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Too many pharmacies, says England’s chief pharmacist

Practice The number of pharmacies in England could lead to a “survival of the fittest” scenario, warned Keith Ridge (pictured), ahead of the publication of an RPS report on the future of the sector today

The sheer number of pharmacies in England could lead to a "survival of the fittest" scenario, NHS England's chief pharmaceutical officer Keith Ridge has warned.


Speaking ahead of the launch of a Royal Pharmaceutical Society (RPS) report on the future of pharmacy yesterday (November 5), Dr Ridge said the government would need to "think carefully" about cutting the number of pharmacies.


"There are too many pharmacies," he said, responding to the report's concerns about the "overcrowded" market. "I think there's a need to think carefully about a transition to getting the right number of pharmacies, through the pharmaceutical needs assessment."


A "survival of the fittest" scenario could be healthy for pharmacy, said NHS England's chief pharmaceutical officer Keith Ridge

More on the future of pharmacy

Pharmacy must 'punch its weight', warns NHS policy expert

The supply vs service debate

Government will cut numbers if pharmacies don't up their services, PSNC warns

"But in among all that is [the potential for the] ‘survival of the fittest' – that, in many ways, is quite healthy, too," Dr Ridge added.


The RPS report Now or Never: Shaping Pharmacy for the Future warned that many pharmacies could close unless the sector assumed an extended role in patient care.


Judith Smith, the report's author and director of policy at think tank the Nuffield Trust, said pharmacies that were unwilling to play a greater service role could face tough times. But she suggested there could be an option to create separate contracts for supply and services to create "two tiers" of pharmacies.


"I think the conclusion is it may not necessarily be a bad thing if some pharmacists want to contract to do one part of [the role]," Dr Smith argued.


But Simon O'Neill, director of health and professional liaison at Diabetes UK, said patients might shun pharmacies that did not provide a wider range of services. "[Pharmacies] may find patients vote with their feet and go somewhere else," he warned. "If I go to a pharmacist who gives me extra advice and support that I don't have time to get from the GP, I'm much more likely to go back to that pharmacist."


Last month, PSNC chief executive Sue Sharpe warned that the government would look to cut pharmacy numbers unless the sector proved its worth through expanded services.


Do you think there are too many pharmacies?

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40 Comments

Leroy Jackson, Community pharmacist

We've seen 62.2 per cent increase (383.5 million items) on 2002-2012

Solution......less pharmacies.

Genius.

geoffrey gardener, Community pharmacist

What we have are too many pharmacies in the wrong areas. What is needed, and probably has been for the last forty years, is a planned distribution of pharmacies. However the volume above all else system of remuneration would have to under go a seismic shift to accommodate this.

MESUT OZIL,

No sir..

what the tax payer wants is value for money and genuine competition

Market forces should dictatate the winners and loosers with pharmacies in rurual localities only be funded as a last resort.........

MESUT OZIL,

recently acquired a takeaway afters years in pharmacy...

£8000 a week in sales.....no SOPs....no CPD.....AND OTHER BULLS**T...
locum 2 days a week..and chill during the weekends..
The profession is dead; time for pastures new....

Gerry Diamond, Primary care pharmacist

The scenarios offer a knee jerk reaction to the current situation, Clearly pharmacists numbers have increased, but the beneficiary will be patients having ready access to a well qualified healthcare professional work force, perhaps two pharmacist for each pharmacy. The argument is not about pharmacy but salaries which is a different argument altogether.

The broader economic argument is simple, like the majority of the population we all want a living wage, good education for children and affordable housing.

I understand that this may be unpalatable, however, I would direct those wanting to become rich out of pharmacy to have an excellent business model or consider an alternative profession.

Healthcare in this country per se, even to some extent the medics is less lucrative than it was in previous years. Although, I am certain that for the most productive and innovative of pharmacists that there will always be opportunity to make a decent living whether it is as universal as it once was is now a very different matter indeed.

Chris Locum, Locum pharmacist

If the population has supposed to increase by 3-4 million over the last decade, this surely has profound implications for resources. How can that translate into fewer pharmacies in the longer term?

There was innovation before contract limitation and the rise of corporate/shareholder profit driven entities. With a new contract and management of long term chronic illness involving Pharmacy, we can deal with some of the excess numbers of pharmacists and curtail intake of students.

With properly funded services we can have innovation all over again and more clinical training.

Without this we face prescription factories, bar coded products in vending machines and fewer human personnel logged on remotely.

Lets face it we stand on the brink of a new revolution with Bio tech offering many possibilities in the longer term future. A piece of tissue or device implanted with drugs takes the strain off MDS and forgetting meds !

We need to determine how we can adapt to the future and the current status quo does not allow for us to do so. If we are not careful then we will end up with a small number of high volume units controlled by overseas companies looking for maximum profit off threadbare margin

MESUT OZIL,

There are too many pharmacies because there are too many pharmacists who
1. want to be their own boss
2. are tired of being treated like dirt from the multipes/contractors.

The solution is simple:
1. REMOVE CONTROL OF ENTRY
2. REMOVE PRACTICE ALLOWANCE
3. TWO YEAR FREEZE ON PHARMACY STUDENTS - take two year break when no students are taken on.
4. A NEW CONTRACT FAVOURING SERVICES AND NOT DISPENSING
5. A PROPER MINOR AILMENT SCHEME - to include ventolin trimethoprim, contraception, otomise ear spray,
6. Prompt payment from the paymasters ie within 24 hours of dispensing drugs
7. A minimum hourly rate for locums to reflect their expertise in the medical field £35 per hr

Jide Opaleke, Locum pharmacist

Very rational thinking in present situation

John Smith, Locum pharmacist

What planet is this man Keith Ridge living on? Too many pharmacies by measure of what? In the absence of greater clarity in his remarks, I am inclined to assume that he is party to hidden motives here.

The population is increasing rapidly, there is a baby boom, the amount of elderly in need of pharmaceutical care is rocketing, and script numbers are rising inexorably. The vast majority if pharmacies that I work in are unable to provide a full range of pharmacy services
due to the sheer volume of prescriptions.

If anything we need more pharmacies. By increasing the quantity, we increase competition and standards must rise as a result. Conversely, by reducing and controlling numbers we will reduce standards, as well as patient preference and access.

orest supyk, Community pharmacist

When I was a young pharmacist in the 80's the average pharmacy did about 3 to 4 thousand 'scripts. Now the average is 5 or six. Due to the constant attrition of remuneration over the years we have played a numbers game, trying to poach trade from neighbouring pharmacies. Then the contract changed and we were asked to provide new services out of an existing cash pot. Its no wonder that the whole system is fit to bust! There is no fat left on the pharmacy carcass now for the DH to render. Enough is enough! Why take more work on for a pittance to lighten GPs work loads?

MESUT OZIL,

JOHN

I HAVE BEEN SAYING THIS FOR A LONG TIME

THE MARKET IS EXPANDING
The only way to improve services is to open the market !!

Big up yourself john !!

Yo Palumeri, Community pharmacist

survival of the fittest is already here

Sanjay Patel, Non healthcare professional

TOO MANY PHARMACISTS AS WELL, NEED T OCUT STUDENT NUMBERS.

Clive Hodgson, Community pharmacist

“Survival of the Fittest” in this context could mean “Survival of those with the Deepest Pockets”.

Large Multiples could well provide a host of temporary loss making “services” with the intention of killing off the less well funded Pharmacies. With the opposition removed they could then do as they please.

Is that what is wanted?

Jide Opaleke, Locum pharmacist

We should not have a phobia for what the multiples will do to kill off competition but develop our services in a that will be difficult to kill off. If adequate remuneration is provided for the true professional services with a renewed contract that focuses on the pharmacists' core contribution to improving and maintaining health. The future for pharmacists will still be preserved albeit not in the shop keeper role Even if hub and spoke model develop the restructure of the contract can be designed for the benefit of the patient with a professional pharmacist at the centre such that owner run pharmacies will continue to thrive as a service and supply contract holder whilst multiples will continue to benefit more from buying capacities unhindered by category M or other clawbacks and the employees/locums will offer either or both service or supply contracts within the non-pharmacist owned or multiple owned pharmacies. This way there will be mutual respect and recognition between employers and employees, and consequently improved patient care from greater greater job satisfaction and patient focus. The phobia for multiples and protectionist environment in which pharmacy is practised is what is killing the profession and stifling innovation in pharmacy practice.

Clive Hodgson, Community pharmacist

Hi J O,

Don’t underestimate the influence/ lobbying power of the large multiples/CCA.

If, or when, there is a new Contract you can be assured that they will have had a lot of input as to its content. Anything proposed that they do not like the look of is most unlikely to happen.

Jide Opaleke, Locum pharmacist

Hello Clive

Sorry I didn't salute you in my previous reply.

I believe the multiples are also yearning for a new contract and are equally vulnerable to change in the cost cutting age we are now. However their reaction to bear down heavily on the pharmacist to deliver more whilst offering lower pay is sign of desperate times but offers no long term solution and it is likely to bring them to reason on a mutually beneficial way forward. I think the market protection is a major disincentive to contract reform and enhancement of pharmacist professional reputation and remuneration as well as patient services development. We need to look to the pharmacists in us not the businessman as custodian of the profession pharmacy not shop keepers or multiples whose first loyalty is not to healthcare but to shareholders. Most other countries do not offer the kind of market protection UK pharmacies enjoy and they still survive well. We need to look inwards to our current beliefs and phobias to be able to confront the problems afflicting the profession.

Disillusioned Pharmacist, Community pharmacist

"Most other countries do not offer the kind of market protection UK pharmacies enjoy and they still survive well." Is that why all the EU Pharmacists are over here further adding to the crisis of Pharmacist numbers?

Jide Opaleke, Locum pharmacist

The protection caused cushioned economy around pharmacy which initially encouraged good salaries because practise allowance cushioned wage bills for the multiples, plus the associated social services benefits which is presumably less in comparison in other European countries and let say rest of the world. This makes it attractive and is well driven and promoted because multiples attract young European pharmacist from certain countries, signing them on lower salary packages from abroad to their benefit. It's free market but morally wrong for Uk trained pharmacists having to go on zero hour contracts, low rates of pay or no work because of the immorality of businesses that are exploiting the pharmacists and destroying self esteem. A lot is wrong with us as a profession starting from the now woefully researched work force requirement that misinformed the society to approve more schools of pharmacy in response to the demand by multiples. Also Independent Contractors bury their heads in sand when it comes to radical shift in remuneration structure that recognises professionalism for fear of loosing the comfort zone of protection and end up playing into the lair of the multiple favouring PSNC who in turn negotiate terms that perpetuates the stronghold of business over the profession. And the majority that are the real foot soldiers of the profession languish in self pity and disillusionment.

John Randell, Non Pharmacist Branch Manager

I honestly see a future where the average salary of a pharmacist has dropped to 25K and they are less respected in society........

If you are young DONT WASTE YOUR TIME, GET THE MONEY NOW BUT MAKE SURE YOU ARE SAVING SO THAT YOU HAVE THE CASH TO MOVE OUT OF PHARMACY AS SOON AS POSSIBLE.........open a buisness or retrain pay to do a master courses in something else.....

I KNOW TOO MANY PHARMACIST 65 YEAR PLUS STILL LOCUMING DESPERATE FOR MONEY.........I DONT WANT TO BE IN THAT WAY AT THAT AGE,......

MESUT OZIL,

WHY ARE 65 PLUS PHARMACISTS WORKING?

WHERE DID ALL THE MONEY THEY EARNED GO?

IF THEY WERE CAREFREE WITH THEIR MONEY, THEN THERE'S NO SYMPATHY....

I'M 35 AND MORE OR LESS FINANCIALY SECURE...
IT'S AMAZING HOW MUCH MONEY ONE CAN SAVE BY NOT DRINKING/SMOKING/FOLLOWING THE JONES'S

DEBT FREE IS THE WAY TO BE........

Gerry Diamond, Primary care pharmacist

Dont think pharmacists will be any less respected by customers as they dont think about your salary when they come to pick up their meds. Nurses get not very good salaries and in general are trusted and respected by the public.

Papa Echo, Community pharmacist

Hi Gerry,
I thought you might find this article interesting, this is in the US but the same can be said over here in the UK :

Nurses Remain Nation's Most Trusted Professionals

http://www.medscape.com/viewarticle/775758

John Randell, Non Pharmacist Branch Manager

i agree customers dont think about salary but its a vicious circle..the recent lack of care in hospitals by nurses has highlighted that if you dont pay somebody a decent wage for what they do they are unlikely to pay attention at CARE for patients simply because they are too occupied wondering how they are going to pay next months BILLS....

its all connected but the news scapegoats health professionals when relaly its the lack of investment that leads to failure in care.......

Gerry Diamond, Primary care pharmacist

Society in general has faced the fact that wages have not increased in line with inflationary rises in the cost of living, for instance, petrol averages £1.30-£1.40 and we were used to 99p per litre and most folks wages are geared to the 99 p price.

Hence, erosion of disposable income has impacted adversely on the general population. These economic factors serve to worsen the malaise, stagnation, over supply of pharmacists and lack of leadership in the profession.

All in all, as Arthur Paraguay as editor of the C&D gives a 'grim' outlook for pharmacy.

MESUT OZIL,

I did what you aere suggesting 4 years ago and now am ready to diversify into pastures new..

Yes I locum 2 days and earn £500 and the rest of the time is spent away from the profession and looking for alternative revenues..

Papa Echo, Community pharmacist

That's what I'm doing at the moment.....now starting my Masters but definately NOT pharmacy related... I think I have more sense that that......

David Sarabowski, Locum pharmacist

Too many pharmacies? For whom? The average pharmacy is now doing 6k items /month, but many of the multiples are doing well over 20k. I locum in these places, frequently the only pharmacist, sometimes with an ACT, more often not. The workload is horrendous, and another pharmacy, or even 2 in the immediate area would still be able to function at above the average turnover. Turn around time for walk in patients is frequently 30 mins plus. I know the situation in London is different, and that's about as far as politicians look. What bugs me is the multiples forcing locum rates down, when we will all lose money at the next costs enquiry time, and they will then use that as an excuse to lower rates again. The government only takes notice of falling costs, not increasing ones.

Jide Opaleke, Locum pharmacist

But it's insane to have to give up at the slightest discomfort and hand over what is rightfully yours as a profession to every "willing and able" without a fight. We are not united as a profession because of the retail aspect of community pharmacy and the parasitic effect on our professional name. In my opinion most of us are cowards at best and can be "selfish and self serving can't be bothered about profession as long as it does not affect my bottom line lot at worst" . Unfortunately, this attitude appears more prevalent with independent pharmacist contractors. I intend to continue fighting to preserve my integrity and self esteem as a pharmacist inspite of the "face off"
We must recognise that there are more pharmacists than contractors and a more general profession saving approach is needed not the narrow protectionist or status quo views expressed by some who most likely have a shop keeper outlook to the profession.

John Randell, Non Pharmacist Branch Manager

Look up the difference between bravery and foolishness...its a fine line.

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