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Internet pharmacies accused of aggressive sign-up tactics

Business Reports of internet pharmacy companies setting up in GP surgeries to gain customers ahead of the switch to paperless prescriptions is causing alarm in the industry

Internet pharmacy companies are using increasingly aggressive methods to gain customers ahead of the switch to paperless prescriptions, pharmacists have reported.

Companies were setting up stalls in GP surgeries and creating a "real challenge" for local contractors, industry insiders told C+D.

They cited the rollout of paperless prescriptions, which will enable patients to nominate a pharmacy from their GP surgery, as a potential reason behind the spike in marketing. Latest figures show 943 GP practices in England have upgraded to the system – 11 per cent of the 8,228 across the country.

Distance selling has usurped the 100-hour contract as the major threat to pharmacy, said IPF chief Fin McCaul

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Jignesh Patel, owner of Rohpharm Pharmacy, Plaistow, said the switch to the second phase of the electronic prescription service (EPS) could prove a "dangerous" time for independent pharmacists. One pharmacy company had gone to a GP surgery in his area to sign up patients, Mr Patel told C+D.

"They actually had a guy signing up people at a table," he reported. "We had to do a lot of negotiating with the GP practice to say this doesn't seem ethical."

The reports appeared to directly contravene General Medical Council guidance on commercial interests, published in March, which emphasised the importance of patient choice and warned against directing prescriptions.

North-East London LPC secretary Hemant Patel said he had witnessed growing competition from internet pharmacies in his area. He unveiled plans to launch a direct mail campaign to promote the benefits of local pharmacies to patients, which he said was supported by local authorities.

Last week, C+D readers voiced fears over internet pharmacy in response to news that Pharmacy2U was sending out direct marketing to patients. Posting on C+D's website, readers warned there would be stiffer competition to come.

"The independent sector has been slow to pick up on the dangers inherent in EPS once rollout is national," said reader Oliver Harris.

"This is just the tip of the looming iceberg as EPS 2 is rolled out," said superintendent Max Falconer. "I can predict the most unseemly, disgraceful, illegal and time-wasting debacle as a massive ongoing landgrab for patients drains the remaining energy and professionalism from pharmacy."


David Reissner, head of healthcare at Charles Russell, reports a surge in internet pharmacy applications

"There certainly seem to be more distance-selling applications being made this year compared with the number made under the old control of entry regulations. Applicants tend to see that as the easiest way of getting a contract.

"Having said that, it's not straightforward – we're seeing NHS England turn down what seem to be fairly straightforward applications, sometimes on fairly specious grounds. We're pursuing a number of appeals against refusals.

"I have one case, for example, where NHS England said it wasn't satisfied my client would meet clinical governance requirements, which they said was an essential service. Clinical governance isn't an essential service, so we appealed.

"In the appeal, NHS England has tried to give all sorts of other justifications for having turned down the application, saying they didn't know what my client's staffing level would be or how they were going to carry out that service. We wouldn't have considered it necessary normally to mention that they would be using a third-party delivery service, but NHS England turned it down on that basis.

"I think NHS England is trying to control numbers of all pharmacies and they certainly don't want distance-selling pharmacies, because every new pharmacy costs the NHS money."

Independent Pharmacy Federation chair Fin McCaul told C+D many small businesses were also looking to get in on the act, and reported that one pharmacist had set up an internet pharmacy business in their garage.

"It's distance-selling that's causing challenges for pharmacy now, as opposed to the 100-hour contract," he said. "Business is very challenging and it seems to be getting tougher."

What's your experience of internet pharmacy companies?

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Usman Mir, Locum pharmacist

internet pharmacies are an innovative way of accessing healthcare services. I have worked at this particular internet pharmacy which did face to face skype consultations and one of them was with an 72 year old patient in a nursing home. The staff from the pharmacy had installed a free skype software to the patients ipad, enabling the housebound patient to communicate with the pharmacist. Many patients would contact us via email, social media or website in regards to queries relating to sexual health. These people would not access brick and mortar pharmacies simply because the stigma and shame attached to such subjects. Yet found it comfortable to communicate with a healthcare professional via the internet on such matter. MURs and NMSs were provided and were far greater quality than that achieved in community pharmacy. Ooops forgot to mention they also provided an effecient prescription collection and delivery service. #inspirepharmacy

Kirit Shah, Community pharmacist

Does the internet pharmacy need special permission for each patient before being allowed to do such MUR/NMS consultations?
Or because it is an internet pharmacy does it gets an automatic authorisation when a licence is granted?
If that is the case I am sure multiples will soon join to provide this service also.
Working in community pharmacy it is very fustrating to find we cannot offer MURs over the phone/skype without getting permission to patients who are house bound and probably would benefit the most if we did!

Usman Mir, Locum pharmacist

Just as any other pharmacy; internet pharmacies would also need permission to provide MURs off premises.

Nalin Shah, Community pharmacist

Contract limitation was the foundation on which the current constantly eroding payment system is based. The dangerous combo of new distance selling pharmacies and electronic prescribing is going to see a lot of established pharmacies being penalised. More expense to the nhs and an undignified debacle as patients are coerced into signing up.

Mike Jones, Non healthcare professional

This is the most pathetic industry i have seen. So what if internet pharmacies market to patients? end of the day 40 hour pharmacies for so many years had it simple, no one could open another pharmacy within 1-2 miles, you don't see this in any other industry? In my local town retail pharmacies including the large chains only started offering a better service i.e. collection delivery, better staff when internet pharmacies came on the scene, otherwise the service, the shops everything was a shambles. its shocking to see these independent pharmacies acting so childish and protective. Bottom line is its competition, look at other industries you won't see existing business owners having a complaint and spitting their dummy out because they have competition? i hope in the next 5 years internet pharmacies take over as they offer more innovation, better service and makes the larger established chains wake up!

Matthew Howard, Community pharmacist

Mike, control of entry is supposed to protect community pharmacies, ensuring access to community pharmacists for patients inas much of the country as possible. The concern here is not just about businesses but also about those patients who want and need to be able to walk into a community pharmacy - be it independent, multiple or supermarket - for face to face healthcare. Some of these pharmacies may be closed as a result of a completely open market - leaving their patients at a loss. That is the point of control of entry.

Chris Pharmacist, Community pharmacist

What nonsense. Please explain how internet pharmacies offer a better service because from what I can see they only offer to deliver prescriptions. Non-existent counselling or advice, no NMS/MURs and no advanced services in fact very little opportunity for patients to discuss face-face any medication related issues whatsoever.

There are some areas where the internet isn't the best way to provide a service and pharmacy is one of them. Patients need face to face contact with a pharmacist not just a delivery of medications every 28 days, whether they need them or not.

Now I'm no fan of the multiples but some of the tactics used by internet pharmacies are a disgrace and an embarrassment to the profession. We had a local surgery directing patients to use an internet pharmacy ($till un$ure how th£y got the GPs on sid£!) and patients had no idea it was happening to them. Many were elderly and vulnerable, this is no way to conduct a pharmacy business.

geoffrey gardener, Community pharmacist

Difficult, many pharmacies have been promoting collection and delivery services, this which negates face to face "issues", I cannot see how pharmacies aggressively promoting such a service can then object to internet pharmacies. The ideal scenario is for the pharmacist to hand the prescription out in person, and enquire if the patient has any questions or concerns, but those days are long gone, profit is the name of the game.

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