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'Does the NHS view me as an inconvenience destined for the scrapheap?'

"If community pharmacy is to save the NHS there needs to be some protection from market forces"

While a service-based contract could “lighten the load” for other healthcare providers, The Supermarket Pharmacist questions the financial benefit for pharmacies

I’m a firm believer that community pharmacy can provide a lifeline for the NHS. However, there are major issues with being that solution. Let’s imagine we can put to one side the funding cuts and the battles with other primary care providers who feel we’re pinching a slice of their pie. The biggest threat to community pharmacy being the solution to the NHS’s problems is the move towards distance supply, and how this is set to decimate the sector.

Distance supply terrifies me. Whether it’s through expensive advertising or a smart-looking app, distance supply is expanding rapidly. A quick look at the Department of Health and Social Care’s (DH) figures tells you all you need to know.

Boots highlighted “lower prescription volume” as part of the reason for its decreasing sales. Meanwhile, Pharmacy2U is investing in new premises and talking of supplying 7.5 million items a month, which would equate to them potentially cornering an 8% share of the prescription market. Such change will dramatically alter the community pharmacy landscape. This is happening. It is real.

With the current funding arrangements, struggling smaller-volume pharmacies will go under, and the multiples will consolidate their businesses. It’s going to be brutal. You’ll initially see some volume increase for local competitors as others fold, but what’s not to say that the cycle won’t repeat itself again and again, until pharmacies disappear from the high street altogether?

Is this bleak situation what the DH wishes to see? Well, apparently not. Community pharmacy can apparently “lighten the load” of general practice through service delivery. ‘Fantastic news!’ we all cry. However, by the time the bigwigs in London get it together, there will probably no longer be a viable network of pharmacies to deliver the GP practice-saving services it desires.

So, what of this new service-based funding? Will this keep all of us in jobs and keep patients healthy and out of the surgery, instead of visiting A&E or clogging up hospital wards? Are there genuinely long-term solutions on the horizon?

The patients that I see come to get their medicines and, on the whole, they just want to get in and out as fast as possible. They're not really interested in services unless they see instant or financial benefit. I can’t see the situation where service is the sole source of income and draws patients into my supermarket pharmacy.

Any premise whereby services alone could provide enough income to sustain my pharmacy is folly. Unless community pharmacy is more closely integrated into primary care – and the service element my pharmacy provides is a critical element of supply – my role and the benefit I deliver will disappear.

If community pharmacy is to save the NHS, in the interim there needs to be some form of protection from market forces – before it’s too late. I also need to see a positive vision from the chief pharmaceutical officer and the DH about what community pharmacy could do, and how they intend to integrate us into primary care. At the moment it just feels that, as a community pharmacist, I’m an unwanted, unnecessary inconvenience, fit only for the scrap heap.

The Supermarket Pharmacist is a pharmacy manager in a well-known supermarket chain. You can follow him on Twitter @Pharm_Super.

9 Comments

Ronald Trump, Pharmaceutical Adviser

R.I.P Community Pharmacists.

Amazon is coming.

Advice: If you don't like it and you're not near the end of your career- start training so you're prepared to go into a different role.

Regards,

Ron

Lucky Ex-Boots Slave, Primary care pharmacist

Many pharmacists that I've spoken to are reluctant in changing careers. Main reasons being -

1) community still pays the best salary especially locum rates despite all the stress and staffing crisis,

2) many have been in community sector for nearly the whole of their career hence not wanting a change,

3) some are not competent or confident in changing to a more clinical role as it is outside of their comfort zones,

4) by changing roles they have to take up more trainings and responsibilities, and more liabilities but these don't come with a pay rise and even a pay cut, so literally no incentive to do so.

Above all I reckon the financial issues is the hardest obstacle to overcome. I don't expect those pharmacists in managerial positions or those locums earning £50k+ a year willing to accept the change since they will be taking a massive pay cut to most likely only a band 7 pay!

One thing that didn't help was supermarkets opening needless pharmacies under the 100hr exemption.

Your general point about the online threat is a valid one, services as they exist now cannot provide enough income to cover costs. 

I'm afraid I can't feel that sorry for supermarket pharmacies though. My local Tesco pharmacy does ~3000 items per month and is open 100hrs per week, does it really need to be there? There are 2 other pharmacies within half a mile who could pick up the slack easily (not that I work in either of them myself). Obviously I'd have sympathy for any staff that lose their jobs.

Good article that poses a question many community pharmacists like myself are asking....Will this [service based contract] keep all of us in jobs and keep patients healthy and out of the surgery, instead of visiting A&E or clogging up hospital wards?

We IMHO unless we have a service based contact 30% of us will be out of a job in the next 3 years and perhaps 50% in 5 years. And the reason - you said it - a shift in patient habits to get their medicines in a different way. We might not like that but Blockbuster is bust and Netfix (who Blockbuster could have purchased for $50m) is the darling of the airwaves and is now worth $1,500m.

Mark Boland, Pharmaceutical Adviser

Your equivocation supports distance selling. Netflix replaced Blockbuster because new technology rendered bricks-and-mortar inconvenient and unprofitable.

If Pharmacy2U is Netflix, then advocating current pharmacy 'services' as a means of survival, is the equivalent of saying Blockbuster could have survived if only they had provided 'added-value' by offering in-house advice to customers about which films they should rent.

The market is about to render a decade of 'MUR anecdotes' a story of inconveinence and unprofitability.

 

Leon The Apothecary, Student

At least one company was looking to cut staffing hours after implimenting their hub and spoke model by 50% straight off the bat. If you consider that the aim is to take away all regular medications, it is completely understandable why business would want to reduce bodies in the local stores.

Mark Boland, Pharmaceutical Adviser

'The patients that I see come to get their medicines and, on the whole, they just want to get in and out as fast as possible. They're not really interested in services unless they see instant or financial benefit. I can’t see the situation where service is the sole source of income and draws patients into my supermarket pharmacy'

This has been true since the start of the new contract in 2005. Services are faux innovations for which there is no demand. By not protecting the supply function and replacing it with 'services' the public dont want, we have made ourselves dispensable to those who will supply prescriptions in the quickest and most convenient way - the thing that patients actually want.

'At the moment it just feels that, as a community pharmacist, I’m an unwanted, unnecessary inconvenience, fit only for the scrap heap'

At the moment you are an unwanted necessary inconvenience, that is needed as a bridge to a distance selling normality. This ought to have been obvious since 2005.

Emmanuel Chisadza, Community pharmacist

Today I consulted with a patient sent to us from 111 who went off to buy my recommended product from a supermarket down the road. My time and expertise is not funded. That cannot be right?

Mark Boland, Pharmaceutical Adviser

France and Germany have strict provisions limiting the supply of OTC medicines to pharmacies, this is based on the assumed advantages of 'expert' supply. The pharmacist is 'funded' through said market protection. This has been surrendered in the UK and is irreversible. Any time spent on this issue, is wasting time you dont have.

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