PJ Online | PJ Letters: OFT report

John Vickers, the Director-General of Fair Trading, is standing aside from the investigation into the possible takeover of Safeway. This is because he has previously been an adviser to a number of supermarket chains and wishes to avoid any suggestion of a conflict of interest.

Presumably, no such conflict existed in the compilation of the Office of Fair Trading's recent report on pharmacy.

Norman Fitt
Manchester

Pharmacists should become specialists

From Mr J. B. Paige, MRPharmS

The Office of Fair Trading's report and the treatment of pharmacy contractors by the Department of Health give notice that the Government will not support an antiquated, inefficient and expensive distribution system for prescribed medicines. On the other hand, its offer to potential "super-nurses" indicates that it is prepared to pay premium rates to any clinical staff who can bring expert knowledge about treatments out of the hospital environment and into the community.

We should be doing that. There are over 20,000 community pharmacists with a scientific education who could be trained quickly to become experts in specific areas of therapeutics so they could set up clinics in local pharmacies and ensure that patients make the best use of the treatments prescribed for them.

We don't need continuing professional development to cut up tablet strips and stick on computer-generated labels. Instead, properly structured training would turn each of us into an expert in one or two specialised fields, able to offer patients the benefit of consultant-standard advice in the gaps between their rare and brief visits to hospital specialists.

The only real obstacle to this new and exciting work for pharmacists is the attitude of pharmacy contractors and the bodies which represent them. As retailers, corporate pharmacy owners are more concerned with prescription volume than patient care and abhor the idea of specialist pharmacists who might be able to demand proper professional remuneration.

It is high time that routine prescriptions were dispensed at off-site, automated dispensing factories for distribution through local pharmacies (just as over-the-counter medicines manufacture and photograph developing are now done off-site). This would give community pharmacists time to develop their proper role in health care. Cutting dispensing costs would help pay for this service.

Barrie Paige
Guernsey, Channel Islands

Abolition could benefit the profession

From Mr C. Morris, MRPharmS

I have just realised that, since the Office of Fair Trading has deemed it in the best interests of the pubic to abolish control of entry regulations, we could use it to benefit the profession as a whole. Since there will undoubtedly be more pharmacies opening, there will be an increased lack of pharmacists. Imagine every year as a fallow year! With the number of pharmacies that will have to shut through lack of pharmacists this could be our chance to put pressure on the Department of Health.

No more would we have to get letters signed in triplicate from each local doctor to close half an hour early every third Wednesday. No more would we have to decide whether to go to hospital to visit our sick spouse or open the shop. No more would we have to decide whether our parent's funeral is more important than Mrs Smith getting her aspirin.

This could lead the whole profession forward to be on a par with other professions that can take a morning off or, God forbid, take two hours for lunch.

Chris Morris
Newquay, Cornwall

Hope the DoH will accept proposals

From Mr J. A. Yusuf, MRPharmS

I would like wholeheartedly to endorse the recent Office of Fair Trading report. For far too long young pharmacists of relatively modest means have been denied access to proprietorship by the closed shop or cartel nature of the 1987 contract.

I have worked in many pharmacies which are the sole prescription dispensers for a given surgery. Surely this kind of localised monopoly is unacceptable greed and it would be fairer to have several pharmacies sharing the prescription load. This would create job opportunities and allow those pharmacists who hitherto have been priced out of the market to create their own businesses.

Those who object to the OFT recommendation are probably selfish proprietors who only care about their share of the market and who have already succeeded in the pharmacy business world.

The threat from multiples can be minimised by astute independents staying one step ahead of them and playing them at their own game. Leapfrogging could still be controlled in exceptional circumstances — market forces will still keep in check the number of pharmacies serving a particular surgery.

I sincerely hope the Department of Health will accept and implement the recommendation as soon as possible.

J. A. Yusuf
London E4

Pharmacy has been thrown a lifeline

From Mr D. F. Miller, MRPharmS

The prophets of doom are having a field day: supermarkets can open pharmacies wherever they want. So what!

Any independent pharmacists who cannot provide a better service than a large multiple should hang up their white coats and put themselves out to grass. The levels of service offered by the large multiples over recent years have helped to reduce the standing of the profession, not only in the eyes of the public but also in that of the Government.

Service driven solely by profit and not patient well-being has led to pressure on the remuneration package and has, in my view, been instrumental in the introduction of NHS Direct.

All that could now change because pharmacists are now in charge of their own destiny. Pharmacist employees are no longer forced to be a small cog in a very large corporate machine. No longer need their expertise be used to make large profits for big chains. They should talk to their colleagues locally and set up new businesses either as individuals or in consortia and take on the multiples offering the kind of service the NHS deserves. In that way maybe the days of the multiples would be numbered.

Most importantly all pharmacists must start treating other local professionals as colleagues and not competitors. If enough pharmacists do this it will not matter how many pharmacies the multiples open: there will be no pharmacists left to work in them. Maybe then community pharmacy will return to the ideal situation of all pharmacies being owned by pharmacists.

Pharmacy has been thrown a lifeline by the Office of Fair Trading and all pharmacists must grasp this opportunity before it is too late.

David Miller
Congleton, Cheshire

GPs given licence to print money

From Mr P. Watson, MRPharmS

Although I would not disagree with the general response of the pharmaceutical professional bodies against the contents of the Office of Fair Trading's report, I am surprised that none has yet highlighted what I see as the major threat from this report, namely, doctors wishing to own a pharmacy on their surgery premises. Doctors are now allowed a direct interest in pharmacy ownership. Any large surgery with spare room could establish a pharmacy and starve any surrounding community pharmacies of prescriptions. This would apply equally in rural and urban areas and few pharmacy businesses could be considered safe.

Essential small pharmacies would be bankrupt within weeks as dispensing doctor practices used their new pharmacy to get back all their "lost" prescriptions at the same time as the existing pharmacy stopped receiving any ESPS payments. Of course, after a few months, the doctors could close their pharmacy and revert to dispensing themselves, and no other new pharmacy contractor would dare attempt anything in that village, or any other, ever again.

The OFT is effectively advocating a licence for many GPs to print money; they will be the ultimate leapfroggers. Ironically, doctors themselves do not seem to have the problem of another surgery being allowed to open and compete next door for their patients. NHS medical services are therefore subject to a rational distribution and control of entry; why should NHS pharmaceutical services be treated any differently?

An unrestricted control of entry would ultimately mean fewer pharmacies, not more. This would reduce general access and advice and will not bring about further reductions in over-the-counter medicines prices. Pharmacists who are advocates of a free-for-all, unrestricted control of entry for NHS contracts should think carefully before lobbying in its favour, lest they shoot themselves in the foot or, more likely, through the heart.

P. Watson
Kingston Pharmacy
Strensall,
Yorkshire

I was on the verge of optimism

From Mr S. P. Bullock, MRPharmS

And so, finally the Office of Fair Trading have pronounced. Apparently we are shopkeepers, subject to the natural laws of "the market". And to think, in the wake of 'Pharmacy in the future' I was on the verge of optimism. Having stood at the crossroads for most of my career, beginning, even, to be almost optimistic.

But never mind, according to some bigwig from Tesco on Newsnight (17 January), the public can expect a much better pharmaceutical service henceforth.

Pity then, that our local Tesco pharmacy was closed last Saturday morning because they did not have a pharmacist and, it would seem, the primary care trust has little power to admonish them. A sign of things to come perhaps?

Steve Bullock
Barton under Needwood, Staffordshire

Doomsday?

From Mr C. P. Chau, MRPharmS

The Office of Fair Trading has expressed a wish to abolish control of entry. If its proposal is accepted, supermarket chains will be able to open a large number of dispensing chemists without any restrictions. Eventually all independent chemists in Britain may be forced to close due to fierce competition.

As local community pharmacists, we have always been committed to providing a high standard of patient care and excellent pharmaceutical services. The contract system has secured our business in the past and if it were to be abolished, we would be unable to provide these free services. A substantial cut in our budget would mean that pharmaceutical services as a whole would be affected.

I urge all chemist contractors to face the situation together and to try and prevent the inevitable domination of the profession by supermarket chains. Was 17 January doomsday for British pharmaceutical services?

Conrad Chau
Aberdeen

A sad day for the profession

From Ms K. M. Morris, MRPharmS

Putting the Office of Fair Trading in a position of influence in the future "profession" of pharmacy is rather like putting a shark in charge of a swimming pool. Predictably it has focused solely on the 10 per cent of revenue that pharmacy medicines contribute to our turnover. The summary report is littered with references to "the consumer" but the word "patient" is notably absent.

The future of pharmacy in which I am interested is about serving the needs of National Health Service patients and providing quality services to the old and young who form the majority of my customers. The thrifty insomniacs who want their prescriptions filled at 10pm and who want to stock their medicine cabinets with "3 for 2" deals I do not care for — the supermarkets are welcome to them.

Indeed the OFT report could have been written by a pharmacy category manager for one of the supermarkets because it shows a complete disregard for the professional/service element of pharmacy and concentrates solely on price/value for consumers. There is no evidence at all of the public being denied fair and reasonable access to dispensing and pharmaceutical services: quite the reverse. There is also no account taken of the hours that surgeries now work. Many are now open "office hours" so a 24/7 pharmacy service (which John Vickers, the Director General of Fair Trading, seems to think the public desperately need) is a myth.

It cannot escape the notice of my fellow professionals that the report implies that innovation and service would improve if the supermarkets were allowed to open pharmacies in every outlet. This is laughable, I would hardly call "buy one get one free" an innovation in this profession and the idea that supermarket pharmacies offer a better professional service should be dismissed with equal contempt.

The problem with this shallow and misleading report, and its recommendation, is that it could return us to the dark days of leapfrogging. How can you plan for the future and invest in premises, staff and services when you are constantly looking over your shoulder and fending off competition who just wants to cream off the dispensing revenue? Without some form of control on pharmacy numbers there is no future for the hard-working and committed professionals that make up the core of the NHS service element.

A question that should be asked is why taxpayers' money has been spent on such an inaccurate and misleading report that has scraped the barrel to justify its conclusions? The "theoretical" savings of £25m on P medicines (the only real issue in the report) amount to 50p per year for a UK resident and I would hardly call that significant. If it were 50 times this level then I think Mr Vickers et al would have a case.

Finally, the reason the OFT findings were headline news on Friday 17 January was more to do with big company PR machines than true public interest. The talk in the business sections of the press was all about share prices and City reaction. If that is not a sad day for the pharmacy profession then I do not know what is. Most of us were too busy in our pharmacies to spend time lobbying the media.

In conclusion, therefore, I would urge the Government to treat the recommendations in this report with great suspicion. The only thing that seems to have been missing from it was the sponsors' logos.

Mary Morris
Northampton

Independents, take cover!

From Mr M. J. Moon, MRPharmS

The Office of Fair Trading has announced its preference for the abolition of limitations on dispensing contracts and pharmacists are worried about the inevitable appearance of new pharmacies in supermarkets.

I suspect that on an individual basis far greater harm will be done to some existing pharmacies by the introduction of pharmacies into health centres.

I have been working in pharmacy for 50 years and remember the time when, for good reason, general practitioners were not allowed to profit from the provision of pharmaceutical services. My independent colleagues had better take cover.

M. J. Moon
Bristol

Independent pharmacy will die

From Mr P. Gamblin, MRPharmS

It appears that the Office of Fair Trading report has removed the debates on the future direction of pharmacy, ie, continuing professional development, medicines management, etc, from the headlines. We, the independent pharmacies, representing some 60 per cent of the retail outlets (and to a lesser extent the multiples), will have been kicked in the teeth again, this time possibly fatally, if the Government accepts this report.

May I take this opportunity to plead for strong leadership from the National Pharmaceutical Association, the Pharmaceutical Services Negotiating Committee and, dare I say it, even the Royal Pharmaceutical Society, to fight our cause. We cannot afford to lose this battle or pharmacy will become a charter for supermarkets and leapfroggers. If this report is accepted, the independent pharmacy will certainly die and with it all the support and much debated proposals for the future.

Help and leadership are needed now as never before.

Peter Gamblin
Gosport, Hampshire

Why OFT does not stick up for the vulnerable patients

From Dr N. Gray, MRPharmS, and Mrs K. O'Brien, MRPharmS

One of the key arguments upon which any successful representation to the Government to retain control of entry will be made is the crucial balance between "concerns about the provision of health services" and "greater benefits for consumers", rightly identified by Dr Darrin Baines et al (PJ, 25 January, p123).

In 2002, we saw a very real example of where commercial imperatives and consumer power resulted in reduced access for a vulnerable population group to a National Health Service pharmacy service. We mean, of course, the decision by Tesco to stop providing emergency hormonal contraception (EHC) under an NHS patient group direction (PGD) to clients aged under 16 years. We recall that the management board took this decision after successful lobbying by a small but vociferous group of consumers and that Tesco's superintendent pharmacist stated that it was "listening to its customers and reacting to their concerns" (PJ, 24 August 2002, p247). Well, obviously not all of them. The commissioners of the EHC service in Manchester, Salford and Trafford boldly removed Tesco completely from the NHS scheme, rightly arguing that there was no room for "cherry picking" clients when the PGD made no provision for pharmacies to restrict access to the service.

The fact remains that vulnerable groups, such as these young adolescents, have relatively little "consumer power" and they rely on the NHS to minimise their barriers to equitable health services. Pharmacists are in an excellent position to speak up for those without such power; the OFT certainly will not.

Nicola Gray
Karen O'Brien
Joint Founder Project Managers,
Manchester, Salford and Trafford EHC Scheme

Stop dreaming and start campaigning

From Mr N. J. M. Engineer, MRPharmS

I read with interest Rajive Patel's letter (PJ, 25 January, p113) and it seems Mr Patel is living in fantasy land.

Should the limitation of contracts go there is no reason why general practitioners should not open pharmacies in their surgeries. In this day and age a majority of young GPs are business minded and are aware that opening a pharmacy within their surgery could provide instant extra income.

Those GPs who are not so business minded, which I am sure is a minority, will opt for a pharmacy contractor to open a pharmacy within their premises and will go for somebody who will pay the highest rent. Therefore the most likely winner will he one of the larger chains which have deeper pockets than an independent pharmacist like Mr Patel.

Supermarkets can give a better out-of-hours service than an independent because they are open for longer hours, seven days a week. An independent pharmacy contractor has not got adequate infrastructure or the financial muscle to open a pharmacy for longer hours seven days a week and make it profitable.

It is clear from the comments made by representatives from the large multiples that they will be worried if the limitation of contracts goes. It is bad news for retail pharmacy in general.

Therefore, people like Mr Patel should stop dreaming and concentrate all their energy on lobbying their local MP and campaigning at a local level against the OFT report.

Navin Engineer
Weybridge, Surrey

Driven into an economic mess

From Mr R. Gartside, FRPharmS

Supermarkets have a right to exist, and do so because of the enhanced personal mobility provided by private transport. Of course they have a right to offer all or any existing or future retail services, but the dispensing of National Health Service prescriptions is not a retail service.

What supermarkets do not have is a right to destroy an existing NHS service provision arrangement and go back to a previous state of chaos simply because they want the NHS to subsidise their commercial operations.

In saying that they want the public to benefit from lower pharmacy medicine prices but they cannot do this without an NHS contract to subsidise their pharmacists' wages, they are really saying that P medicine prices are too low to be viable, given the need for pharmacist supervision of each sale.

All concerned should read Adam Smith's 'The wealth of nations' on "the wages of the apothecary" where the founder of the "dismal science" shows that medicines must have high margins because of the extra skill needed to sell them. This is as true now as it was more than 200 years ago.

The reality is that we have ended up with a position where extremely rich companies say they cannot afford to sell medicines and want the NHS to give them a contract which will pay the necessary staff and overhead costs so that they can cut their retail prices. An arguable, if hardly sensible, position which simply highlights the economic mess into which the Department of Health has driven community pharmacy.

Bob Gartside
Llanberis, Gwynedd

Up the pole and on the dole

From Mr G. D. Thorne, MRPharmS

The version of the Beecham carol quoted by Ann Hunt (PJ, 25 January, p117) was written in a pre-1939�45 war minute book of the Nottingham pharmacy students' society. Also there were the words of a song which included "we're up the pole and on the dole, the sons of pharmacy". I can recall no more, but following the Office of Fair Trading's decision it may become relevant!

G. D. Thorne
Oakham, Leicestershire

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