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Concern raised over potential GP stake in online repeats service

Pharmacists and GPs question ethics of online repeat prescription service but lawyer says it it is legal

Pharmacists and GPs have raised concerns over online prescription business Pharmacy2U's latest venture, which offers surgeries a stake in a repeat prescription service.


Both professions questioned the ethics of communication sent out to GPs, which claims they could stand to earn "significant, uncapped revenue" by partnering with the business.


Pharmacy2U managing director Daniel Lee said the part-ownership model met "all regulations" and a leading lawyer confirmed it was not against the law (see legal view).


But healthcare professionals believed there would be a "huge temptation" for GPs to make the partnership more profitable by encouraging patients to take their repeat prescriptions to Pharmacy2U – a practice that goes against General Medical Council (GMC) guidance


A letter to a practice in Essex, leaked to C+D, offers GPs the chance to establish their "own branded repeat prescription service" and  generate "ongoing, uncapped practice revenue"

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A letter from Pharmacy2U to a practice manager in Essex, leaked to C+D on Thursday (June 5), offers GPs the chance to establish their "own branded repeat prescription service". It touts the potential to generate "ongoing, uncapped practice revenue, without any impact on notional rent or sub-letting contract issues". The letter does not give any details of how the partnership would work and Pharmacy2U simply describes it as an "ownership model".


Fin McCaul, chair of the Independent Pharmacy Federation, branded the tactics "very unprofessional". "It's an inducement for the practice to set up a restrictive scheme," he argued.


If GPs took up the offer, it could be to the detriment of the local population, Mr McCaul stressed. "Things like this destroy local solutions and local pharmacies – the infrastructure that's in place to support not just prescriptions, but first-line treatment for patients," he told C+D.


British Medical Association prescribing lead Bill Beeby expressed "extreme concerns" over Pharmacy2U's proposition. Although most GPs "would not be impressed" by the communication, he stressed there were already anecdotal reports of GPs directing prescriptions for financial gain.


"The money you're talking about is such a huge temptation," Dr Beeby told C+D. This was especially true at a time when surgeries were feeling the sharp end of government cutbacks, he added.


But he warned there was no excuse for GPs encouraging patients to go to a particular pharmacy for financial gain or failing to declare commercial interests. "It's against all the GMC rules, potentially deprives patients of free choice and puts pressure on them they shouldn't have," he said.


 

Legal view: "The challenge is to identify unlawful inducement"

Noel Wardle, partner, Charles Russell

"It is not unlawful for doctors to hold a share in a pharmacy business. There are, however, legal and ethical issues that must be considered.

"Firstly, the pharmacy terms of service prohibits a pharmacy owner from promising any provider of primary medical services - including any person employed or engaged by a GP practice – any gift or reward as an inducement to recommend that patients present their prescriptions to a particular pharmacy.

"The doctors' code of conduct does not explicitly ban prescription direction.  However, doctors are required by GMC guidance to:

treat colleagues fairly and with respect

not ask for or accept any inducement that may affect or be seen to affect the way they refer patients

not allow any financial or commercial interest in a pharmacy to affect the way patients are referred

be open and honest with patients about any interest in a pharmacy that could be seen to affect the way patients are referred

not try to influence patients' choice of healthcare services to benefit themselves (or anyone close to them).

"The challenge for pharmacists faced with a case of suspected prescription direction is being able to identify there is some sort of financial arrangement that amounts to an unlawful inducement. Alternatively, they must persuade patients to complain where the GPs have sought to direct them to use an alternative pharmacy. We have had some success in the past in persuading doctors to see the error of their ways, or persuading the parties to engage with the LPC and LMC to resolve issues."


Dr Beeby revealed there had been even more aggressive bids for GP partnerships. One pharmacy company had offered a colleague a "five-figure sum" to set up a promotional table in their surgery, he said.


Numark managing director John D'Arcy warned the "potential for commercial gain" could tempt GPs into entering a partnership with the intention of directing prescriptions. "This would be unethical and a fundamental erosion of patients' freedom of choice," he argued.


Jignesh Patel, owner of Rohpharm Pharmacy in Plaistow, said he had a good relationship with his local GPs, who had made him aware of Pharmacy2U's approaches. But he highlighted the potential dangers in other areas.


"What about all those other GPs? Those pharmacies will have no idea what's happening behind their backs and will start losing large chunks of their businesses," Mr Patel stressed.


Pharmacy Voice reiterated that prescription direction "impaired patient choice and undermined free and fair competition between pharmacies". The lobbying group said it had presented the government with a set of anonymised case studies as part of its work with other pharmacy and GP bodies to highlight the problem.


Do GPs in your locality have a share in any pharmacy business and what impact has it had on your business?
 
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18 Comments

MESUT OZIL,

This rise in applications for 100hr Pharmacies is due to the multiples lobbying the NHS to train more Pharmacists to reduce their wage bill. This led to an over supply of Pharmacists who were struggling to find work. They never realised that pharmacists would apply to open their own Pharmacies and the system has basically backfired to the benefit of locums who have got together and opened 100hr Pharmacies.

The next attack on the multiples will be online Pharmacies and amazingly this route is still open for those would be locums looking to open thei own Pharmacy. Boots scripts have stagnated for the past few years due to the attack from 100hr Pharmacies/online Pharmacies.

Dont you love competition !!!! mwah

Tariq Iqbal, Accuracy checking technician

Already see this happening in Dudley and recently in Selly Oak

London Locum, Locum pharmacist

Guys, it's a bit late now for Pharmacists trying to preserve our so called profession. We've been killing ourselves for years and have even been assisting those quietly chopping away over the years.
Have a look at how taxi drivers have responded to the threat posed to their livelihood by a new app called Uber. They intend to gridlock Central London as a form of protest. Do you reckon Pharmacists as a collective could ever do something remotely similar?
Ph
Couldn't organise a [email protected]@ up in a brewery as a form of protest.

Hayley Johnson, Community pharmacist

No, we couldn't organise something similar. Why? Because ultimately, it would be patients who are affected. We deal with peoples' health. I certainly would not put that in jeopardy.

London Locum, Locum pharmacist

Dead right Hayley which is also why Pharmacy is dead. But don't worry about people's health, Other health professionals will take care of that.

MESUT OZIL,

Bit hypocitical of pharmacists to moan. You could say the same for Pharmaices atatched to surgeries. Surgeries automatically give them emergency scripts even though it is for another Pharmacy.

Fin McCaul, chair of the Independent Pharmacy Federation, branded the tactics "very unprofessional . ITS CALLED BUSINESS!! I suppose yu called this cartel we currently have in the UK market as professional?
LOL

Usual [email protected] from contractors who for years had a monopoly suddenly being intoduced into the reality of business IE COMPETITION. `

Clive Hodgson, Community pharmacist

Entirely predictable and entirely down to the seriously flawed EPSr2 nomination process that facilitates and encourages this sort of activity.

I think safe to predict that there will be a lot more of this as EPSr2 rolls out.

Were the PSNC asleep when the initial designs of EPS were drawn up many years ago? Why did they not object to such an obvious flaw?

Rajive Patel, Community pharmacist

This P2U character, Lee, seems to be a bit of shark.

If surgeries want to partner with this shark, whose company is incidentally part owned by EMIS, the same EMIS that install practice software solutions, then let them go for it.

I think when people realize that their local pharmacy's commercial viability could be affected, and hence their acute treatment supplies, then they will have second thoughts. I would say it would be a good strategy to counter discredit P2U, and there are plenty of ways to do this, believe me.

Also, it may be an idea for local pharmacies to approach their surgeries and club together to offer them a partnership model, and pay the practice by way of private consultancy, hence avoiding the impact on notional rent, as Lee points out.

There are plenty of ways to skin a shark.

As for Lee, let him

MESUT OZIL,

PATEL - you seem a tad envious...........

Oliver Harris, Owner

Not just the PSNC who were "asleep" on this as the other poster commented but many in leadership of independent pharmacy have been burying their heads in the sand or just simply haven't lived through an industry digitising and have not understood the implications. Have to be careful what i say here as P2U are well know for being itchy trigger fingered with heavyweight lawyers but they have form on promoting themselves to GPs (seem to remember it was suggested they allegedly tried to promote a "send prescription to p2u" button in EMIS software a few years ago.) As the other poster says they are part owned by EMIS who also own RX. We have been warning of the inherent dangers of that setup for years now. This current idea of theirs is not new. Do a
quick search for doctorschemist and mydoctorschemist on google - a GP from
the southwest has been trying to sell internet pharmacy franchises to GPs for a while.

As we have been saying for a considerable time and i commented recently on
C&D, when sectors are digitised they change profoundly and pharmacy will not
be an exception. This is just the tip of the iceberg and it's what the government wants. The main motive behind this at the DoH is reducing cost. EPS enables hub and spoke, increased automation and fewer larger drug buyers and shortened supply chains enabling the further reduction in the average cost per item paid out to pharmacy. Which is all fine if you are Boots and you have infrastructure and size to take advantage of those economies of scale but a death toll for independents unless the law / contract changes to allow independents to federate and run hubs or sub-contract out some fulfilment to third party hubs themselves and earn extra revenue from delivering services. (How long will it be before Alphega pharmacies are offered use of Boots hubs I wonder?)

I think we also have to see this in the political context. The purse strings to the NHS have been given to GPs and now they are all involved in a huge collective lobby that they aren't paid enough to cope or to open at weekends or actually go and visit old people in their homes etc and the government is likely to double down and "adjust" the rules to let
them earn more income...

Marc Borson, Community pharmacist

With all the work GPs have to do, i really wonder why they are so fixated on Pharmacy. If this becomes popular amongst GPs, it demonstrates that they are conflicted in their prescribing activities. Perhaps we should pay GPs 50% less so we can employ double. Reduce their role to diagnosis and consultation only whilst making prescribing the responsibility of medicine optimisation pharmacists incentivised to prescribe cost effective treatments and facilitate compliance.

London Locum, Locum pharmacist

Nice idea, but GPs stick together and their lobbying is very effective. Their pay only goes one way. Our lobbying groups are essentially brown nosers so our pay spirals downwards.

John Randell, Non Pharmacist Branch Manager

I think when people realize that their local pharmacy's commercial viability could be affected, and hence their acute treatment supplies, then they will have second thoughts.

THIS IS AN EVOLUTION ..ADAPT OT DIE ....people sould stop clinging on to old issues beacuse the longer you do the less you are doing to offer the likes of pharmacy 2u a challenge

London Locum, Locum pharmacist

I have doubts as to whether the public are concerned about the financial viability of their local pharmacy

Rajive Patel, Community pharmacist

Yes agreed. I'll just bung my local practice. I think a nice 55" Flat Screen TV is the order of the day ;)

MESUT OZIL,

I think when people realize that their local pharmacy's commercial viability could be affected, and hence their acute treatment supplies, then they will have second thoughts. I would say it would be a good strategy to counter discredit P2U, and there are plenty of ways to do this, believe me.

Patel - Do you use supermarket for your groceries? Do you think people care about local shops when they use major supermarkets? Again it is hypocritical of you to suggest that online will threaten the supply network for acute scripts? Sounds like scare tactics....where you scare your customers into thinking that you wil be forced to close if they dont being their repeatscripts to you.....LOL

Clive Hodgson, Community pharmacist

Hi Rajive,

I have a real feeling that this is going to rapidly spiral into an unseemly and ugly knife fight for repeat nomination business in which the honest Pharmacist, probably giving an excellent service, is likely to end up face down in the dust.

As you observe Pharmacy2U is largely owned by clinical software company EMIS. It is not rocket science to work out how that connection could be unfairly exploited to secure business to the detriment of others who, on a level playing field, would win on service and patient satisfaction.

Pharmacies cannot survive on just acute prescription business. You just have to hope that your local surgeries know this and appreciate your value to the community and resist the overtures of Pharmacy2U and others.

And further. I understand that at least one of the large multiples is giving its branches and pharmacists “lock in” targets for repeat nominations. I think we all know of the extreme pressures (and bullying) some foreign owned Multiples apply to their Pharmacists to meet Company targets. Again not rocket science to work out the implications of this. (No disrespect to those employee Pharmacists working for those Multiples intended…..you have everyone’s sympathy).

I have said it many times before, EPSr2, and especially the nomination process, is the most disruptive and damaging thing to hit Community Pharmacy in a very long time.

MESUT OZIL,

As you observe Pharmacy2U is largely owned by clinical software company EMIS. It is not rocket science to work out how that connection could be unfairly exploited to secure business to the detriment of others who, on a level playing field, would win on service and patient satisfaction
On a level playing field? How can this current system of a cartel system be called a level playing field? What a joke!!!

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