A land-grab that should concern us all

By Malcolm Harrison

Amidst winter pressures and the struggle many face just to keep their businesses afloat, the Professional Standards Authority (PSA) could add further pressures with its recommendation that healthcare regulators, including the General Pharmaceutical Council, should be given extended powers. 

Pharmacy owners will be concerned about what could be an attempted regulatory land-grab. Doesn’t the GPhC already regulate pharmacy businesses? Technically, it doesn’t. It holds the register for professionals and premises and sets standards for both. It has power to inspect premises to assess whether they are being met.  

The PSA’s Safer care for all report highlights some of the biggest challenges to the quality and safety of health and social care in the UK. While much of the report forms an obvious route to enhance the safety of the public and the reputation of healthcare professionals, some of its other arguments appear to be based on anecdote rather than fact. 

As a registered pharmacist, I am clear that there is a role for effective regulation across healthcare. It is critically important for patients and professionals that clear, pragmatic and progressive standards, supported by clear guidance, are developed for professionals and practices. 

I am also clear that a balance must be found. There is a risk that unnecessary regulation can add operational burden to businesses that are already under pressure to maintain standards, while keeping costs under control. 

Owners cannot operate with impunity because the GPhC doesn’t regulate pharmacy businesses. In England, for example, one must be mindful of the Competition Act 1998, the Employment Act 2002, the Company Law Act 2006, the Human Medicines Regulations 2012, the Health and Safety at Work Act 2015 and the Consumer Rights Act 2015, as well as the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013. 

During debate at the PSA conference, it was clear that there is a fear that private businesses might put profit ahead of care. That they will cut corners, take shortcuts, and place unfair pressure on professionals to maximise returns. But while there are examples of where this has happened, I don’t think the financial pressures some believe might drive the wrong behaviours are unique to the commercial sector.

I cannot think of an NHS trust that isn’t facing cost pressures or a publicly funded institution that isn’t having to make tough budget decisions. NHS healthcare professionals are constantly finding their judgement conflicted by decisions around cost, staff availability and centrally imposed targets. 

As I thought about the question put to me at the conference, I considered the role of (healthy) competition in regulating pharmacy businesses. In an open market, competition is a force for good. It encourages enterprise, drives efficiency, raises standards, creates and widens choice, reduces prices and improves employment practices. With the emergence of new digital technologies, there is huge scope to enhance the quality and accessibility of care. 

"It is critically important for patients and professionals that clear, pragmatic and progressive standards, supported by clear guidance, are developed"

Unfortunately, readers of the PSA report could be forgiven for thinking that such advancements contain unacceptable risk and that their development should be controlled by regulators. Our sector has first-hand experience of how this can stifle choice and drive patients away from safe sources of legal medicines.

If there is a move to regulate new technologies, it must be done with the input of those who are innovating, delivering and engaging with patients and customers. It cannot be left to those who purport to be experts, but who might have no actual experience.

In 2021, the CCA responded to the Government’s consultation on healthcare regulatory reform. We were clear that since the Pharmacy Order was laid in 2010, the profession had undergone unprecedented change that shows no sign of slowing. Overly prescriptive legislation can hold back the sector and professionals alike. Twelve months on, our position is unchanged.

It would be naive to think that there are not individuals or even businesses looking for short-term gain. That patients receive care that is not of the required quality and may even suffer harm as a result. However, I do not think that commercial interests per se harm people. 

Community pharmacy has shown repeatedly how healthy competition, supported by effective and progressive regulation, can enhance patient care and outcomes. Think ibuprofen, PMRs, 24-hour access, flu and Covid vaccinations, the billions saved through competitive medicines procurement. 

The businesses I represent are in the business of care. They care because the people who run them care. They care about the quality of the service they provide and the value it represents. And they know that their reputation for quality and value is key to their long-term commercial success.

Malcolm Harrison is the chief executive of the Company Chemists’ Association (CCA)