How painful could a transition away from purchase profit be?

Community pharmacy must let go of its reliance on purchase profit, but this won’t be easy, says Mike Smith, chairman of Alliance Healthcare. P3’s Carolyn Scott asks his views on issues for the sector

Q. Is the role of community pharmacy sufficiently recognised? Is there more work to be done?

I have said for virtually all of my 50 years as a pharmacist that the role of community pharmacy is not sufficiently recognised. Those who have heard me speak publicly over the years will know that I always refer to the need for pharmacy to change; this is never truer than today.

I’ve heard patients say they didn’t realise that pharmacists could do things like blood tests, blood pressure tests and cholesterol tests, and give medicines advice. I think that probably is very much down to our poor PR – frankly, we’ve not been good at selling what is a very good profession.

I think the main problem is that we go to the Department of Health with three different voices – PSNC, NPA, RPS – which led to a recent Pharmacy Minister, Alistair Burt, saying “You need to come to me with one voice”, and he’s absolutely right.

I’m therefore hopeful to see significant change in our professional bodies. I hope that the new chief executives and board members can and will bring some new thinking.

Community pharmacy brings so much to patient care and medicines use. Because medicine is no good without compliance, it doesn’t matter what you give a patient if they don’t take it, it’s a waste of everybody’s time. Plus, the thing that’s really over looked, as far as community pharmacy is concerned, is that it performs a very important social function – but this is not recognised; it’s not paid for.

Q. What does community pharmacy need to let go of and what does community pharmacy need to preserve at all costs?

To me, there’s a simple answer. We must let go of our reliance on purchase profit. And the relationship between the pharmacist and the patient, face-to-face, is sacrosanct. The minute you lose that, you lose probably 80 per cent of the actual value of the pharmacist. The ability to hold a one-to-one conversation with the patient is really important. You can’t do that down the telephone because you can’t read body language, and the minute you lose the pharmacist from the supply chain, we’re gone, in my view.

I’m not resistant to change, but for all these reasons bricks and mortar pharmacy must continue to have a place in the provision of primary care.

Patients come out of the GP’s surgery, and maybe they’ve been diagnosed, say with diabetes. They’ve got a load of instructions and new tablets, and they’ve not understood half of what the doctor has said – they can sit down and talk with the pharmacist, and that’s invaluable.

Q. The closure of some House of Fraser department stores is perhaps a timely reminder that people’s lifestyles and consumer habits have changed dramatically – maybe forever. What are the issues for pharmacy in terms of rise of online pharmacy, automation, hub and spoke etc. and where do you see this going in the next few years? Will the transition be painful?

High street pressures are terrible at the moment, and for pharmacists who have horrendous rent reviews, crippling commercial rates, minimum wage, and things of this nature, the pressure is coming from all directions. I think this may lead to closures.

As NHS margin continues to fall, and I’m sure it will, pharmacists have to identify alternative, sustainable income streams through services. We have to replace it with something. We have to pay our staff, to pay our insurance, our rates, and then hopefully have some money to take home for the family.

We always used to reckon on a simple rule that the NHS payment would pay the wholesaler, and then the rest would be your margin. We are now regularly speaking to pharmacists who say they are having to draw on personal savings to pay the wholesaler. One pharmacy owner said he was down £17,000 last month and then he’s still got to pay his wholesaler.

However, I do believe that the transition from payment for volume to payment for service will be even more painful than what we’re experiencing now. I think online pharmacy is a real threat – IT use will inevitably increase over the next generation. I have got doubts over hub and spoke, however, having seen some who have tried it go on to withdraw from it because it hasn’t brought about savings.

Q. The NHS has turned 70. Looking back in history, has the NHS been good for pharmacy?

The NHS is good for everybody, but the problem is that we are struggling to afford it. In my view, co-payment is inevitable, and this has been reflected recently by the decision to move some OTC prescribing to patient purchase instead.

Medicines waste is a particular issue for the NHS, which no one is really tackling. People don’t want to tell the GP they’re not taking the medicine, so they just stick it in their cupboard and when the family go around to sort out their affairs they find a cupboard full of expensive medicines. The thing that frustrates me is that we all know these problems exist and still nothing happens.

Q. What disappoints or frustrates you most about pharmacy today?

Our negativity. It’s such a high-pressure environment, that I can understand this, but I do think I would like us to turn this into positive energy.

Take time out to plan for the future and take back some control. Get a locum for a day or something and plan, what are you going to be doing in six months? What are you going to be doing in 12 months and how? I think that this is really important. It’s such a labour intensive business, that sometimes you can’t see the wood for the trees.

Q. You have a strong interest in encouraging students on the profession. What sort of career do you hope for young pharmacists qualifying today?

This is a topic that’s dear to my heart. I think the first thing I’d say is we have to leave them a profession suitable for their truly outstanding academic achievements. These are really smart people; their clinical skills are second to none. However, it really upsets me when I see young pharmacists working in prescription factories for £15 an hour after five years of university training. That’s not, in my view, a suitable career.

Q. What is the single most impressive thing that you have seen in pharmacy in your time in the profession?

Pharmacist prescribing, for sure – we wouldn’t have dreamt of that when I qualified. Doctors sat at the right hand of God and you did not question their prescriptions (well I did, as you can imagine), but you wouldn’t have dreamt of prescribing medicines. Though it does frustrate me that we have pharmacist prescribers who are finding it difficult to find a prescribing role.

Q. As in general practice, the life of the single-handed independent pharmacist is looking increasingly difficult. What messages do you have for independents?

Partnerships to mutual benefit are a possible route I think, but mergers can be difficult. Entrepreneurs tend to be more used to rowing their own boat.

Everyone does need to make sure that they have advice on management. One of the things that is apparent to me is that cash flow is key in community pharmacy, and the minute you can’t pay your bills, you’ve got a problem. Alphega Pharmacy has a lot to offer members there. You have to try to be the best, as the reality is that only the fittest will survive.

We also all need to be on top of some of the tricky current issues. For example, with generic medicines, something has got to change, frankly, because the current system is unsustainable. Two of the things that keep coming up in conversations are the uncertainty about the future around FMD and Brexit. FMD is going to happen, but I don’t think we’re adequately prepared for it in community pharmacy.

Another suggestion from me is to encourage pharmacists to get in touch with their GP to see if they can agree to carry out more consultations of a triage nature. Say, for ladies coming in with a UTI or a child with impetigo, or something like that. We can deal with that, with agreement from the GP, and there have been many examples of arrangements like this over the years.

Working together, with other pharmacies and with GPs and others, must be the way forward. Don’t get left behind doing things the old way.

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