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Dr Messenger: Put an end to shopkeeper jibes

"Lingering tension between the diametrically opposed roles of scientist and shopkeeper is what undermines your credibility"

Why are pharmacies keeping quiet about their tiny revenue from retail, asks Dr Messenger

Patients and GPs don’t always see eye to eye on matters of medicine – just take the average conversation on the need versus want for antibiotics, for example. But recent comments about pharmacists from patient group National Voices will be echoed by the average GP.

According to the group, pharmacists are “locked in a dysfunctional retail model” from which they need to “break free”. Otherwise, it seems, they will never make the best use of their skills and training.

Quite right, my colleagues will say – that lingering tension between the diametrically opposed roles of scientist and shopkeeper is what undermines your credibility and presents a significant obstacle in the push for general practice and pharmacy to work in perfect harmony.

Even more interesting than this rare consensus is the reaction of pharmacists to the story. A number have pointed out that the income split in independents is something like 90:10 for NHS compared to retail. I have to admit that this is a real revelation to me – and, I suspect, to all my colleagues. And presumably to National Voices, too. It’s a message worth propagating, because it’s one that might help improve relationships between pharmacists and those who are a bit sniffy about them.

The fact is that most GPs view pharmacists as primarily ‘retailers’ and therefore as having a completely different agenda to those of us who perceive ourselves as working valiantly in the frontline of the NHS. Even if you thought we did it for the money, too.

So bang that drum and enlighten us GPs. Better still, cordon off 10% of your pharmacy and badge it as the ‘evidence-free/retail zone’. That way, you may well find GPs taking you far more seriously – at least 90% of the time.

Dr Messenger is a GP trying to negotiate the impenetrable structures and commissioning quagmires of the reformed NHS. Genuinely good friends with his local pharmacist, he offers a GP take on the primary care issues of the day. Please don't shoot, he comes in peace


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Calum Nelson, Locum pharmacist

Don't tell us about it, talk to the multinational holding companies and private equity firms who own most of the pharmacies these days. The people who make the decisions and who actually see the patients are so far removed that I recently worked in a pharmacy where the staff don't even know who owns it.

Farmer Cyst, Community pharmacist

Here's the thing though - the punters WANT to buy this evidence free shit. They saw the advert on the telly and thought they'd try it. Buying it from a Pharmacy gives the whole thing a more powerful placebo effect. Cough medicine is the classic - they don't need it, it wont help and having a cough for 10 days isn't serious even if you do stare at me for a second or two whilst you try and see if I'm lying to you or not. Cough medicines aren't going away, even if they do go out of Pharmacies. When they buy it from Tesco though, who is going to tell them not to go to the doctor if they clearly don't need to (or vice versa!). Given that there are millions of repeat purchasers of cough medicines, it must be doing SOMETHING for them, even if it is all in their head. Would that effect be as strong if they bought it alongside their food for the week? I'd suggest not. Getting your placebos from a well lit environment which you perceive as 'medical' is good for the patient, good for the Pharmacy and good for the NHS in general.

James Mac, Community pharmacist

Also true. I don't think cough bottles etc. do people any harm in the short term, and to suggest that by selling "evidence free" treatments pharmacies damage people's health by encouraging them to self-treat minor conditions is spurious. Everyone looks out for the people who shouldn't be using the stuff, like for example those with obviously serious symptoms who are trying to cure themselves with rennies / immodium and whatever. IMHO all pharmacy medicines have a strong "placebo" effect - someone behind the counter is telling you what to take and why, and might even be able to explain to you how it works. You can see the converse where someone doesn't believe your advice, I honestly think they won't experience the psychological side of symptom relief. I remember one surprisingly cynical young lady make sarcastic comments about everything I recommended for her holiday, including her MALARIA TABLETS. She thought it was idiotic to take them as they can make the skin more sensitive to the sunlight, and din't I realise she was going on holiday?

James Mac, Community pharmacist

The same old chestnut. Pharmacies have always been businesses. If you want to have a fully "evidence based" dispensary, then nationalise them all and let the state sort it out.

Kevin Western, Community pharmacist

why would that make a difference?

Leon The Apothecary, Student

The idea I believe would be that you could avoid the independant private goals and work along the NHS guidelines of not-for-profit ideals. Would it work however is a whole discussion in itself.

James Mac, Community pharmacist


Leon The Apothecary, Student

From my experience it depends on the pharmacy. Some places do genuinely take in huge amount of money just through their retail business, and prescriptions is just a bonus on the side. Other places it's vice versa. And some are straight down the middle! Dispensaries need a source for their prescription numbers and currently having a shopfront is the optimal way to do it. With Hub and internet pharmacies they theoretically bypass this need so maybe we may see a change in this demographic?

Kevin Western, Community pharmacist

As "other Pharmacy staff" I am not sure how much access you would have to the figures, but outside Boots, the supermarkets and a very small number of independents the breakdown will be as the good Doctor says. The otc non medical share is shrinking rapidly as a result of supermarket competition and shopping trends as well as a shift to more a "ethical" image for Pharmacies. The otc medical sales will be small compared to nhs income in most independents.

Leon The Apothecary, Student

Just like I said Mr Western. My role titles aren't an option I'm afraid. I have however had to do many different pharmacies end of month and financials. OTC is definitely shrinking although there's still a number of pharmacies that do survive on it. Not for much longer I daresay, as you say there are a definite shift towards prescriptions over OTC. With a more universal and constant prescribing stratagem across the whole of England they may even thrive upon NHS alone. Pharmacists have a tough line to follow between business and professional. You do a good job, and it's nice to see more recognition for the work pharmacists do.

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