The Pharmaceutical Journal Vol 267 No 7163 p293-296
1 September 2001

This page
Reprint
Photocopy

  Statutory fees
  Community pharmacy
  Intervention
  Exemptions
  Career promotion
  Pharmacy education
  Preregistration
  Indemnity insurance
  Generic names

Community pharmacy (3 letters)

The contract is the problem

From Mr E. W. Black, MRPharmS

I read with interest the article by Robert Gartside (PJ, 18 August, p226). In my view, the profession will never evolve into what most thinking members of the community pharmacy fraternity aspire for it to become, unless the remuneration structures that exist within the National Health Service are completely changed.

The contract is the problem. It is politically impossible for the profession itself to advocate a wholesale reform of the contract, as all real power within the profession lies with the contractor pharmacists, and the companies who hold multiple contracts.

Despite the Government’s constant tinkering at its edges, and the erosion of profit margins, the contract is still fundamentally a payment for piecework. Under these circumstances it is entirely understandable that proprietor pharmacists, and community pharmacy business employers, aspire to dispense more and more prescriptions. If a contract is held for a busy successful pharmacy, a good income can be generated, and this allows the owner the time to become involved in pharmaceutical politics. Therefore, it is these individuals who tend to rise to the top within the profession’s power bases. It is they who can exert the most influence on the future development of the profession. It seems unlikely that these people are going to advocate changes in remuneration that could adversely affect their income or could erode any potential financial return to be made from their businesses.

I would suggest that it is these vested interests, as much as any real concerns for patient choice, that have prevented patient registration, and the resulting benefits that could accrue in clinical care, through a more rational distribution of patients within the community pharmacy system.

Through innovative schemes, pharmacy has demonstrated frequently how it can, if given the resources, have a genuine impact on patients’ health, and the efficiency of the NHS. The nature of the contract, and its financial rewards for ever-greater prescription numbers, can prevent implementation of such novel practices. Pharmacists are often simply too busy, and the resulting pressures on time and moral can easily act as a disincentive to improve practice.

It is these busy pharmacies that see the majority of patients, and therefore could exert the most overall benefits on the nations health, but there is often a shortage of time to do anything other than dispense. Conversely in quieter pharmacies, any potential impact is likely to be considerably less significant.

Community pharmacists have never been better qualified to deliver improvements to patients’ health, but unless changes are made to allow us to do so, the profession will continue to stagnate, and to be largely marginalised by the powers that be within the NHS.

The profession should act now to advocate wholesale reform of the contract, before the Government finally realises the lack of true value community pharmacy currently gives to the health service. This could result in a community pharmacy structure none of us would want: not even the contractors!

Ewan Black
Glasgow

Dithering as the abyss looms

From Mr I. Elliott, MRPharmS

Is the profession dithering as the abyss looms? I am fearful for the future of a profession of which I have been proud to be a member for many years.

What is the likely outcome for community pharmacy under primary care trusts with no community pharmacist on the executive committee? A “massive” 23 per cent of established primary care trusts include pharmacists on one committee or another. That is 77 per cent that do not. Is this the outcome we want?

My other worry is the workload we readily subject ourselves to. How many other professionals regularly work the hours we do, or indeed have the life or death responsibilities we do? There must be an average number of prescriptions per month that one person can genuinely be sure they have supervised or counselled correctly. There must be a point where two pharmacists are essential, and yet I would suggest that this point is well exceeded before sufficient remuneration is generated to cover this. This cannot be right and yet we allow it to go on. What outcomes do we want? What are our reasons for wanting these? What actions are we prepared to take?

Ian Elliott
Burnley, Lancashire

Test the market for locum fees

From Mr M. Goldin

I read the letter from Ajay Patel (PJ, 25 August, p261) and I want to tell him that he has my sympathy. I am a locum pharmacist and I feel that I am being underpaid for what I do.

I once heard somebody on the radio being asked how much he charged his customers for an item he manufactured. His answer was: “I charge what the market will bear.” Why do not we test the locum market and see what it will bear? Or are we scared that we might price ourselves out of the market?

Monty Goldin
London NW11

Back to Top

Previous Topic (Statutory fees)
Next Topic (Interventions)
Send your letter to The Editor