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Mandeep Mudhar, head of Alphega Pharmacy, tells Arthur Walsh about the ways the network helps its members thrive

Independents are living through a time of uncertainty, Mandeep Mudhar tells me. Head of Alphega Pharmacy since 2021, he says member businesses are facing the same headwinds as the rest of the sector: “cash flow, remuneration, dispensing at a loss – the whole funding structure and the uncertainties it creates”. 

Drug Tariff clawbacks are a particular headache. “Every business needs to be able to forecast and tell themselves: this is what my turnover looks like, this is what my costs look like. When you haven’t got that certainty, it creates a huge moment of challenge. You still need cash to pay the bills and the salaries.”

On top of that, the sector has been set the task of reorganising its workfl ows from top to bottom: “Pharmacies are asking, how can I juggle my time and my team’s time in delivering services without dropping the ball in terms of the core, which is dispensing.”

The growing membership organisation – “we’re now just over 1,450 members” (around 500 more than three years ago) – tries to give independents tools to cope with the pace of change. For example, Alphega business mentors might recommend carrying out a ‘time motion’ study to assess what staff are doing when – including owner pharmacists.

Happily, Mudhar says, the sector is largely open to the new opportunities. As supervision regulations change, he fi nds that some members are spending almost the whole working day in the consultation room delivering services. “A few years back, they would have said I’m spending the majority of my time in the dispensary because that’s where I need to be.”

Delegation is still a big leap for some. He comments: “In my early days as a pharmacist, the thing was, you are the final signatory on that prescription. If it leaves and you haven’t checked it, it’s on your shoulders. If you’ve still got that mindset, it’s a big change to trust someone else to do that.”

“We’re helping pharmacists make that leap, and it’s absolutely wonderful to see when they do. It frees them up to deliver the services they need to.” 

For many, it’s a more satisfying way of working. “That is what they were trained to do: put their clinical knowledge into practice.”

He says he saw the importance of pharmacy services well over 30 years ago, having identified both their entrepreneurial benefit for independents and their suitability for evolving patient needs.

Don’t just cut costs

A community pharmacist by training who has worked in academia before moving into commercial roles with Numark and now Alphega, Mudhar says: “I have, I hope, a really good understanding of independent pharmacies and their needs, because that’s what I know.” Alphega is part of Alliance Healthcare, by Cencora. 

“One of the elements of the Alphega proposition is very much about ensuring our members get the best commercial terms when buying. 

"That is very much an Alliance Healthcare offering and we work closely with Alliance teams to ensure they continue to provide the best terms for our members – things like making sure they get their deliveries on time and in an efficient manner. If you don’t get our stock at the right time at the right price then all the value-added stuff gets lost, because those things are quite stressful to a pharmacist.”

We discuss wider cost challenges facing contractors, whether it’s landlords upping rents or increases to business rates and the minimum wage. “Some of this stuff is unavoidable. We aren’t saying for a second you must cut costs, because the work still needs to be done. But are staff in the right place at the right time?”

“That’s where we come in and look at how they’re deploying their teams. We advise against cost-cutting as a knee-jerk reaction; it’s the first thing organisations tend to do when costs go up. We encourage them to deploy costs in a diff erent way and look at staff as an investment, not a cost.

“Are you buying in the best possible way? Using the best systems to track the prices of products you’re buying from various wholesalers? Are you keeping an eye on what’s going on with reimbursement and pricing? There are many ways of dealing with cost.”

The key is to “take a step back and really analyse things,” he argues. “There is always room for improvement even in a highly efficient pharmacy. Let’s face it, every pharmacy gets twice-daily deliveries minimum from every supplier. So, do you need that amount of cash tied up in the stock you have in your dispensary? There may be some pretty expensive stuff there.”

“Retail is definitely an investment,” he continues, before quickly adding: “We’re not talking about ploughing huge amounts of money into over the counter (OTC) – but you can do little bits of improvement in the retail environment by having the right planograms; the right type of medicines; and making sure you’ve got the right signage so people know where everything is when they walk into the pharmacy.”

Just a one per cent uptick in retail turnover “may make all the difference in paying the incremental rate and rent hikes, whatever it is that’s been imposed on you,” he believes. “Try and get out of a difficult position by growing your business – that’s the message we continue to put across to them.”

Private services are the key area for investment, he maintains. “If you speak to our members who’ve embraced that area, they consistently say it’s possibly the most buoyant sector within pharmacy practice at the moment – largely because there’s a huge opportunity around weight management.

“We seem to have fi nally reached a point where patients are willing to pay for an element of their healthcare. It may not be a majority, but I think there is an understanding that they cannot get some care options from the NHS, whether it’s weight management, travel health, or whatever else it may be. They can get that service from a pharmacy.”

Alphega encourages members to perform a local analysis to assess appetite for potential new services, also offering set-up support with Patient Group Directions and finding training providers.

“And then there’s the marketing,” he says. “Clearly, for you to grow your private services you need to be effective at marketing – but again, you don’t have to sink a huge amount of cost into it. You’ve already got a very loyal customer base coming in.”

Website messaging and in-shop displays are important marketing tools, and when it comes to social media “Facebook still works but whether we like it or not, TikTok plays a big role, particularly for weight management”.

Many younger members tell him that patients find out about their services through the latter app. “Sometimes you have to play in those channels to attract people. Our message is please, make sure you do it in a responsible way, because there are pitfalls if you don’t.”

Information sharing is a two-way street, says Mudhar. And these talks with members are “in no way” a tick box-exercise, he says. “A member might come to me and say, I think you guys are missing an opportunity here. I’m working with a great provider of blood testing services.

"Within a few days we’ll go and look at that provider and, if it works, will start engaging to see if they can provide a service to the rest of our membership. Independents are, by nature, entrepreneurial and will sometimes fi nd opportunities before we do. Why not learn from them?” 

Measuring success

If Alphega’s membership is growing, it’s partly due to the independent pharmacy sector being “so buoyant” in terms of market share, says Mudhar. He insists it also shows the group’s offer is still relevant, with word of mouth an important source of newcomers and the company’s network of business mentors “always prospecting”.

With it comes a challenge: “Are we continuing to remain current and innovative? Are we still doing what we should be doing – meeting the needs of the independents out there?”

How does he measure the impact of Alphega’s efforts? “Some of it is through meeting them and asking questions. I’ll see a couple of members each week. There isn’t a day that goes by without one of our business mentors having in-depth conversations with members. That’s where you really fi nd out about the challenges around cash flow, as well as opportunities for services.”

How do Alphega members perform compared to the sector average? “It’s sometimes difficult – not every pharmacist has EPOS data in terms of quantifi ably tracking sales data, although we have some members who do, and by and large they do perform better than non-members because we can see the volume of product being bought from, for example, our parent company.

“If they can quantify their overall turnover, and quite markedly you’ll see that there’s been an uplift in their OTC turnover year-on-year. It gives you heart that despite a market that’s quite challenging, to see there is growth in the OTC channel of a traditional community pharmacy means you are giving them the right level of support.”

How many onboarding members are new entrants to the market and how many are more seasoned owners? “In the last year or so, I’d say a majority have been new contractors, which is really heartening for me. What I’ve noticed is they’re not only joining because they’ve heard from colleagues or friends about us, but also because they see a need for the support that we provide.”

Younger contractors are more ready to invest in the shop fl oor’s appearance, he says. “That’s a big shift from where retail was 10 years ago, when it was seen as almost an afterthought because OTC was such a small part of their turnover.”

“Also, they obviously want to operate in a highly professional manner in delivering services. It’s been really heartening to see that these younger pharmacists are open to listening and to change.

“The consumer is quite critical now in terms of how they want to shop. They have so much choice. Gone are the days when you just had to go to a pharmacy because there wasn’t another one nearby, you can be quite picky now.”

A pharmacy that “looks the part” will have the advantage, says Mudhar. “That’s no disrespect to the previous owners, but if the new owners put money into refurbishing the shopfront and creating a modern, fit-forpurpose consultation area, it pays dividends.”

A trend with more established owners is that many have grown their estate in recent years, and now are faced with the complexity that comes with group operations. “They’re still independents, but what they’ve identifi ed is that it’s very diffi cult for them to manage the group and create the same level of consistency.

"They can’t have a huge amount of central cost or a big head office. What they look for is a partner like us, who can become their area manager and create some consistency among their pharmacies in terms of service delivery.” 

Digital change

“I’ve always been of the belief that digital is where you will bring efficiencies to a pharmacy,” Mudhar says. “I’m not talking about spending hundreds of thousands of pounds on the latest tech. It can be simple tools like one we’ve created to manage holiday bookings. It costs nothing, it’s part of the Alphega proposition. It can be as little as that or as big as a huge robot.”

His team will ask other questions, like: Are you maximising the PMR? “Those systems are there to bring you efficiencies, but many pharmacists are probably not using the whole system.”

Does Mudhar see artificial intelligence (AI) playing a role in the pharmacy of the future? “I get a lot of questions about AI and internally we’re exploring it. At this stage, I don’t think it’s a panacea for everything. It has to be used responsibly.”

He says there is “no doubt” that some pharmacy processes will be the better for it, for example the stock ordering process and other “mechanistic” tasks.

But there are limits. “I think you’ve got to be really wary at this stage about using AI for any patient-facing decisions. The pharmacist has enough knowledge to deliver that information credibly.”

Pharmacists can be traditionalists and“slower adopters,” he tells me. Is that a challenge? “It can be. Part of it is, if you’ve spent so much of your life doing the same thing day in, day out – and having to do it very safely – being asked to change your way of working because of services takes time.

"On the flip side, it’s heartening to see how quickly many have made that change because they have no choice. When your back is against the wall fi nancially, you know you’re going to be disadvantaged if you don’t change.”

Member innovation

I ask if he’s seen Alphega members off ering innovative services. “We have some incredible stuff going on,” he replies. He’s recently been to a North London pharmacy running a private genomics service, and cites others doing diagnostic testing for blood pressure, cholesterol and other health issues.

“We always urge people – if you do this off your own back, please make sure it’s with a credible provider and that the information being given to patients has proper backing. If not, then let us evaluate it for you.”

Other examples include community outreach initiatives like vaccination programmes, or members who have found a positive way of working with their local GPs. Some doctors can be a shortsighted when it comes to the newer pharmacy services, he says.

“But I meet members who say they and their local GPs are literally hand in glove. The GPs see it as a huge amount of work that’s been lifted off their plate.”

“Part of my mission has been to take the learnings from those members and create communications for others so they can try to unlock that relationship with their GP. There’s always a way around it.”

He thinks the upside to services comes in the form of job satisfaction and a clinical role in the community “that hopefully gives you a good status in the primary healthcare team as well, which can be used to get more funded services commissioned”.

How does he see 2026 shaping up? “One of the things I’m really keen to understand – I keep coming back to this – is how do we deliver more efficiency for headroom? Particularly with the new supervision arrangements coming in.”

He also wants to scope out technology providers, “not quite to the length of hub-andspoke technology but who can help improve the dispensing process”, as well as continuing to share insights from member innovations with the wider group.

And they are looking at diagnostic testing providers too: “We are always looking at different ways of enhancing the knowledge of our pharmacies and their teams in terms of training and sharing insights.”

Some members took part in the NHS prescribing pathfinder programme, and he has been busy taking notes from their experiences. The question is: how the NHS will extrapolate pathfinder outcomes to the wider network responsibly? “It will be an opportunity for all the new prescribing pharmacists coming out to have ideas. With GP support and training , the health system will be able to embrace the fact pharmacies can now do this.”

“As with all things now, it’s a question of how do we go. We have good examples from Scotland where it has been working. We must take account of what’s happened there, where it’s an accepted role for pharmacists.”

He thinks it’s too soon to expect a prescribing service in the 2026-2027 contract. “The trainees coming out now will still need that period of training but there has to be a recognition that it will happen, even if it’s funded on a local basis to start with and then factored into a national contract at a later stage.

“There will be cost implications that need to be looked at with having a lot of prescribers out there. But you have to weigh that against the huge benefits it will bring to the health system, and I hope the pathfi nder project will now quantify this – the hours served, the pounds it has saved in GP practice – and help build a business case to roll it out.”