,000 . So it would be interesting to know what action, if any, NHS England would take.

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