The Pharmaceutical Journal
Vol 268 No 7193 p494
13 April 2002

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Is community pharmacy as we know it in danger of disappearing?

By J. D. Glassman

Is the Government in danger of killing off community pharmacy as we know it today and destroying the highly efficient supply chain that community pharmacists offer? Community pharmacy currently provides the Government and the public with an effective distribution service of medicines prescribed on the National Health Service. Community pharmacists finance the service from their own or, if they are public companies, from shareholders' pockets. They rent or purchase premises, fit them out at their own expense, equip them with the latest computer hardware, which needs to be maintained and upgraded at regular intervals, and train and employ staff to help run the pharmacies.

An expensive stock of medicines then has to be purchased. The pharmacy has little or no control over what to stock. That is subject to the prescribing whims of the local doctors, which often depend on which drug company representative has been active locally.

The pharmacy is expected to make no profit on the outlay of the cost of the drugs that it supplies to the public on the NHS. There is no compensation for medicines that become obsolete or pass their expiry dates. There is no opportunity to have a half price sale to clear short-dated stocks. Patients expect to find their medicines in stock at their local pharmacy, and most pharmacies can dispense 80 to 90 per cent of the prescriptions presented from stock.

Community pharmacies were being rewarded for providing this service with the magnificent sum of 97p for each item dispensed. Community pharmacists increased their productivity last year by some 6 per cent, which involved more capital outlay for increased stock. Because this volume increase was some 3 per cent more than projected, the Government imposed a 10p reduction in the dispensing fee. After much lobbying, the Health Minister magnanimously decided that the reduction in the fee was too punitive, and allowed community pharmacists to keep half of the money that they had earned from extra productivity. The extra prescription volume was brought about by circumstances not of their own choosing, but by Government directives such as national service frameworks and new prescribing guidelines.

Each year heralds increases in rents, rates, staff wages, utility bills, increased petrol, parking and transport costs. Community pharmacists have increased thresholds imposed by their wholesalers before discounts are allowed, making it more difficult each year to obtain discounts equal to the NHS discount claw-back.

Community pharmacy has lost resale price maintenance on medicines due to the powerful lobbying of supermarkets such as Asda, and now, due in no small part to lobbying by Superdrug and others, faces an enquiry by the Office of Fair Trading into the restriction of entry into NHS contracts. One must wonder at the motives of these companies, which claim to want to give the public the opportunity to save money on the medicines they need. How soon will the plight of community pharmacy follow that of the small grocers, fishmongers and other independent retailers who no longer have a place on our high streets. How does this fit in with the Government's plan for regeneration of urban high streets?

There is also the threat of the review into the supply of generic medicines, probably the one area where community pharmacists have an opportunity, by employing careful purchasing skills, of generating sufficient profit to keep the pharmacy operating, and not going into receivership.

The future

We are now told that the future of community pharmacy lies in medicines management, in managing repeat dispensing and prescribing, in giving prescribing advice to surgeries, in the provision of local pharmaceutical services and in roles such as training other health care workers, leaving the more mechanical role of sticking labels on patient packs to dispensing technicians, who will be sufficiently trained to be competent to self-check their work.

Many community pharmacists are forward thinking and eager to carry out the new roles, keen to work in this new NHS where the pharmacist will be embraced as a fully fledged member of the primary health care team. There are, however, some who view the rosy future with scepticism. Where are the resources? Where are the trained dispensing technicians going to come from to relieve the burden of the dispensing process and free pharmacists' time for the new roles? Where are the relief locum pharmacists going to come from to take our places when we leave the pharmacies to visit surgeries, clinics, patient's homes, etc? We already have a manpower problem.

Mandatory continuing professional development, life-long learning and the requirement that primary care trusts hold "accreditation of competency to practise" lists will surely lead to the decision of semi-retired mature pharmacists and women pharmacists with families to take the decision to retire from the register rather than endure the process of being tested for competency, just to do a few odd days to help out when needed to provide emergency cover.

Not surprisingly there has been little mention of the new and extra funding that will be needed to finance the new roles and the education and training of support staff and pharmacists, and for the IT needs of community pharmacy in the future. Who is to foot the bill to encompass the electronic transfer of information and prescriptions, and to link community pharmacy into the NHSnet? Will other primary health care professionals have to put their hands in their pockets as I suspect community pharmacists may have to in the near future?

Community pharmacists also have the threat of one-stop primary care centres and the increasing development of new health and primary care resource centres, which will relocate GP surgeries into new centres of excellence. Fine for the public who can access these centres, but unfortunate for the many who will lose not only their local GP, but also their local pharmacy, which will not be able to survive without the prescription trade from the surgery that they have served for many years. There has been no mention of compensation for community pharmacies that are forced to close due to relocation of their local surgeries to new health centres.

Will the public be happy to have their pharmaceutical services provided in the superstore pharmacy, or will they embrace the new technology and have their prescriptions dispensed at some remote prescription factory, ordered and transmitted electronically over the internet, and delivered some time later by post or courier service? Will they not miss the personal contact they now enjoy with their local community pharmacist? How will the people who cannot fill in the back of the prescription form manage with the need for new IT skills?

We appreciate the need for raising the standards and improving the range of services that we provide for the public, but new services need new funding. To ask more of community pharmacists, many of whom are already over-stretched, may be too much.

It may be that the Government, rather than improving access and equality to pharmaceutical services, is in serious danger of over-stretching an under-funded profession, with the potentially dangerous consequence of the highly efficient supply and distribution chain breaking down. This could lead to reduced access for the general public to local pharmaceutical services and a valuable and highly respected local health care professional could simply disappear local high streets and from urban housing estates. Such a loss would create whole new areas of health care deprivation.

Mr Glassman is a community pharmacist and secretary of City and East London Local Pharmaceutical Committee. The views expressed in this article are not those of the LPC