The Pharmaceutical Journal Vol 267 No 7176 p778-781
1 December 2001

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Letters to the Editor

Remuneration (5 letters)

A slap in the face is not the way to treat productivity

From Mr K. C. T. Patel, MRPharmS

Enough is enough. How long can we be expected to stand by while our very livelihood is threatened. It is time to for action. It is time we showed the Government that we will not accept this ridiculous imposition of a dispensing fee cut by 10p to 87.4p back dated to 1 November resulting from an increase of 4.9 per cent in prescription volume (PJ, 24 November, p733). A slap in the face instead of a pat on the back is not how one treats productivity. All pharmacy bodies and local pharmaceutical committees need to act in unison and impose sanctions. We should sever all links with the Government at national level and the with health authorities and primary care trusts at the lower level for three months.

The Government has a broader agenda of delivering the NHS plan. Without our co-operation, the Government cannot deliver medicines management, repeat prescribing or electronic prescribing. This sanction would not affect our business in the short term but would threaten delivery of the Government plan. The chairmen and secretaries of all LPCs and Royal Pharmaceutical Society branches should pressure the Pharmaceutical Services Negotiating Committee and the Society into taking this firm stance. The National Pharmaceutical Association and the Company Chemists Association should fully back such sanctions.

Prescription volumes are estimated to be up by 6 per cent in the current year. Therefore, if we do not act now, we are in for another cut in dispensing fee next year. This cut in fees does not just affect pharmacy owners. The repercussions will be felt by all community pharmacists and support staff. It will determine future wages and working conditions for all. What may I ask can one buy for 87p? Coupled with the discount claw back of £10.8m imposed from 1 December, the generic price cuts and the investigation of control of entry, this dispensing fee cut undermines the confidence of community pharmacists at the very time the Government and ourselves should be looking to invest more in pharmacy.

This kind of indiscriminate squeezing can only lead to further cutback in our investment and workforce development in pharmacy. This in turn would jeopardise patient safety and make it impossible to deliver the Government's agenda. Do patients need to die before the Government appreciates the foolishness of their actions? An extensive campaign should also be launched to drive up public sympathy and also influence politicians in order to ridicule the Government's decision.

Kirit Patel
Chairman
Day Lewis Group Plc

Time for direct action

From Mr J. Downing, MRPharmS

Since the Government clearly has no intention of recognising the value of community pharmacy it is now time to take direct action to preserve our position on the health care ladder. We have stood by and allowed the Government to increase both the power and pay of the nursing profession while at the same time we have failed to stress the existing benefits of the current pharmacy network. How is it that a nurse is trustworthy enough to be able to prescribe dressings and drugs with only the minimum of training yet a pharmacist is not considered trustworthy enough to dispense a loaf of gluten-free bread without first obtaining a prescription from a GP?

The Government's valuation and lack of understanding of the pharmacy profession is clear by the reduction in the dispensing fee. I would suggest that we should co-ordinate action to ensure that pharmacy services are not available for periods outside of the normal seven-hour day. We should not open for dispensing during lunch hours. The practice of not taking proper breaks has gone on for long enough and only serves to devalue the profession in the eyes of the Government.

We should also consider a national closure for a period of two to three hours to gain publicity for the plight of the local pharmacy network. The reduction of the fee (PJ, 24 November, p733) is a classic case of a complacent Government falling on a banana skin and we must seize the opportunity to gain the political high ground.

Now is the time for the profession to unite and demand the resources we deserve.

Jim Downing
York

We must stand united

From Mr S. K. Bhatti, MRPharmS

In light of the recent settlement (PJ, 24 November, p733) I write to voice the anger that I am quite sure all pharmacists, especially contractors, are feeling at the moment. The Pharmaceutical Services Negotiating Committee has once again "negotiated" on our behalf and achieved a remuneration settlement that beggars belief. In the 10 years since I opened my own business the Government has effectively paid us less each year and gross margins have dropped from around 23 per cent to the current level of around 15 per cent.

Which other profession would tolerate the treatment given to pharmacists by this Government? The costs of running a business increase year on year so where does the average contractor find the money to keep on subsidising the National Health Service? Is there a single GP who would accept a 50 per cent reduction in his capitation fees because his list size has doubled?

The only reason the Government gets away with this every year is because it knows it can. As a group of professionals we have never even threatened industrial action but it is something we must look at seriously now. This means not only independent contractors but all the major multiples as well. But therein lies the problem. Our profession has never stood united on anything. There has been constant in-fighting to increase our own prescription volumes at the expense of those of our neighbours. This "I'm all right Jack" attitude has to give way to a concerted effort by all pharmacists to work together for a better deal for all in our profession.

What would be the effect on the NHS if every pharmacy closed for business for just one day? Would that not make the Government sit up and take notice? I believe that before we can discuss new pay for so called new roles we must receive adequate remuneration for the tasks we are currently undertaking.

Sunil Bhatti
Bilston, West Midlands

More support, please, Society

From Mr P. Gamblin, MRPharmS

As a proprietor pharmacist of over 25 years I despair of the future. Last week brought news of a reduced professional fee, at a time when prescription numbers are growing, and that a paltry 3.7 per cent increase has been imposed on the global sum for our latest remuneration offer (PJ, 24 November, p733). This comes on top of the depressing sight of our dispensing fees being reduced over the past 10 years from over £1.40 to the present pathetic level and at a time when our workload is increasing along with our overheads — mainly salaries. Now is not the time for the Royal Pharmaceutical Society to be inflicting "pie in the sky" ideas on the future of pharmacy, particularly unpaid ones. The Society should be supporting and encouraging its members in these difficult times — not creating havoc with all the new‚ mainly free-of-charge activities currently being mooted.

If I am performing my core activity, ie, the portion for which I actually trained — supervising and counselling and correctly dispensing prescriptions — how am I going to perform all the latest unwanted roles mostly away from the pharmacy without incurring huge extra costs, even supposing I can find sufficient reliable locum pharmacists?

Already my evenings and large parts of the weekend are spent sorting and endorsing prescriptions and the everyday mountains of paperwork involved in the running of a busy pharmacy. What joy, then, to engage in a lot of continuing education and continuing professional development, without which I just may not be able to practise in the future. I must be doing something wrong somewhere.

Come on Royal Pharmaceutical Society! Let us have some proper support in the future. Can the Society not work more closely with the Pharmaceutical Services Negotiating Committee and the National Pharmaceutical Association to improve our standing in the Government's eyes? We want no more new activities without adequate funding.

Please show us the support other professions get from their respective associations before it is too late.

Peter Gamblin
Gosport,
Hampshire

Economics of the madhouse

From Mr M. Fagelman, MRPharmS

I have been in practice for over 20 years both as proprietor and director of a small chain of pharmacies. I have withstood the rough seas of change and the erosion of profitability and degradation of morale during most of that time, but I feel we have now reached the end of the line. We simply cannot continue with a contract with a payment formula irrevocably linked to a "target" for the supply of dispensed medicines to the nation — a target over which we have no control whatsoever, the actual total or numbers being determined purely by the demand of patients to have prescription written and the willingness of doctors, dentists and nurses to write them. Each time these theoretical "targets" are exceeded then then our "piece-work" rates are reduced.

This is the economics of the madhouse. One wonders how we accept to work to such a prejudicing formula at each annual round of negotiations when it is clear that the numbers increase each year relentlessly.

I now work approximately 70 hours per week including administration and paper work. This is about 40 per cent more than when I first started. I simply now am unable to run any faster to stand still.

I have never allowed previous disappointments to affect my practice but I intend now to do no more development work — something I have in the past strived to maintain.

If the Department of Health only wants a cheap, medicine-issuing service, then that is what I will provide and no more.

I hope that the Pharmaceutical Services Negotiating Committee, the National Pharmaceutical Association and other bodies are now liaising with major multiples to call an urgent meeting to address the entire basis and implications of the current contract and united what immediate actions we can take to demonstrate our seriousness in demanding major change.

Malcolm Fagelman
Oldham,
Lancashire

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