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What are the consequences of stopping your delivery service?

"If charging for deliveries becomes common practice across the sector, I would have concerns"

Clinical editor Kristoffer Stewart asks if we should be concerned that pharmacies are changing their delivery policy

Free medicine deliveries have been a bugbear ever since I started working in the sector. I imagine the arguments against this service are often the same: the extra costs to the pharmacy; patients not being in for delivery; and reducing the opportunity for face-to-face patient contact.

One pharmacy where I worked tried to manage these problems by introducing a ‘three strikes and you’re out’ policy. If a patient missed a delivery slot on three separate occasions, then they were barred from the service. But even this rule eventually fell by the wayside because of a host of issues: poor record keeping, staff not being aware of the new procedure, and patients pleading exceptional circumstances.

So it came as no shock to me that Rowlands announced last week that it has decided to scrap its free home deliveries for all but “housebound patients” and – following the example of Lloydspharmacy – start charging an as-yet-unspecified amount for everyone else. It's clear that Rowlands are feeling the pinch from what they’ve described to C+D as the “draconian” cuts to the pharmacy funding budget in England.

And it's not only Rowlands. A C+D poll in December 2017 found a quarter (27%) of pharmacies were planning to charge patients for deliveries, while another 42% were “considering” this option.

But if charging for deliveries becomes common practice across the sector, I would have concerns.

1. Will the vulnerable be affected?

I’m worried that a charging system would cost the most vulnerable in society the most. People who live in areas of highest deprivation are both more likely to suffer from preventable health conditions, and have the least disposable income. I believe this potent combination could result in less than timely access to medication and reduced patient care.

2. Who qualifies for free deliveries?

I wonder how Rowlands will find an effective way of determining who is truly housebound, and therefore still entitled to free deliveries. The comments I’ve read on social media have suggested that “staff know their patients” and should be able to make this call, or that pharmacy teams can “liaise with the GP surgery”. But will the pharmacy team know a patient who is housebound – and by definition can’t come into the pharmacy – all that well? And what happens if a pharmacy doesn’t have a positive GP relationship, which can be a minefield at times?

3. How to calculate the cost?

Will the service be a charge-per-delivery, or a one-off payment – perhaps on a yearly or half-yearly basis? If pharmacies charge per delivery, what happens if the GP surgery sends items through in dribs and drabs? What happens if the pharmacy owes the patient an item? It’s neither the pharmacy's nor the patient's fault if an item is not in stock, so who should pay the delivery fee?

4. What happens to delivery drivers?

What effect will a change of this scale have on delivery drivers? The argument could be made that the additional fees will make these pharmacy staff members more affordable, but what happens if people refuse to pay and start picking up their prescriptions or turn to distance-selling competitors. Could this result in many drivers being made redundant?

Delivery drivers are invaluable to the pharmacy team, and one of the few members who have the opportunity for face-to-face interactions with housebound patients. Just look at Bedminster Pharmacy's driver Shirley Jamieson, who was crowned C+D's Pharmacy Staff Member of the Year 2017, and described by her manager as the pharmacy's “ambassador” for their patients.

So should free deliveries be saved?

I’m honestly in two minds about whether pharmacy should charge for medicines deliveries. I don't believe that everybody who receives deliveries truly needs them and I would like the opportunity to see these patients – who have been absent from the pharmacy, but are not truly housebound – face-to-face, so they can benefit from a pharmacist's expertise. I can see why more patients collecting their medicines from the pharmacy, instead of getting a free delivery, can be a good thing – as long as staffing levels are adequate.

However, I worry that some patients – who do truly benefit from free deliveries – may lose out if the system is changed. If patients can no longer rely on the care they expect from their local pharmacy, will they turn elsewhere?

Kristoffer Stewart is CPD and clinical editor of C+D, as well as a locum community pharmacist. Email him at [email protected] or contact him on Twitter @CandDKristoffer

Result

Has your pharmacy started charging patients for medicines deliveries?
Yes, we already charge some or all of our patients
23%
No, but we are considering it
45%
No, we would never consider this
32%
Total votes: 100
9 Comments

Paul Dishman, Pharmaceutical Adviser

Only offer a delivery service to elderly and/or vulnerable people who cannot collect their own prescriptions. Tell everyone that delivery is a discretionary service and that any abuse will mean that it's withdrawn. People who value a service won't mess you around.

Adam Hall, Community pharmacist

Please stop trotting out the "affects the most vulnerable" line - if prescription delivery had EVER been important, the Govt would have paid for it but pharmacy was stupid enough to do it for free, so the govt and patients all sat back and said a) goodness, you must make such a lot of profit that you can afford to provide this service at huge cost to yourself and b) thanks very much. The consequences are a) funding cuts and b) expectations that anyone can have a free delivery. I have news - NO-ONE ELSE IN THE HISTORY OF COMMERCE delivers for free; they hide the cost in the inflated price (or they charge separately). In answer to the questions of who qualifies - NO-ONE. It's NOT and NHSD service and we should not provide it.

A Hussain, Senior Management

I agree with you to a point and it is the fault of pharmacy, but my local chinese takeaway,indian takeaway,pizza shop etc deliver for free.  They aren't the most expensive around either so it's absorbed as an accepted cost of doing business.  I think our service should be paid for, but we arrived at this situation and to survive within it certain pharmacies had to deliver.  No good sticking to your guns if you end up losing much more than your service costs.

 

 

Adam Hall, Community pharmacist

One more thing - if your local take-away closes due to lack financial viability, who in the rest of the take-away service sector says "this is a terrible thing. How will the house-bound get access to diabetes-inducing intake?"

Adam Hall, Community pharmacist

Likewise, I agree with you to a point but, given the government are intent on squeezing margins for pharmacy, and I would be suprised if any delivery doesn't result in a net loss to the pharmacy, there is a point at which you let those patients who don't make you any money go elsewhere and let those pharmacies take the loss. Compare us with Dispensing Doctors - any item they get no discount on, rather than  dispense at a loss, they give the prescription to the patient and the patient goes to a pharmacy, who dispenses it at a loss! Now, you tell me, who is the mug that is "concerned for patient welfare" and who is the "financially astute service provider who is looking to their long-term sustainability"?

Uma Patel, Community pharmacist

The delivery by the takeaway joints is NOT free.The gross margin in this industry is about 70-80% as compared to 30% in pharmacy and they don't have to employ a pharmacist. Cost of delivery is in the price and you pay CASH on receipt. Any service which is not paid for at the point of delivery is not valued and is likely to be widely abused

C A, Community pharmacist

Refusing delivery could just push people into using certain online services... which could then result in the law of unintended consequences

Richard MacLeavy, Dispenser Manager/ Dispensing Assistant

Yes you are right but these certain online services are loss making. Unless some element of their model changes they will evenutally run out of investors and go bust. Plus in my experiance patients who switch to online pharmacies come back a few months later as its much more hassle having to collect it from a post office depo with minimal opening hours than a pharmacy whenever they miss the delivery, also these services cause you all sorts of problems with acute items sent EPS to your nominated pharmacy, leave you a few days each month without medication as they are behind on dispensing and kill the dog when the posty pushes the meds through the letterbox to rover assiting from inside. 

Tony Schofield, Community pharmacist

At the end of the day, those that continue to offer free delivery will advertise and patients will make a choice. It’s not a big deal. However remember that some deliveries of surgical items do attract a fee for home delivery paid by NHS. So charging again could have consequences......

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