The Pharmaceutical Journal Vol 267 No 7170 p544
20 October 2001

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Community pharmacists: professional people paid as artisans

By Malcolm Goldie

Because of the shortage of locum pharmacists a number of national multiple pharmacies are closing shops on an occasional daily or half-day basis. Pharmacists are being moved from one shop to another and in certain cases being asked to work without dispensing assistants. The public limited companies concerned are very much profit orientated with a share price to maintain and shareholders to satisfy, so it may be assumed they would take all possible steps to keep trading. Pharmacists are being recruited from South Africa and they need to undertake a retraining course before joining the register. Spanish pharmacists who, being European Union nationals, only need to satisfy examiners of their competence in the English language, are also being targeted. One company has written to many UK pharmacists, myself included, offering employment. Pharmacist employees of that company are being offered bonuses if they can recruit pharmacists who will work for the company. There is obviously a shortage of pharmacists and their recruitment into community pharmacy employment is becoming increasingly difficult.

Now a shortage of locums can always be overcome, on a beggar-my-neighbour basis, by paying above the going rate, which is in the region of £18–£20 per hour as recent correspondence in The Pharmaceutical Journal has recorded. (Scaffolders and joiners are reportedly being paid about £15 per hour hereabouts, while optometrists are paying £250 per day for ophthalmic optician locums — and this is for purely professional duties.) Despite the shortages and the fact that pharmacies are being closed, management has chosen not to offer increased locum rates and I am prompted to wonder why. There appear to be two possible reasons:

1. Because a totally inadequate profit appears not to be being made in certain pharmacies and it is cheaper to close a store than employ a locum at an inflated rate. (This would suggest that some pharmacies must be on the borderline of viability, if not beyond it.)

2. Management is fearful of escalating locum rates, which may in the future develop into a “rod for their own back”, as pharmacy manager’s rates would have to reflect the increased payments. (However, at least one multiple chain negotiates managers’ salaries on an individual basis, so it seems hardly likely this reason holds good.)

The second reason is just an extension of the first, which confirms that profits within community pharmacy are under considerable pressure. One of the basic laws of supply and demand seems, almost incredibly, to have become suspended for locum supply — that if there is a shortage then prices rise and in a glut prices fall. This adds credence to item one of the above argument, unless it is that locum pharmacists believe it to be immoral to ask more money for their services, or are they just nice people who are altruistic and work for love, compared with ophthalmic opticians?

It is possible to develop this theme even further. Although one can see that inflated locum payments may render the dispensing process unprofitable, it had always been assumed that money was being made on the sale of over-the-counter medicines and toiletries that could subsidise the dispensary — perhaps not as much as was thought. Since the general public is very much into supermarket shopping and traditional pharmacy lines are being picked up with the weekly groceries, to the detriment of turnover and profits, the profession cannot expect a reversal of this trend. Thus the question must be asked, does the future of community pharmacy lie solely in the supply of medicines and the dispensing of prescriptions (fees for which service are being paid at what amounts to little more than artisan rates) or does it lie elsewhere?

Where and what is this “elsewhere”? I suggest the future of pharmacy lies in developing its professional and advisory roles. We pride ourselves on being the experts on drugs and their use — let us stick to our lasts and develop these roles, and ask our negotiators to ensure we receive a fair rate for the job. This does not preclude the supply of medicines but is an additional role. As long as pharmacists are being remunerated for only providing a supply function with minimal professional input we shall continue to be paid at current rates, which the Government is seeking to reduce further with its proposals on the pricing of generic preparations. As long as we are perceived as retailers we shall be treated and paid as such with our return on our time and effort falling, as more of our counter business is taken by supermarkets and Government parsimony reduces dispensing profits.

When the Government unilaterally swept aside the cost-plus contract, the Pharmaceutical Services Negotiating Committee was informed that the only topics that would be considered for negotiation were motivation, retention and recruitment. Has not this stage now been reached?

I know many community pharmacists who are sick and tired of the increasing workload, the shortages and the problems, and given the chance they would quit the profession tomorrow. The profession needs some strong leadership and we, the forgotten foot soldiers of the National Health Service, need remotivating. We need to win a battle instead of losing every one that we fight and our negotiators need to produce tangible results.

The problem is how we actually achieve the change from a supply-based profession to one that is paid for its professional input. Much has been written on the subject. The pages of the pharmaceutical press are filled with articles on what may be offered and to whom. The part that is missing by and large is the preparedness of community pharmacists to change their mindset and realise that the profession cannot continue to compete with supermarkets and be remunerated as artisans.

In their defence it must be said that all too often the busy practitioner is totally involved with keeping their business running, the invoices paid, the VAT remitted, or claimed back, and completing the thousand and one jobs that occupy the day and most evenings. Multiple pharmacies are not immune from the situation and the pressure is on them as well, albeit slightly differently. Somehow or other it must change — a different course is the only way to survival. It may be that the answer is to empower dispensers and thus make available the time to engage in the way forward.

The downward spiral needs to be broken. Running harder and harder only to stand still, or worse go backwards, is not an option for the future and community pharmacists must be prepared to retrain where necessary and embrace enthusiastically these new ideas.

This is a tall order. Somehow a bridging period needs to be introduced. During this time the changes suggested would have to run in tandem with existing business practice. This process needs to be started sooner rather than later. Bring on the strong leadership — quickly.

Malcolm Goldie is a pharmacist from Newcastle-upon-Tyne