The scandal at the heart of community pharmacy isn’t Boots

"Independent contractors are subsidising the NHS’s drugs bill from their own pockets"

Contractor Graham Phillips says community pharmacists should not be distracted from the real issue putting the sector under pressure – NHS mismanagement

Like many C+D readers, I watched last month's BBC Inside Out investigation into staffing levels at Boots wondering: “Is there a smoking gun?”.

Pharmacists came out well. Boots came out of it relatively unscathed. No doubt there were big sighs of relief at their corporate head office in Nottingham, and in Monte Carlo, where the chief executive of Boots' parent company, Stefano Pessina, lives. There was no shock-horror, revelatory sting in the tail at the end of the programme. 

But in my view, there is a scandal at the heart of community pharmacy, generated at the top of the NHS.

It began in the heady days of mid-2013. NHS England launched the Pharmacy Call to Action, and held a series of meetings asking how patients and professionals could reimagine the NHS. Sadly, nothng ultimately came out of it.

The commissioner called for an honest and realistic debate about the future shape of the NHS in order to meet rising demand and patients' expectations, set against a backdrop of flat funding which, if nothing changed, would result in a funding gap of £30 billion by 2020.

Then in December 2015, England's chief pharmaceutical officer Keith Ridge wrote to the Pharmaceutical Services Negotiating Committee about the cost savings and patient safety benefits of robot dispensing. He later claimed that hub-and-spoke dispensing could handle two out of every three prescriptions in England.

In May 2016, while appearing in parliament before the all-party pharmacy group, Dr Ridge compared the 3% dispensing error rate in community pharmacies with a “0.00001%” error rate at “large-scale automated dispensing facilities in Sweden”. He later back-tracked and apologised for “inadvertently misleading”, and accepted that it was “not appropriate to draw a direct comparison” between the two countries, because of the way these error rates are recorded.

Around the same time, having buried the Call to Action he initiated three years earlier, Dr Ridge commissioned his own review of community pharmacy, by Richard Murray of the influential King’s Fund think tank.

It came out equally positive, and made some specific recommendations. The then pharmacy minister, David Mowat, waxed lyrical about the review and made numerous parliamentary promises about how the report would be responded to, and would shape the future of community pharmacy. “The Murray Review,” he told the House of Commons, “sets out a road map...and NHS England is determined to implement it.”

That was until October, when Dr Ridge (are you spotting a pattern?) declared that the NHS wasn’t going to respond to the review after all. C+D concluded at the time: “When it comes to the more ambitious, and pharmacy-specific, proposals – revamping MURs, a national smoking cessation scheme or pushing for greater minor ailments commissioning – NHS England has either done nothing or actively back-tracked.”

Contractors left to foot the bill

Move forward to this year, and the current turbulence in the generics market, combined with the refusal of the NHS to recognise the resultant price increases or grant sufficient price concessions, leaves independent contractors literally subsidising the NHS’s drugs bill from their own pockets, as the NHS pays contractors below the cost price for the drugs we purchase on its behalf.  

The purchasing system that I subscribe to automatically emails me every time one of my branches pays over the drug tariff price for a generic drug. I’m getting tens of warning emails per day, but like you, I’m continuing to supply these medicines, because patients’ health trumps profit. But with each email I receive, a shiver goes down my spine, as the perfect storm of funding cuts and losses drives me ever closer to going out of business

So the true scandal is the utter failure of the NHS to consider the patient safety implications of deliberately under-resourcing and destabilising a system that dispenses over one billion prescriptions, and makes the same number of potentially life-threatening interventions, every year.

Independent research from 2012 showed that one in 20 GP prescriptions contains either a prescribing or a monitoring error, affecting one in eight patients. Although most errors are “mild or moderate”, one in 550 of all prescription items contain an error judged to be “severe”.  

But the risk of a dispensing error is just the tip of the iceberg. What is the risk that, having been put under impossible pressure and utterly demoralised, community pharmacists either make an error, or fail to spot one made by a GP? As the BBC programme made clear, patients trust and believe in community pharmacists to spot mistakes. 

Graham Phillips is director of the Manor Pharmacy group in Hertfordshire

9 Comments

Sue Per, Locum pharmacist

Mr Phillips, has software that alerts him on over payments; how about installing software that alerts him of the underpayment or profit on purchase alerts. I am sure that overall he will be in profit.Just need to look at the P &L accounts of all these pharmacies filed over the past decade., and the evidence shows, healthy profits eneough to command high premiums for pharmacies for sale.

As for Mr Pessina, he took advantage of contract limitations, and adopted the stretch and extract model to maximise profits off the generous taxpayer funded pharmacy contract... and it still continues.

The excess purchase profits made over the past decade should be clawed back, and faster with lightening speed., until the cotractors start selling up, instead of expanding their estate!!!! for yet more profit, through contract manipulation.

Scrap Specials, MUR's and NMS's

Introduce demand-led services such as smoking cessation, Minor ailments, other CCG led comissioned services, weight management - Basic health checks for Blood Pressure, Diabetes etc...

 .,

Graham Phillips, Superintendent Pharmacist

What Sue Per doesnt seem to understand is that independent pharmacists have driven down generic prices by buying well. The savings are passed on to the NHS and as a consequence we have saved the NHS around £10 billion over the last decade. Any excess profits are clawed back by the NHS. I'm not her to defend Boots but I do think we need to focus our attention on the true perpetrators of anti-community pharmacy "crimes".  Why she would want to scrap clinical services as part of some unfocused rant is beyond me. Unless she wants to see the end of community pharmacy- thereby biting the hand that feeds her? 

Mohammed Patel, Community pharmacist

I agree.

Another important point is, to note, that when these massive conglomerates go belly-up, the people in their yachts never even flinch. It's the people on the shop floor who end up paying with their jobs. It's the families whose hard-earned pensions become worthless and the thousands of people who lose their only source of income who lose out.

Corporate greed and profiteering have utterly destroyed the profession of pharmacy in the UK. And it's only going to get worse folks.

It's so easy for people behind desks on a 9-5 shift with real breaks to tell us to prove our worth and provide value to our employers to secure our future. Although how someone can do so many MURs, NMSs, travel vaccinations, EHC consultations and chlamydia treatments, whilst still doing the same bread and butter tasks as they were doing pre-2005, is beyond my comprehension. And you cannot make any mistakes lest you end up like poor old Elizabeth Lee!

Ilove Pharmacy, Non Pharmacist Branch Manager

I think the ship began to veer off course before 2013.

Mohammed Patel, Community pharmacist

Eight years prior, in 2005. That's when we hit the iceberg.

Paul Dishman, Pharmaceutical Adviser

*This comment has been deleted for breaching C+D's community principles*

Paul Samuels, Community pharmacist

Dr Ridge was & is continuing to act as the Government hatchet man for matters pharmaceutical.* Drug concessionary prices,as Graham points out, are way out of line with reality in most cases.

Perhaps Government can legislate maximum prices to be applied to generics & insist that branded generics are not used.

We can live in hope but reality is a little harsher!!

*This comment has been edited to comply with C+D's community principles*

Mohammed Patel, Community pharmacist

Stefano Pessina is worth almost $20 BILLION and never has to worry about making a dispensing error. In fact, I'm sure he never has to worry about anything at all.

How has he amassed such a disgusting fortune? Luck? Business ingenuity? Or have pharmacists been over a barrel to pay for this ultra-luxury lifestyle? In any case, it's clear where the money has been going!

Answers on a postcard please.

Meera Sharma, Community pharmacist

Spot on! This follows the emerging theme of corporate greed - Carillion, Capita and the never-ending list goes on. Until the system is corrected, there are some people making a lot of money at the expense of tax payers. High time this greed is curbed, if the will was there!!

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