PJ Online | PJ Letters: Remuneration

Everyone actively involved in community pharmacy knows that the manpower situation is extremely serious with regular closures of pharmacies for single days when no pharmacist locum can be found at any price which the business can pay.

To cut the dispensing fee at such a time is a step of such mind-boggling irresponsibility that it is worthwhile examining the motives of those involved. The Department of Health has been obsessed for some time with the notion that there are too many pharmacies. It is not known on what basis it has made this judgement; certainly it has not been made on the basis of any detailed working out of the nation’s pharmaceutical needs or a knowledge of what happens on the ground. The average pharmacy now dispenses about 4,500 prescription items per month, or an average of 200 per day, or one every two to two-and-a-half minutes. These are almost impossibly heavy workloads by any standards, particularly bearing in mind the extreme accuracy with which the work is conducted and the dire consequences of mistakes.

The Department of Health also must believe that current goodwill values for pharmacies indicate that people are making too much money. It does not seem to know how this is being done, but the goodwill values and the number of new pharmacy applications convince it that money is being made somehow, somewhere, and it intends to put a stop to it.

British governments and the Treasury have for a long time been unable to appreciate the distinction between capital and current expenditure, even though our Victorian forebears had no such difficulties. This inability has had fairly disastrous consequences, from the mess at Railtrack to the convolutions of the so-called Public Private Finance Initiative. By way of contrast, one only has to look at the Stock Exchange where the value of shares is only slightly affected by their yield, and where the yields themselves are far below what can be achieved on the money market or even in a building society. Share values are driven primarily by the view that investors take of the future and by the balance between the demand for shares and their supply.

In much the same way, community pharmacy goodwill values are driven by motors other than simple, sixth-form economics. A significant driver is the desire of supermarkets to incorporate a pharmacy as a marketing tool. Apparently the presence of a pharmacy in a supermarket increases the footfall (the number of visitors) by approximately 1 to 2 per cent and the extra income from this more than makes up for the inevitable losses from operation of the pharmacy. Another driver is the need for the multiple pharmacy companies continually to expand both to keep up their share price and to extract ever better discounts from their suppliers, which depend in good measure on the number of branches owned by the multiple company. Again, for these reasons, the multiple companies can afford a small number of unremunerative branches because of their beneficial effects on the organisation as a whole.

For all of these reasons, the demand for community pharmacies would remain high, and so would their goodwill values, even if all profit were temporarily squeezed from their operations. Only total abolition of the control of entry regulations will have an effect on goodwill values, and if these are destroyed then the asset base of the multiple companies will be eroded, perhaps to the point where they cannot cover their debt. The consequences of such a move do not need to be spelt out. Or perhaps they do. If you do not have asset cover for your debt you are bankrupt and must cease operations.

In my humble opinion, the misunderstanding of the finances of community pharmacy shown by this reduction in the dispensing fee is likely to land us in as complete a mess as the misunderstanding of Railtrack’s finances which produced the shambles in the railways. Is this really the DoH’s intention?

Bob Gartside
Caernarfon, Gwynedd

How politicians’ pay compares

From Mr P. H. Heyes, MRPharmS

In your editorial last week (PJ, 1 December, p766) you mentioned that Hazel Blears said pharmacists had enjoyed a 4 per cent increase in income in real terms over the past decade. I wonder what percentage the politicians have enjoyed after their pay rises this decade.

P. H. Heyes
Whitley Bay, Tyne and Wear

NPA action is ill-judged

From Mr B. Shooter, MRPharmS

Both the letters from colleagues (PJ, 1 December, p778) and your editorial (ibid, p766) summarise the anger and frustration that National Health Service community pharmacist contractors are feeling as a result of the recent imposition of our remuneration settlement (PJ, 24 November, p733).

However, the 10p per item reduction should have come as no surprise to us because we all should know that the dispensing fee is a part of the global sum divided by the number of prescriptions dispensed. The rise in prescription numbers and up-to-date balance sheets have appeared in the monthly PSNC News. I do wonder why the Pharmaceutical Services Negotiating Committee chose not to warn us of the inevitable.

Difficult as it is to accept, the Government does have every right to reduce the fee under the terms of our contract and would be wrong not to do so.

I am an optimist and I do have every confidence that the PSNC under its new leadership will attain the remuneration results that we need and deserve.

I am really upset, however, to read that the National Pharmaceutical Association has seen fit to protest by withdrawing from the repeat dispensing negotiations, leaving Boots at the table alone. Who gave the NPA the mandate to act unilaterally in this fashion? Did we all when we completed the application form for membership for the NPA?

I feel that the NPA board has acted with pique rather than the considered judgement required on this occasion.

What we want are negotiations carried out robustly and professionally to achieve the just result to enable us at least to recoup the additional costs associated with our increased productivity.

The last thing that independent community pharmacists need at this moment is, in my opinion, the ill-judged, emotive action exhibited by our elected representatives on the NPA board.

Barry Shooter
Romford, Essex

Let’s get pharmacy noticed!

From Mr N. M. Rudolph, MRPharmS

So the Department of Health has shown its true colours — a 10p reduction in prescription fees is to be imposed: for a pharmacy dispensing 5,000 prescriptions a month this equates to Ł6,000 per year. What happens when the overpayment (due to pharmacists dispensing more prescriptions than envisaged, of which they have no control) is repaid? Will the price per prescription increase to this year’s rate plus a 3.7 per cent increase? It seems not. One must hypothesise that this extra money will be spent on "new pharmaceutical roles" while the dispensing fee in real terms falls dramatically again.

It is not reasonable to be expected year in, year out to dispense the extra prescription workload for a relatively decreasing amount of money. No other business would accept such a proposition.

Do not presume that I am against the new roles envisaged for community pharmacy. Far from it. I would dearly like to be involved, but there must be one unnegotiable element and that is proper payment. To run a pharmacy efficiently there must be enough profit to pay trained and motivated staff of a high calibre, purchase modern computer hardware and software, keep sufficient stock levels etc, to be able to provide excellence for patients. At present this is clearly not possible, with the dramatic decrease in profits in sight to cope with the ever-increasing prescription workload. On top of this, are we going to be expected to participate in new roles, for what amounts to the same monies as we already receive?

The back of community pharmacy is breaking. Governments continually ignore our established voices: every year the payment settlements are late, more often than not imposed and never sufficient.

The time surely has come for action — pharmacists need to show their immense displeasure. Not only contractors, but all community pharmacists need to unite against these impositions.

Anyone who agrees with me is invited to write to the address below with a view to taking this matter forward and getting pharmacy noticed.

N. M. Rudolph
Vantage Pharmacy, 407 Nuthall Road, Nottingham NG8 5DB

Do something about it!

From Mr J. R. Ahmed, MRPharmS

I have just read the Pharmaceutical Services Negotiating Committee’s letter regarding my National Health Service remuneration 2001–02 (PJ, 1 December, p767), as well as the letter from Hazel Blears, and I am appalled. I have been an independent pharmacy contractor for 14 years and every year I have been told by the PSNC that a so-called negotiated settlement has been imposed on us by the Government and nobody seems to be able to do anything about it. I have been told to do more work for less pay because we have a monopoly employer dictating the terms and conditions of my employment.

Where in the civilised world can someone have money deducted from them for doing more work than an employer had predicted would occur? It seems that the imposed settlement allows the Government to set lower sums, saving money on the one hand, and when these sums are exceeded (surprise, surprise) they deduct more money from us.

Where does this leave pharmacy? This sorry tale must stop before the hidden agenda of this and past Governments destroys the pharmaceutical network that we have at present. Writing to Members of Parliament will have no effect. We must change the system that produces this annual mess. Employment law now comes under the European Court of Human Rights and I am quite certain that my rights are being trampled over by this Government and so legal action should be started straight away. The only means of changing the situation is to threaten and carry out this threat if no response is forthcoming from the Government.

Pharmacists do not belong to a union but if we did we would have had much better remuneration than we presently do. Maybe the threat of strike action by all contractors would stir the Government into taking notice of our fair demands (strike action would be where patients did not suffer, eg, close all pharmacies for one hour in the afternoon). The days of appeasing the Government by accepting the imposed settlements should be over. The "wait and see, we might get new money for new services later on" approach is flawed because our remuneration is being eroded now so any so called new money is what we should have received anyway. Any threat by the Government of abolishing the contract limitation on new pharmacies should be challenged with a show of solidarity by all contractors, independents and multiples.

We cannot make the situation any worse than it already is by asking for fair remuneration so I say this to the PSNC: challenge and change the flawed system we have at present. Stop writing the "we are sorry" letters every year and do something about it.

Jawaid Ahmed
Birmingham

We must take industrial action

From Mr S. K. Rabheru, MRPharmS

We must take industrial action against the appalling rate of remuneration we face (PJ, 24 November, p733). If we do not, we might well be dispensing prescriptions for free in five years time. There will be some who think that this could backfire in that, if pharmacists went on strike, the Government will do something to make sure patients got their medicines, perhaps by getting people other than pharmacists to dispense prescriptions.

But who? Dispensers? I doubt that they would be happy taking responsibility for even making sure that the box they are giving out is what the doctor writes on the prescription, never mind checking for interactions and drug dosages.

How about doctors? Most doctors do not have adequate time to spend with their patients, never mind dispensing drugs as well (except dispensing doctors). All I can say is let the Government try. Let it feel the impact of passing on the responsibility of dispensing to non-pharmacists. Only then will our efforts of dispensing, including checking dosages and interactions, be highly valued.

We should demand adequate remuneration not just for dispensing prescriptions but also for pharmaceutical interventions, like identifying unnecessary drug therapy, which would save the National Health Service money.

I hope at least one of the pharmaceutical organisations takes action against our pathetic remuneration. If none can be bothered, then let us form one soon.

Snehal Rabheru
Leicester

Who will be able to afford locum cover?

From Ms J. R. Tadros, MRPharmS

I have in front of me three documents. The first is a leaflet produced by the National Health Service called "Not sure what to do when you feel ill?" for distribution to patients. Inside, patients are assured that they can consult me in confidence, without an appointment and, of course, for free. The second is a letter received today from the Pharmaceutical Services Negotiating Committee explaining the events that led to the reduction of the NHS dispensing fee. The third is a prospectus from King’s College London for a postgraduate diploma in community pharmacy.

My pen is poised over the application form. The reason for my hesitation? I am a self-employed locum wishing to improve my qualifications, ready to take my part in Pharmacy in the Future (at my own expense, naturally), but I seriously doubt whether there will be a contractor left in the land who can afford a locum at all, let alone one who demands appropriate remuneration.

How can the Department of Health advertise our services on the one hand and refuse to pay for them on the other? Easily, it seems. It already has.

Janice Tadros
London NW2

The pharmacy profession is not united

From Mr F. R. Bayliss, MRPharmS

The sad and sorry saga of the backdated 10p cut in our dispensing fee makes depressing reading (PJ, 24 November, p733). I have, for what it’s worth, sent a letter to Hazel Blears, but the bottom line is that we as a profession do not put up a united front.

The latest example of this disunity was the campaign by Asda and others to be the darlings of the consumer and have resale price maintenance for medicines abolished. We all know that selling medicines is somewhat more responsible than weighing potatoes in a greengrocers. The profit margin was there to provide some recompense for the expertise involved. Now this has gone, in the name of competition, and we all lose.

Another example is the failure to agree a standard fee for dispensing a private prescription. I find it degrading when someone telephones me to ask how much we would charge for a particular drug. The caller tries other pharmacies and takes the prescription to the lowest bidder. We have lowered ourselves to the level of street pedlars in a bazaar. Ask any solicitor to write a letter and there will be a standard fee. We should do likewise.

I have not forgotten the time when pharmacists were falling over themselves to buy premises nearer to surgeries — leapfrogging. We all thought that had stopped when contract limitation was introduced. But around the same time, on-cost was abolished.

When I qualified it was professional misconduct to offer a delivery service for National Health Service prescriptions. Now we are allowed to pay someone to drive a van and deliver medicines to patients, even though the Government pays us nothing for the privilege.

About 25 years ago, it was suggested that every pharmacist should join a trade union, and the union negotiator, rather than the Pharmaceutical Services Negotiating Committee, would handle our dealings with the Government. Even if this step were taken now, I fear it would be too little too late. Pharmacy as we know it is an endangered profession.

F. R. Bayliss
Cuckfield, West Sussex

Pharmacy in the past, not the future

From Ms P. Grant, MRPharmS

The two cover stories on the front of The Pharmaceutical Journal for the 24 November — "Ways for pharmacists to reduce waste" and "Department of Health decimates dispensing fee" — highlight the dilemma which has beset the pharmacy profession since its foundation.

How much longer can the Royal Pharmaceutical Society refuse to accept the blatantly obvious fact that, until the system of remuneration is changed and community pharmacists become salaried employees of the National Health Service, pharmacy in the future will continue to be pharmacy in the past. Local pharmacy development groups continue to founder and worthwhile projects sit unrealised on the pharmacy shelves while the implementers spend their days delivering more and more medicines in paper bags to expectant, demanding patients.

Council members must be totally out of touch with the reality of community pharmacy as they stand calmly by and watch the operational and commercial side of pharmacy slowly strangle the professional side. They would only need to spend one single day in the dispensary of a busy community pharmacy to observe this strangulation in action.

How many of our Council members would be prepared to do this?

Pam Grant
Poole, Dorset

Next Topic (Mistletoe)
Send your letter to The Editor