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The government's callous reaction to potential Lloydspharmacy closures

James Waldron: This is most likely the tip of a devastating iceberg

The Department of Health's reaction to Lloydspharmacy's announcement demonstrates everything wrong with its attitude to the sector, says C+D's editor

The significance of Lloydspharmacy’s decision to cease trading in 190 branches across England can’t be overstated.

This is concrete proof that even the giants of the sector can’t absorb the sheer scale of the funding reductions and category M clawbacks being thrown against it. With one announcement, those fears of 3,000 pharmacies closing suddenly don’t feel quite as far-fetched.

Even if the government is not beaming from ear to ear at the news its brutal policy has produced results, it certainly doesn’t appear alarmed. In its response to C+D yesterday, the Department of Health stressed that the hundreds of affected Lloydspharmacy branches equate to “just” 1.6% of the total number of pharmacies in England. It’s this callous logic – equating thousands of affected pharmacy staff and patients to a slim percentage – that perfectly encapsulates the faulty thinking in Westminster.

It also conveniently ignores the fact that this is most likely the tip of a devastating iceberg. A mere 1.6% may not sound much to the lay reader, but we mustn’t forget this is the toll being exacted on a single business. If Lloydspharmacy – the UK’s second largest multiple, with the financial safety net offered by its owner, US healthcare giant McKesson – has resorted to the nuclear option of jettisoning almost 200 branches, what hope is there for England’s four-and-a-half thousand independent pharmacies?

We wait with apprehension to see which branches the multiple will decide to close. Lloydspharmacy is not picking these stores based on whether they are located in a “cluster” – the buzzword at the heart of the government’s strategy for starving the sector of funding – but because they are no longer “commercially viable”.

This means these branches could include pharmacies in remote rural locations or deprived urban estates – desperately needed by their communities, but rendered unviable by funding cuts, and no longer enough of a business opportunity for prospective buyers to take an interest.

I sincerely hope that’s not the case, and the staff at these branches are able to secure continued work under new owners. But the harsh funding situation created by the government in the name of “efficiency” will only make this harder.

So who can community pharmacy turn to? Pharmacy minister Steve Brine has told C+D he wants “realistic and sustainable” funding for the sector. With the cuts having claimed their first high-profile victim – and the resulting national media coverage – will he be convinced that now is the time for a policy change?

Labour MP Kevin Barron plans to pose this question to the minister at an all-party pharmacy group meeting next week, which C+D will be attending. It will be an opportunity to see whether Mr Brine will replace good intentions with action, and prevent this rockfall from becoming a landslide.

James Waldron is editor of C+D. Email him at [email protected] or contact him on Twitter at @CandDJamesW

22 Comments

Nalin Shah, Community pharmacist

Everyone always gives their narrow point of view  knee jerk opinions.

No one can guess the bigger picture as its beyond their reasoning capacity.

This will be a  non-story in a matter of days.

 

 

 

 

 

 

 

Steven Marley, Community pharmacist

If the NHS were to be completely dismantled, this would be the best thing to happen to community pharmacy. Right now pharmacies are being forced to operate at a loss to provide services to the public. Pharmacies could charge for services and all prescriptions would be private, most likely costing much less than current NHS charge. Or else a flat rate of £5 per item, this would allow people on insulin etc to not have to pay through the nose. Maybe a system such as this would prevent drug prices going up in the absence of the NHS. Other services could be private and charged for (but not too expensive), maybe except for advice - that should still be free. Sundry items could be charged for but still cheap, however it would all add up, considering the NHS does not reimburse for this. Maybe pharmacies would then be free to advertise incentives for getting prescriptions. There could still be government programmes to assist people unable to pay, but this should be means tested,  not based on conditions or age. I am not a contractor so there will be gaps in my knowledge. Please correct me if I am wrong and I invite discussion, but please do not get nasty.

Martin Roberts, Pharmacy technician

One of the many problems with getting rid of the NHS would be that you would see a huge rise in pharmacutical costs where they would reach prices much like in the USA. It is only because the NHS has the bargining power of a big organisation that it can keep those prices down.

The NHS doesn't need to be dismantled, it needs to be adiquately funded, but it also needs a restructure and they need to cut bloat and waste from NHS Trusts. I've worked in NHS Hospitals and the culture is antiquated, the staff are constricted by filling out forms all the time, and as for waste, I've seen with my own eyes that due to improper storage Hospitals end up discarding thousands of pounds worth of medication a week. But that is again down to culture within the NHS because staff "don't have time to put things away properly" which leads to fridge items being put into cupboards and tablets stored lose, (although it does mean that they are then wasting time searching for medication they can't find, they then order more from pharmacy, which then leads to an excess of expensive drugs in their cupboards which end up going out of date)

But cutting the budget does not lead to efficiency savings, it does not remove the waste because those at the top of the NHS are far removed from what is going on at floor level of the NHS so they don't know where the waste is or what needs to be done, instead they just do the obvious and cut staff where they can, or as we've seen in this case, you have the government target the wrong areas as they are out of ideas and pharmacies are easy targets.

Edward H Rowan, Locum pharmacist

The NHS won't be dismantled any time soon.The British people would never vote for any politicians who advocate that. They can't even make minor alterations to exemption categories, never mind making everyone pay.

Chris Locum, Locum pharmacist

It will remain free for now. Just have the CCG put the supply of services out to tender slowly and gradually. Any willing provider will come along and take over. Removing most pharmacists with a change in supervision rules cleaves them from the public purse (i.e. privatisation ). Eventually, an insurance-style system comes through, but no one will see it because it is done slowly. There is a move to creating ACO - accountable care organisations (HMO - Health Maintenance Organisation in the USA). check out operators such as Kaiser Permanente which the government is bent on emulating.

James Harbottle, Community pharmacist

Whilst the PDA are trying to secure bargaining rights for Pharmacists the DoH (+friends, you know who I mean) are pushing for remote/tech supervision. Does Mr Hunt really want another powerful union to contend with along side Nurses/ Doctors? Of course not. Does S.P want Pharmacists to have bargaining rights? Of course not. American business views this as tantamount to communism. (note American history, Pinkertons vs Unions). Point being that scurrying along with the supervision changes will protect the business from any industrial action in the event (heaven forbid) that Pharmacists are granted bargaining rights. After all the, pharmacy could continue running basic dispensing/ sales therefore nullifying any leverage that we have.

Steven Marley, Community pharmacist

I only meant hypothetically, highlighting the irony that the very existance of the NHS is killing pharmacies, taking services away from the public that needs it. Having a local pharmacy where you make a contribution towards goods and services provided is better than having no pharmacy. The British people would not vote for anyone who would openly advocate that, but they have voted for a government who is slashing funding and taking away desperately needed services, not just community pharmacies.

R A, Community pharmacist

Its called consolidation, know the market is just left with the large chains and the dying independents, Lloyds Pharmacy knows for a fact that by closing many branches they reduce their operating costs. Couple that with the fact that the DH is unlikely to grant the opening of new pharmacies they literally have a win win situation.

CAPT FX, Locum pharmacist

I completely disagree with this article and my observations and convictions are anchored in the 17 or so years o have worked for this behemoth now in obvious meltdown.
I think the Department of Health has every right to feel exasperated by these multiples. They are not angels in this whole scenario. If anything I think they deserve each other.

When the Electronic service was started years ago, the Department of Health provided infrastructure payments to enable Pharmacies to get Computer software and Hardware to connect to the spine to facilitate this process. As I write this article all the Scanners in this multiple have never worked. No one has ever cared to get them to work leaving staff to manually do work that was meant to be automated.

Their Computers don't deserve to be called as such. They are as close we can get to typewriters in 2017. The level of improvisation you find in this multiple will be frowned upon even in Africa and the third world.
My point here is that Community Pharmacy should have invested in their businesses over the years rather than the lip service they made whilst mourning about underfunding at every turn. They should have done it in a manner that would have convinced the Department of Health that they are worthy partners. My observation is that infrastructure payments were obviously reported as profit or revenue .

The service delivery of Community Pharmacy outlets particularly those owned by multiples is appalling and no one cares anymore. Should the Department of Health ignore this and all the patient complaints resulting from poor service delivery resulting from inadequate resources.

These multiples particularly Lloyds Pharmacy are too big and unwieldy to ensure high quality at point of delivery. They remind me of a big African family. Because of their size the family can't afford clothes so the children run around naked and hungry. The parents never know where their children are and whether they are fed or not. Such parents always tend to be Bullies and react violently if anyone mentions anything about their family. They will always be mourning about how life has been unfair on them. Yet they are content to say anything without doing anything to improve their capacity to help themselves. And even worse they will not stop having more children when it makes sense to stop.

This mirrors the Lloyds Pharmacy story in the last 12 months. There are smaller multiples who have been fantastic for this profession and I felt proud working there. They deserve to make noise and my point here us that Lloyds Pharmacy don't deserve even to make this poorly timed political gamesmanship. They are a poor example for this profession to use as a yardstick and the Department of Health knows that.

As a black person Lloyds Pharmacy has the worst race relations ever . They should get new computers, get those scanners going and stop turning people's livelihoods into pawns in this political gamesmanship game. Let worthy exemplary multiples lead the way on this argument.

janet revers, Community pharmacist

I find the tone of this comment extremely unpleasant. There was no need to make a comparison with a "big african family".

CAPT FX, Locum pharmacist

May I say this to the Editor and to Janet that for a while we have lived in this Pleasant bubble whilst the reality out there is anything but pleasant. I have respect for C & D community principles and I have apologised when I was out of line.
I can not be pleasant in any discussion to do with Lloyds Pharmacy. On 33 occasions since the Brexit referendum I diarised I was called the N word in their branches, including Senior Managers. Every day a Lloydspharmacy door opens serious professional violations occur and the professional environment ir atrocious. It's beyond a joke because no one cares and there are no checks and balances.
The people punished are those working hard to try and keep these outlets following and observing regulations. They are in perpetual meltdown and I don't believe sweeping serious issues under the carpet is the solution.

I contend they are not a good example to lead debate or discussion on any issue in this profession. I agree with and respect the Editor's principle in using this issue to highlight effect of cuts and the response from the Dept of Health. But its futile to defend Lloydspharmacy, they make this profession look bad and i challenge anyone to visit their branches.
It's time things are said boldly , directly and candidly otherwise our profession will be bismirched by Companies like this.
They should clean up their act first and then make political statements. Or they should engage their branch Pharmacists.

CAPT FX, Locum pharmacist

There are times when issues have to be said in a direct manner and this is one of them. My tone and the manner I approach issues reflects the national mood and the manner in which issues are discussed. Gone are the days when diplomatic civility marked debate and ordinary discussion. 

I was born in Colonial Africa and that picture I portrayed is understood both by those born in Africa and the majority of people in this country who happenned to be our yesteryear colonial masters. I also felt that nothing would bring out what I wanted to say more than that picture and any one who has worked for this company will agree. 

At times it is highly patronising for anyone to look at a comment from an angle whether its pleasant or not instead of the fact contained therein. Its the same like I have experienced in my travels where every time I answer someone back to defend myself , someone says " I wont have you talking to me like that".  The facts are there and I am sure no one born in Africa will take offence from my analysis.

janet revers, Community pharmacist

I was not attacking the content of your comment in any way and your anger is justified. I just think the same point could be made, and in fact is often better made, in a more restrained tone. BTW I work for this company as well at least for now!!!!

Ilove Pharmacy, Non Pharmacist Branch Manager

Waldron do you not think the government and Lloyds have already sat down in grand surroundings and chopped this all up already in the same ways they do with Boots.

You are either very naive or simply pretending to be ignorant and show sympathy with community pharmacists. 

locum norfolk, Locum pharmacist

no one knew supervision was on the cards to extent that it has come to light... we know nothing of the current move that has been made in response to closed door conversations that will only come out later down the line. GAME IS UP...

S Morein, Pharmacy Area manager/ Operations Manager

Yet in another article in this journal, Lloyds clearly say that many branches are already significantly progressing to a sale (nice goodwill consideration there). The other closing branches will be those where Lloyds operates a monopoly within a locality. So save costs with zero chance of new competition. The story should really be why can a multiple or any other contractor be so insulated from patient choice that they can just close a branch to increase their profits. Perhaps that could be discussed by those poor destitue contractors on their 2 centre conference in Vietnam? After all the destitute and financially stretched always travel half way round the world for a conference, as Manchester or Birmingham would push them over the edge to monetary ruin.

Simon MEDLEY, Community pharmacist

of course they're callous,  they're tories and pharmacy is a public service.....

Mark Boland, Pharmaceutical Adviser

1) Pharmacies are private contractors who have been gifted a monopoly to supply a service to the NHS. So a public service in a technical sense. 

2) The Conservatives continue to be elected in free and fair elections. Their supposed tight control on public spending being a key strength. 

3) Cutting a public service does not necessarily make a government callous. People often only want to see cuts in areas that do not personally affect them. This could be called a callousness in voters. 

4) The general public don’t really care about community pharmacy. The electoral success of the Tories is very much down to their ability to judge (with great precision) the often fickle and self-interested attitude of the British people. They perceive pharmacy cuts as a saving with a zero electoral cost. 

Note, these are all positive statements, not normative. 

Jenny P, Hospital pharmacist

>2) The Conservatives continue to be elected in free and fair elections.

They don't hold a majority at present, so justifying sweeping political change on the basis of an electoral mandate is difficult.

Mark Boland, Pharmaceutical Adviser

They have a working majority that was able to pass the pharmacy cuts without any genuine resistance from the oppostion. It is 'sweeping political change' in the eyes of interested parties, the electorate appear wholly uninterested.

 

Seal Patel, Community pharmacist

Think it wil be fine in terms of patients. Plenty of other pharmacies they can choose from. 

 

Dave Downham, Manager

At 6.3% of 3,000 considered excessive, they may believe that it's a good start.

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