Nigel Swift is MD of Rowlands Pharmacy and deputy MD of Phoenix UK and, with oversight of Numark membership too, he loves his job. But the issues that face UK community pharmacy currently are the worst he’s ever seen. By Arthur Walsh

“It is so serious,” says Rowlands Pharmacy managing director Nigel Swift of the dire situation facing England’s pharmacies – worse than he’s ever seen it during his 23 years in the sector.

I speak to him in late November, just days after LloydsPharmacy announces its total withdrawal from the community pharmacy market, a predictable development that nonetheless shocked many.

Swift – who also acts as deputy managing director for Rowlands’ parent company Phoenix UK, with oversight of Numark membership operations – started his pharmacy career in what was the UK’s second biggest chain and spent many years working for its then parent company Celesio. The news has clearly resonated with him on a personal level: “It’s a huge turning point,” he says.  

While he believes a quick succession of corporate buyouts “didn’t help” Lloyds, he is clear on where the blame lies: “It’s primarily about the funding. It’s heartbreaking. I’ve never seen it like this.”

It’s not just Lloyds that has suffered, of course. “Across the board, people are exiting pharmacy,” Swift says. “It’s almost impossible to make it pay under the current English contract.”

Boots is pulling out of several hundred stores, while many independent contractors are “putting their own private money into their businesses” and some small chains like Whitworths Chemists have been forced to sell up completely.

Then there is Rowlands Pharmacy itself, which is down from around 500 pharmacies when Swift joined in 2021 to 380 now. In November 2023, Rowlands published annual accounts showing a £219 million loss for the year to February 2023, primarily driven by a £216m impairment charge the company said was necessary due to “the uncertainty of future pharmacy funding” as well as a dip in profitability.

Swift tells me about the company’s plans, which include  a close/merge/sell strategy at branch level: “We’re looking at the size of the estate and at profitability in the long term.”

Exiting pharmacies is “the last thing we want to do”, he says, adding that the company has bought 34 stores in Scotland where “the contract is much more beneficial to pharmacy”. The company wants to maintain as much of a presence as it can in England and Wales, but it’s not easy. “We are looking at England and saying that a particular store will not be profitable for us within a one or two-year time span, but luckily, we can then offered it to a Numark member and hopefully keep that within the family. That’s what we’ve done with each of the Rowlands stores we’ve exited – offer it to a Numark member. It’s key that they get first choice on those pharmacies.”

Swift identifies a fundamental need to assess business model viability: “If you look at the larger chains – of which we were one at one point – the biggest problem is the huge cost of having a centralised support centre. For me, anyone that’s got a support centre can’t make pharmacy profitable, that’s what I believe.”

Rowlands was undergoing a restructure when Swift spoke to P3pharmacy at the end of November. “We’ve got to keep it as lean as possible,” he said.

Rise in membership

I speak to Swift at a busy time for Phoenix UK, as Rowlands stores gear up for the traditional winter rush, and the growth of the independent sector – driven in part by the Lloyds sell off – has led to an uptick in Phoenix’ wholesale market share. The company is investing for future growth with the opening in July 2023 of its biggest UK depot, in Wakefield. While there are some “teething problems” with the new warehouse, Swift is confident that “soon enough, we will be number two in the market – that’s our target”.

The company is also busily gearing up for the launch of Pharmacy First, which he describes as being of “critical” importance. Pharmacies are flat out getting ready: “We need to show we’re good at this. The worst case scenario would be if there’s not a massive uptick in consultations.” Delivering all the necessary training in a short time frame is “intense,” he says, forecasting a busy start to 2024.

But the key item on the agenda is the huge rise in independent pharmacies joining Numark, which offers group purchasing advantages as well as support with business functions like marketing. “When Steve [Anderson, Phoenix UK group managing director] took over a few years ago, we had 1,000 members – today we have 5,600.”

Almost 70 per cent of independent pharmacies are Numark members, claims Swift. “Hopefully we can help them make their business profitable and drive it forward.”

Again, LloydsPharmacy crashing out of the market has been hugely significant. “As the independents started buying the old Lloyds branches up, we were there to help them convert them to a new independent pharmacy,” Swift says, explaining that since December 2022, 1,000 pharmacies have switched from being a Company Chemists’ Association member store to joining an independent with one to five branches.

Numark has been in close contact with the new owners throughout the process. “If you suddenly grow from five to 20 pharmacies, it’s not viable to create a huge support centre for them – this is where we can help,” says Swift.

“A big part of the Numark offer to members is the different buying portals and making sure they get the best value for money,” he says. The more loyal to us they are as new members, the bigger the discount they get and the bigger profit they’ll make.” This helps free up time in the pharmacy, he says – something that will be critical as more services are rolled out.

Swift describes a synergistic relationship between Rowlands branches and Numark members, with services often trialled in the chain before being offered out to the membership and a centralised team offering support to both. “Anything we’re doing at Rowlands, we can show the value and profit margin in it and point independents to the way we can see the revenue generating. Everyone’s desperate to put more revenue and profit back into pharmacy.”

Turnaround

Where does he see that revenue coming from in these difficult times? NHS services should be the number one focus, he replies, saying Rowlands has had a “huge turnaround” with NHS services in the last two years: “If you take something as simple as NMS in England, it’s a real opportunity to work with patients in your community and also drive the business.”

Flu is “massive” business too, although NHS England’s decision ahead of the 2023 drive to drop the pandemic measure of offering 50-65s a free jab has hurt numbers. “There have been a lot less people compared to the last two years,” Swift says. “That really worries me as we get into winter and NHS beds fill up.” Flip-flopping on the start date didn’t help either, he notes.

Private services constitute another growing arm of the business, with Swift citing vaccination services like travel, chickenpox, shingles and pneumococcal, as well as ear microsuction. “And the big thing this year has been weight management with Saxenda,” despite ongoing stock issues.

“If we can get supply sorted out, weight management would be a fantastic private service,” he says. “There’s a real demand for it. We’ve got patients built up on a waiting list for a service we can’t get stock for.”

“There is also a huge piece around OTC,” says Swift, which some can be too quick to downplay. “OTC only contributes around five per cent of sales, but if you take a deeper look, it’s at least 10 per cent of margin.”

UK pharmacies have the lowest sales contribution from OTC in Europe, he says, explaining that customers on the continent are far more used to seeing a pharmacist about skin complaints and other such ailments. When some continental-style services have been trialled in the UK, “people just weren’t used to that kind of shopping experience in a pharmacy.”

Automation has been another vital ingredient in cost management efforts, with Rowlands’ use of Nupac and Medipac automated dispensing solutions helping it to reduce staff overheads and streamline operations. Swift says that when he started out at Phoenix, its use of automation was one of the things that most impressed him, adding that error rates are now “negligible” as a result. Over half of all Rowlands’ scripts are dispensed off site, releasing time for pharmacists and pharmacy technicians to deliver services.

“We’re always looking for ways to increase that efficiency,” Swift says.

The company’s centralised PilPouch service has helped it to sweep up business from chains that have stopped doing MDS trays – which he says, are “really expensive labour-wise” – and to grow this activity in Scotland, where MDS trays are still commonly used.

If and when hub and spoke legislation is passed, it will be “really key for our Numark members”, Swift believes. For the time being, members benefit from the Golden Tote prescription picking service, to which over 100 members have signed up and are “really seeing the efficiency”.

Swift has expressed concerns about distance selling pharmacies (DSPs) in the past and is keen for progress to be made to clamp down on those that claim to operate nationwide but in reality target much of their business in their locality. “That’s been on the agenda for God knows how many years,” he says. “Every October, there’s supposed to be a new legislation bill, but it’s still not arrived.

“We have a DSP ourselves for Rowlands patients who don’t want to come to the pharmacy. We need to put ourselves where the patients want us, and some patients want that. But the volume is very low and, frankly, we don’t want that volume coming through. For us to dispense an item like that costs us money every time.”

He says the surge in patients switching to DSPs during Covid has “flattened now”.

Need for change

How can the sector go about securing a better contractual settlement? “It’s about people standing up and shouting about it – I don’t know how we get Government to listen. Over my 23 years in the sector, the pharmacy bodies have been speaking to Government constantly and it doesn’t seem to have made much difference. I’m not saying they don’t do a good job – it’s like it just falls on deaf ears.”

There is a constant sense that “we’re not taken seriously in England as a real healthcare provider,” he says, as evidenced by things like the introduction of ARRS without consulting the sector. “The constant change of health ministers doesn’t help,” he adds. “We try to link in with the new minister and understand what they need from pharmacy, but then a new one comes in and you have to start again.

“Six or seven years ago, NHSE was saying there were 3,000 pharmacies too many. Well if that’s the case, we’ve still got another thousand to go. We’re going to remove pharmacists from communities and that’s going to have a huge impact.

“For lower volume pharmacies, it’s almost impossible to survive. Look at the Sainsbury’s branches – they were on average 5,500 items a month. It’s impossible to make that work, and it’s been no different with us. We’ve been closing pharmacies and merging some that are very close to each other.”

He doesn’t rule out further Rowlands divestments, but says: “I think we’ve identified where we want to be and it’s important to have credibility with our new members. We have a retail estate and we’re sure we can run it.”

“The sad thing about the divestments over the last two years is that the business top line is that our items are growing, our OTC is up 45 per cent compared to two years ago and services are up 50 per cent. We’re doing everything we can, but we’re still having to exit some locations because we can’t make them work for us. You’ve got prescriptions coming in where you’re dispensing at a loss and that’s not a viable business for anybody.”

Pharmacy First is undoubtedly a positive indicator. It’s “really welcome,” says Swift, although there is some frustration that it has taken so long to arrive. It will be instrumental in making community pharmacy careers more attractive through a clinical role, as well as relieving pressure in the NHS – which he describes as the key USP pharmacy must drive home in negotiations.

But with the rise of services, the sector’s manpower problems only become more acute. “These past two years, I’ve never seen it so difficult to get a pharmacist or technician into a pharmacy,” he says.

And there are medium and long-term questions that must be answered too. “What happens in 15 months when that money [the £645m announced as part of the primary care recovery plan] is gone? We need concrete guidance about where the next batch of money is coming from.

“The Pharmacy First money is definitely very welcome, but it’s just not life changing. If you look at the average value per pharmacy, it still leaves many that will be loss making, or just about breaking even, because the contract has been flat for five years.”

This will be particularly acute in April, when the national living wage (NLW) rises. “It’s definitely welcome for our colleagues, but the Government needs to reimburse us,” Swift says. “It will be a big test for every pharmacy in the country. The NLW has risen annually for the last few years and this is the biggest increase, while the contract has been flat. And it’s not just about the 10 per cent rise in the NLW, because you’ve got to maintain salary differentials between roles to keep people in the business.”

A new contractual settlement is due in April, although Swift suspects the negotiations will run past the deadline. But whenever it is announced, he says: “We will need a huge investment.”

Biography

Swift says he fell into pharmacy 23 years ago, starting out as a LloydsPharmacy area manager in “one of the toughest regions” in the North of England. “It was completely new to me, but within the first couple of months, I loved it – the fact that we were serving communities and helping people.”

After positions in Rotherham, Scunthorpe and Barnsley, Lloyds parent Celesio posted him to Milan, leading to him working on the continent for six years. When he came back to the UK, “it was a bit of a shock to see how pharmacy was treated here – and that was before the cuts. Pharmacy is taken so much more seriously in Europe, it’s a real pillar of the health services.”

Swift has been with Phoenix for just over two years now, having joined at a time when the German entity was expanding its reach throughout the continent and in Ireland, where he had once worked for Celesio. “It was an exciting time.”

“There’s such a fantastic culture at the Phoenix group, which is family owned,” Swift says. “It’s not this big corporate environment. People listen to you across the whole business. It’s the best job in the world.”

“Phoenix is now the number one in Europe, with 45 billion turnover and 45,000 employees. We’re lucky we’re family owned and there’s enough finance there to support the UK.”