Is ‘retail’ a dirty word?

Leela Barham asks whether calls for a change in how community pharmacy is talked about, focusing less on its commercial realities, could help to embed community pharmacy as a provider of healthcare in the minds of, well, everyone...

Community pharmacy’s future in England is as “an integral part of the NHS, delivering clinical services as a full partner in local primary care networks.”1 So says NHS England in the Community Pharmacy Contractual Framework 2019-2024.

Yet that clinical focus isn’t always front and centre in communications from the sector’s representatives, who are understandably anxious that pharmacy businesses maintain a healthy bottom line. Could a change in the way community pharmacy talks about itself help to ensure that the Government and patients truly appreciate the shift going on in the sector? 

Difficult trading conditions 

Janet Morrison, CEO of Community Pharmacy England, responded in a LinkedIn post to the news that Boots is to close 300 pharmacies over the next year by saying it was “reflective of the very difficult trading conditions within community pharmacy”.

This prompted Hemant Patel, clinical lead, health inequalities and population health management at Mid and South Essex Integrated Care System to call for a change in how community pharmacy’s own advocates talk about community pharmacy. In a LinkedIn post, he wrote: “In light of the negative connotation associated with the term ‘trading’ within the NHS business environment, I would like to propose an alternative phrase: ‘delivering care’.”

He reasons: “As pharmacies are primarily focused on providing healthcare services to patients, the term ‘delivering care’ accurately captures the compassionate aspect of their work.”

Time to change the terminology

Patel wants to see a shift in communications. “This terminology shift may contribute to fostering a more favourable perception of pharmacies within the NHS and reinforce the notion that their primary objective is to ensure the highest level of care for patients,” he said in his post.

Speaking to P3pharmacy, Patel elaborated on his thinking: “Our discussion around the language employed within the community pharmacy sector thus far indicates that the terms used – such as ‘trading’ or ‘delivering services’ – subtly steer the way stakeholders, including the NHS, policymakers, and the public, perceive pharmacies and their work. 

“They suggest a commercial, transactional image, which potentially overshadows the central role of pharmacies in providing patient- centred care, and this can influence how smoothly pharmacies integrate into the broader healthcare system.”

Mike Hewitson, superintendent pharmacist and managing director at Beaminster Pharmacy, as well as a member of Somerset Council, told P3pharmacy: ”We, as a profession, have never been good at playing up the clinical side, the patient care work.” 

He believes there is an opportunity to get more traction for the sector by “telling stories, making things relatable and human, rather than just the numbers. I think we can get a lot more traction from that”.

Language matters

It’s not just the sector itself that has used more commercial-sounding language when communicating about community pharmacy. The King’s Fund published an explainer in December 2020, which points out that a community pharmacy is sometimes known as a retail pharmacy. It goes on to say that the traditional model is “a retail outlet that also has qualified healthcare professionals providing some healthcare services”.

This phrasing probably didn’t mean to focus on the commercial, but it can be read that way. ‘Retail pharmacy’ has clear commercial connotations; retail is defined as the sale of goods to the public in relatively small quantities for use or consumption rather than for resale. The use of “also has” and “some” when referring to healthcare services could infer that the latter is less important than the former. 

It’s probably unfair to pick on the King’s Fund too much; the term is still in use by some today. But maybe it’s time for the King’s Fund, as much as the sector itself, to refresh and update how community pharmacy is described. 

Commercial focus necessary to deliver clinical services 

Perhaps one of the biggest challenges community pharmacy has is not that it makes money from commercial activity and that it’s talked about (it isn’t alone – private healthcare is delivered by others in the NHS family), but that it must do so to survive.

Patel brings up the balance between the clinical and the commercial, saying: “There is a necessity to acknowledge the importance of sound business operations. Indeed, we must strive for a balance – recognising our commercial obligations whilst emphasising our commitment to patient care.

“It is this balance that will lead to more supportive policies, increased investment, stronger partnerships, a motivated workforce and, ultimately, improved patient care.”

Hewitson believes “it’s a really difficult nuance” when talking about the commercial and clinical sides of community pharmacy. It’s also right that funding has to be part of the conversation. “The argument for more funding has to be made,” he says. “It is absolutely essential because the day to day work is so grossly underfunded.

“We need to get people to understand that what more funding could deliver is more services to patients. That in turn improves outcomes.”

This means it’s not just semantics – it’s economics that matters.