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Mail-order prescriptions: convenience, but at what cost?

"Delivering medicines remotely may have its appeal but something profound and unique is lost"

A mail-order pharmacy model may be handy for patients, but it might spell the end of community pharmacy without adequately replacing the care they provide, cautions Leyla Hannbeck

It was inevitable that after Amazon registered itself as a pharmacy trademark in the UK, that another business seeking to make profits from the growth of online retailing would make its move.

Royal Mail has now teamed up with Pharmacy2U to provide same-day delivery of medicines, including prescriptions. This is the same Royal Mail that has joined the FTSE100 index of Britain’s largest publicly owned companies and has seen business boom during the pandemic as people order more from their homes.

What’s not clear is our sector’s response. Do community pharmacies sit back and watch as digital does to us what it’s already done to the rest of the high street? Or do we fight back, playing to our strengths, reminding everyone of how we also fulfilled a great need for face-to-face contact and advice during the COVID-19 pandemic and will continue to do so long after it is over?

Delivering medicines remotely may have its appeal but something profound and unique is lost. Gone will be the personal, one-to-one contact between pharmacist and patient. The Royal Mail worker or Amazon delivery driver knocking on doors may be carrying a package of medication but that’s all they are doing: transporting it. They’re not supplying vital advice and expertise to go with the parcel.

They’re not drawing on years of specialist training and knowledge to impart care; they are not local medical experts, easily accessible for professional advice, no appointment necessary. They are not familiar with local doctors like community pharmacists, who are in frequent contact with a patient’s surgery. They’re not able to ensure that a patient knows how to take their medicine correctly – something community pharmacists do regularly, helping reduce medicine wastage and saving the NHS money. They do not provide the reassurance that they’ve read the prescription and that yes, because they know the patient, what they are giving is the correct treatment in the right quantity.

In addition, patients come to us for things like vaccinations, the morning after pill, to stop smoking and for advice on minor ailments. Our door is always open; the online pharmacy’s contact with you ends when you close yours.

Robots are not infallible – they do exactly as they’re programmed to and don’t interpret and question. The number of pharmacists per patient in online prescription ‘factories’, compared to community pharmacies, is minimal.

Neither is it the case that online dispensing somehow saves the NHS vast quantities of money and is therefore to be encouraged, despite previous “unrealistic” claims by Pharmacy2U in its advertising that were challenged by the Advertising Standards Authority in 2018. This is a myth that must be laid to rest. All pharmacies are paid in the same way from the same pot, whether they are mail order or located on the high street. All that will happen is that because the mail order supplier has a lower cost base, the mail order supplier will make and retain more profit.

Delivering medicines remotely will reduce the amount of funding available to “bricks and mortar” pharmacies. They will be less able to employ as many trained, skilled staff and will not be able to supply the same levels of care and attention. Eventually, many will close completely. 

The Association of Independent Multiple pharmacies (AIMp) is not opposing technology – indeed many of our members have actively embraced it, recognising the need for convenience and innovative ways of working. But this is provided alongside their face-to-face operations. The government, the media and the public should ask themselves: if bricks-and-mortar pharmacies are no longer there, who will people turn to? Surely not to over-pressured A&E departments and strained GP surgeries that are all now struggling with post-pandemic workloads.

AIMp has been actively highlighting the value of local pharmacies in the national media and to decision makers and we will continue to do so as much as we can. For instance, AIMp drafted a paper on mail order pharmacies which we are actively engaging with regulators and decision-makers on. We must campaign to get the support we need while we adapt to change; we have no choice – for ourselves and for the public we serve.

Leyla Hannbeck is chief executive of the Association of Independent Multiple pharmacies (AIMp)

22 Comments

William Johnson,

I have been retired for 25 years, but during my 30 years as a pharmacist I made it a point to hand the medicine out personally, so that if the patient had a query they could just ask me - they didn't have to request to see the pharmacist. Now, as a patient, that never happens. Usually I don't even know which one is the pharmacist. So I might as well have it delivered by Royal Mail, especially as I have shares in them!

Mark Boland, Pharmaceutical Adviser

The marketplace is now unrecognisable to 25 years ago.

We are constantly told that people want the 'personal touch' and how much of a 'shame' it is that we are losing independent shops. 

However, people's words do not remotely relate to their actions. When people are asked to put their money where their mouth is, they choose price, speed and convenience.
 

 

Matthew Edwards, Community pharmacist

My wholesaler has just been forced by MHRA to get temperature controlled vans for a journey of 4 hours to ensure viability of the medicines.  Are we going to see similar rules applied to internet pharmacies so that a similar safety standard is achieved?

sunil maini, Community pharmacist

Yet another headline grabing service offered by Pharmacy 2u.No way can they make this work nationally.Dundee doctor sends eps script at 3.30pm,having phoned nominated pharmacy to request urgent same day delivery.How does this work from a pharmacy in Yorkshire? ~Simple.It doesn't!! No wonder this company has never made a profit!!

Mark Boland, Pharmaceutical Adviser

Nobody has anything to worry about then. 

Mark Boland, Pharmaceutical Adviser

An article telling the public what they ought to want. A conversation that nearly always proceeds down the route of pretending the public actually wants what you think they ought to want (which in most cases is what you need them to want).

On the whole, the British public wants very fast, very convienent and very cheap. With natural British hypocrisy they claim they support independent shops and think it is 'terrible' what has happened to the 'High Street', even though the hard facts of their spending show that they actively select to shop with online giants / supermarkets.

The British public know they are fat and they know why. They know what they ought not to drink and eat. They know they ought to exercise more. They are fully aware of the miriad of 'health advice' fired at them from all angles and they actively choose to ignore it.

It feels good for everybody involved to pretend none of this is true. Of course, for many people their employment depends on this pretence. But hypocrisy and pretence can only mask reality for so long. Bricks and mortar pharmacy will not dissappear but slowly shrink to something much smaller than it is now. We will listen to the mood music of above whilst it happens.

Ashley Pharmacist , Pharmacy owner/ Proprietor

@Mark, your title says pharmaceutical advisor, I feel sorry for whoever you are advising! 

Mark Boland, Pharmaceutical Adviser

Is that it? 

Antony Shaw, Community pharmacist

I think this article was written by King Canute, its going to happen and you can't stop it.

Ashley Pharmacist , Pharmacy owner/ Proprietor

@antony, the thumbs downs on your comment suggest people don't agree with your sentiment. The pandemic showed that  there is much more to communiy pharmacy. 

Mark Boland, Pharmaceutical Adviser

The fact that so few people even comment about anything related to pharmacy, tells you how little people care.
 
The pandemic merely showed that pharmacy employees, along with supermarket employees, are considered lowly compared to the NHS angels. 

Terrible work conditions, appalling wages but still open everyday with face to face public contact, however high the risk became to their health. No genuine recognition for any of this and appeals to now offer services for free to bail out the NHS and its backlog.

Ashley, I feel sorry for any employee you try to speak for.

 

Ashley Pharmacist , Pharmacy owner/ Proprietor

Mark, I haven't claimed I speak for employees and it's not in my title either so what are you in about? I think in your case the saying should go if you haven't got anything smart to say then don't say anything at all.

Mark Boland, Pharmaceutical Adviser

No, you said the pandemic showed that there is much more to community pharmacy. Community pharmacy isn't an abstract idea, it is the people who work in it. 

So by definition you are saying that what pharmacy employees did during the pandemic showed there is more to them than people would have otherwise thought.

Pharmacy employees were sh*t on during the pandemic. They were paid appallingly, worked into the ground, shown no respect and subjected to a high risk of infection. They haven't been rewarded in any genuine way at all.

The pandemic has shown how little respect there is for community pharmacy employees. Nearly every single employee I have spoken to is intensely angry about how they have been treated. Their personal sacrifice isn't something you can use to promote some abstract idea of community pharmacy.

Community pharmacy is an industry in which people on very low wages are subjected to intense workloads and life and death responsibilities. It is an industry based on bullying and the pinning of blame through absurd standard operating procedures. It is an industry in which employees are treated as second class compared to the rest of the NHS. 

To say that the appalling treatment of community pharmacy employees during the pandemic shows what community pharmacy can do - is disgraceful. As if the work rate you can screw out people for such low cost is something to be proud of?

Shameful.
 

 

Chris Pharmacist, Community pharmacist

Jesus, you need to tone down the rhetoric a bit there Marc.

NHS employees (doctors and dentists aside) all have a reason to complain about their pay and all include community pharmacy employees fell pretty aggrevied about their working conditions.

 

I'm not really disagreeing with you but tone done on the negativity with regards to community pharmacy, it isn't all doom and gloom out here you know.

Mark Boland, Pharmaceutical Adviser

Why should I tone down a rhetoric that describes what I have seen for a decade or more? So bullsh*tters can paint a completely false picture of the reality of the shopfloor.

Pure chaos, baskets everywhere, gross understaffing, totally inadequate workplace facilities, phoney 'clinical' services not wanted by the public and completed according to a bullying target culture.

A completely uncompetitive marketplace where incompetence is protected by control of entry and vertical integration.

The idea that those who have profited from community pharmacy are in any way fit to criticise new entrants to the market place is laughable. Why is posting medication any worse than the hell hole dispensaries that are common place in community pharmacy? 

The biggest and most ardent critics of community pharmacy are the employees. It isn't governments or the public. But their voices are silenced at every opportunity by those who profit from the current contract, painting an absurd picture of excellence that masks the actual reality. 

 

 

John Cleese, Production & Technical

I think the thumbs-downs (all 6 of them, at the time of writing) are more closely related to the echo-chamber nature of the people who read the comments sections of the C+D website.

Adam Hall, Community pharmacist

Patients will get the service they deserve. The demise of 'bricks & mortar' pharmacies will go unnoticed, until you need an urgent supply of antibiotics, or the next pandemic when the only easy access to healthcare will have gone by the way. My one hope is that by then, I'll have retired and will point and laugh at the dimwittedness of Joe Public

Keith Mitchell, Community pharmacist

When you're retired, you become "Joe Public". It's good to see someone who can laugh at themselves.

Mark Boland, Pharmaceutical Adviser

Urgent supplies of antibiotics just doesn't cut it. There will be fewer pharmacies so people will just have to drive 10 minutes further. 

Richard MacLeavy, Dispenser Manager/ Dispensing Assistant

We should point out how online pharmacies increase cost to the NHS. When it all goes wrong as it often does and medication deliveries get delayed local pharmacies and NHS 111 are expected to pick up the peices typically through a referral for an emergency supply. Then when the rx still hasn't been delivered the surgery have to issue another rx to a local pharmacy. So many prescriptions end up having to be issued twice and therefore cost twice the amount to fulfill and often with a Community pharmacy referral fee on top to bridge the gap in bettween. 

John Cleese, Production & Technical

"So many" - how many, Richard?

Ashley Pharmacist , Pharmacy owner/ Proprietor

Spot on!

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