Congratulations to Superdrug (PJ, September 11, p370). With one bound, as one says, community pharmacy will be free! But free of what? Superdrug would have us believe that the restriction of contracts is all that is stopping a brave new world and advancement into the millennium (and all the usual buzzwords). Yes, it might be, but not, I suspect, for the reasons that Barrie Simner (Superdrug's head of pharmacy) advances.
For what has he done? Or rather, what have his advisers done? Have they pointed towards a brave new world or whatever, or have they simply highlighted the dilemma which is now and has been facing the Department of Health pharmacists for some considerable time? The columns of this Journal and others that deal with community pharmacy issues have for some considerable time been stating that there was no profit to be made; indeed, recently, my old friend Malcolm Almond, writing in this column, advised those over 50 to "take the money and run" (PJ, August 7, p198). That is partly, too, why I got out of that particular rat-race some 15 years ago. I was sure the writing was on the wall; perchance I jumped a bit too quickly! Having said that, of course, why did Boots announce, a couple of years ago, an expansion plan? And repeat it, too, recently? Why has Tesco spent good money on legal fees at the High Court endeavouring to gain contracts? Come to that, why has Superdrug employed expensive consultants and contributed a considerable amount to the PJ's income by including their "suggestions" as an advertisement?
The answer, of course, is that for a vertically integrated company with substantial buying and negotiating power, community pharmacy as presently organised and paid is hugely profitable. What is more, multiples come across, because of the equalisation deals, as more "user-friendly" than independents. How many independents supply Zeneca's atenolol against generic prescriptions, and how many supply parallel imports? I have lost count, too, of the times prescribers, let alone patients, in community and hospital complain about patient information leaflets in Spanish or Greek. And these do not come from prescriptions dispensed in large multiples.
Mr Wally Dove (chairman of the Pharmaceutical Services Negotiating Committee), speaking at the British Pharmaceutical Conference recently, referred to the problems with recruitment and retention (PJ, September 25, p491). However, from the Department's view, is there actually a problem? Many smaller businesses complain at the situation; equally, the situations vacant columns of The Journal frequently refer to "expanding groups" and, again in the PJ of September 25, agencies claimed to have buyers waiting. This emphasises the fact that there is no shortage of contractors. Whether or not a contractor has problems is not the Department of Health's problem.
Like all employees, private or state, I am taxed on a PAYE basis. I am prepared to see increases in taxation to pay for improved health and education; I am not, though, prepared to see that increase in my taxes go straight to the bottom line of highly profitable companies like Boots, Tesco and Superdrug. I know that if there were to be an increase in taxation for a teachers' pay increases some of that would be reflected in my wife's pay cheque. If there were to be an increase in taxation earmarked for "community pharmacy", I fear that some would end up in Tesco's shareholders' pockets. I am not going to vote for that and I suspect that I am not alone, and that the Treasury knows this.
This, of course, is why all the chairmen of local pharmaceutical committees who have supported the open letter to Frank Dobson (PJ September 4, p361) are both right and wrong: right to complain that pharmacists are not getting the deal they ought to and are not being encouraged to contribute what they can to our NHS, but wrong to blame the Secretary of State. The situation is surely analogous to what happened a dozen years ago when community pharmacy discovered, coincidentally, the needs of nursing and residential homes and monitored dosage systems. Did we market these systems to the homes? Did we impress on our customers the added value we could offer? Did we go to the Department, remind it of the then newly implemented Registered Homes Act, and suggest pilot schemes with a view to payment? No, we just gave the homes monitored dosage systems in an effort to maintain market share. There are a number of good things which community pharmacy could do, can do, and indeed is doing; I can, though, understand the Department of Health hanging on in and waiting to see if someone will do these good things for nothing, again in a bid to ensure footfalls through their pharmacies!
I argued in these columns three years ago (PJ, August 10, 1996, p170) and elsewhere as far back as 1986 that new contractual arrangements were needed in order to take account of the substantial shift from an owner-manager profession to a managed profession. After all, can we really honestly say that the present network of community pharmacies represents the ideal? Are the ambitions of the graduate of the 1980s (never mind those who are coming through now) really being met by the current community structure? If Mr Dove is right, and new graduates are failing to join the register, should we perhaps ask ourselves why. Professor Michael Pringle, also at the British Pharmaceutical Conference (PJ, September 25, p490), seemed to be arguing the same thing, and the advertisement columns of the PJ seem to be pointing to a similar trend.
So, to return to Superdrug: just suppose it might be, say, 75 per cent on the right track. How about some relaxation of limitation of dispensing contracts, but much better payments for (redefined) essential small pharmacies. And, rather than issue new contracts at £75,000, why not provide the opportunity to sell at that sort of price for those independent contractors who wish to retire — in other words, a return to the concept of the "major relocation". This could be coupled with opportunities for pharmacists to become involved in surgeries, as predicated by Professor Pringle.
Some are concerned that older pharmacists who leave community practice have no work options; I suspect that their skills will still be needed both during the extended hours offered by supermarkets and in Professor Pringle's surgeries. They might not have "state of the art" clinical skills, but my experience, after making such a jump, is that the "university of life" has much to offer in these circumstances, especially around mental health and care of the elderly. Some ex-proprietors, too, might be surprised at how much advice on medicines is actually sought by members of the public from supermarket pharmacies.
So, we should not throw out Superdrug's proposals unread but treat them as a contribution to the debate. And Mr Dove and the PSNC should ask themselves who it is they represent and whether the interests of contractors really are the same as those of pharmacists.
Mr James is a community services pharmacist from Benfleet, Essex