PJ Online | PJ Letters: OFT report

Our company specialises in pharmacy stocktaking and I run an agency for the sale of pharmacies. In 1987 when last there was a "free for all, open where you want" attitude, we saw the creation and the demise of many pharmacies. We, as a company took many losses as pharmacies closed. Many of today's owners have built up their pharmacies from little to something that was to finance their retirement. In 1987, I took plenty of calls from would-be "blow everyone else, I'll take someone else's hard sweated living for nothing" persons. Now the Office of Fair Trading has handed such people the opportunity of starting all over again. Why can the National Health Service not refuse a contract? Supermarkets have already killed off most of the bakers, butchers, greengrocers and plenty of other independent traders. Why should they have all and sundry bowing to their every wish?

It is no secret that there is a shortage of pharmacists and particularly of those able to run their own businesses. Supermarkets are open late and so will probably need two pharmacists to take care of the hours of one store. Will this inspire any up and coming pharmacist to buy a business? Indeed, what will attract anyone to become a pharmacist, when their only form of employment after years of study is to work unsociable hours in anything but a sterile environment.

I think that the whole point that is being missed is that the good pharmacists are those that are moved not so much by profit, but by being caring of their patients. I have worked in both independent and supermarket environments and pharmacists who work in the supermarkets give one an impression of feeling cheated out of their role of listening to a patient's ills, and using their skill and judgment to help those in need. In one supermarket pharmacy where I worked, pharmacists were instructed to accept baskets of shopping to tally up as well.

How long will it be before supermarkets allot part of their car parks for the building of doctors' surgeries, thereby ensuring the demise of the independent and larger community pharmacy companies in any given area? This is corporate business greed gone crazy, and I hope someone can nip it in the bud before it is too late.

Derek Essen
Essen Valuers & Co

Worried by potential loss of goodwill value

From Mrs J McMurray, MRPharmS

I write in response to the assumption made by John Evans of Asda that there were only three ways by which a 38-year-old pharmacist could have owned a pharmacy (PJ, 1 February, p158). I am a 37-year-old pharmacist who borrowed a considerable amount of money five years ago to finance the purchase of a pharmacy and I am sure that I am not the only one.

When the control of entry regulations commenced the value of goodwill increased and now if the regulations go the value will decrease. So what will happen to people like me who paid a lot as a result of a Government decision in 1987 and now face owning something that is potentially worthless (with a large loan outstanding) if the Government adopts these recommendations? I am worried.

J. McMurray
Oswestry, Shropshire

Moving towards extinction

From Mr C. R. Williams, MRPharmS

Taking into consideration the opinions of our members in relation to the Office of Fair Trading's report, it would be interesting to speculate on the future of pharmacy in a brave new world as follows:

• All general practitioners take on dispensing, employing anyone they like under the umbrella of delegated responsibility at an hourly rate of £5.50. GPs use any additional revenue to prop up a personal pension

• Supermarket chains try to get a foot in the door of dispensing surgeries by offering to help them financially in their new role

• The Royal Pharmaceutical Society extends its membership to cover technicians due to the flagging pharmacist membership

• Community pharmacies in small towns and villages become extinct

• Pharmacy students change to more reliable courses like plumbing and electrics

• have always believed that pharmacy is a vulnerable profession and acting in part as shopkeepers, selling toys and sweets, must compromise our integrity. I believe our own evolution is one of extinction.

Charles Williams
Crowborough, East Sussex

The public must make a stand for community pharmacy

From Mr J. P. Currie, MRPharmS

Following the Office of Fair Trading report on regulation of community pharmacy, the initial reaction from all the caring sectors of the profession must be one of insult. However, upon reflection, perhaps John Vickers and his team have handed local community pharmacy the greatest ever opportunity to demonstrate to the Government and Civil Service their true value to health care provision within the National Health Service.

Since publication of the report, I have actively promoted the issue within my local community and canvassed opinion of the potential outcome, following deregulation. The response has been astonishing: alarm at the long-term consequences of local pharmacy closures, and respect and support for pharmacy services.

A former Government minister who regularly visits my pharmacy informed me that if a member of Parliament receives from his constituents six to 10 letters on a subject, then there is an "issue" to be addressed. Over the past two weeks I have encouraged many of my patients to write to their local MP expressing their concern (providing them with a briefing paper and a stamped addressed envelope). I have had over 200 pledges of support, not to mention a petition with 1,500 signatures and addresses.

I have recently met my local MP, who was supportive and commented on the 60 letters he had already received on the subject. I feel encouraged that perhaps the Government may realise that health care provision should not be influenced by narrow sectional interests.

Now is the time for the public, not the profession, to demonstrate to the Government the major contribution community pharmacy already makes to patient care within the NHS. I encourage pharmacists to mobilise the communities they serve and seek the influence of their local MPs.

James Currie
Bradford, West Yorkshire

Our leaders must engage in the battle sooner rather than later

From Mr G. Hall, MRPharmS

It is common knowledge that general practitioners are severely stretched, and a report due out next week will indicate the Government's own recruitment target may fall short by up to 10,000. The Department of Health in both the NHS plan and "Pharmacy in the future" views pharmacists as a huge untapped resource for the overstretched National Health Service. The DoH views the 12,000 "chemists shops" across the United Kingdom, easily accessible on the high street, as future "consulting rooms" or surgeries. Where, then, is the logic in losing a third of these premises, replacing them with less accessible pharmacies in out-of-town superstores, which is what could happen if the Office of Fair Trading recommendation is implemented?

There also appears to be little financial logic. The Cabinet Office estimates that if repeat prescribing was transferred from GPs to pharmacists this would release 2.4 million GP hours. If pharmacists were also able to take on one fifth of all GP appointments that are for minor ailments, and manage chronic diseases and drug treatment reviews, it would save the NHS £380m annually. This compares with the OFT estimate that deregulation would save consumers £30m through cheaper medicines.

The argument is partly about whether community pharmacists are clinical professionals or shopkeepers. The Health Secretary, Alan Milburn, declared his views at the most recent Labour Party conference: "I see pharmacists as clinicians, not as shopkeepers." The OFT clearly disagrees with him, seeing pharmacists as small shopkeepers running restrictive practices. But the argument is also about the real needs of NHS patients for rapid, open access to treatments for minor illnesses and chronic diseases.

This is a battle between the DoH and the Department of Trade and Industry. The arguments are clear, important to all patients, and have huge significance for our profession and the future shape of the NHS. Our leaders must engage in this battle sooner rather than later.

We need to put an eloquent and factual argument together if we are to persuade the Government of our case within the 90-day response period. We need to show this is a decision of big business power, namely the supermarkets, against the needs and development of the NHS.

Graeme Hall
Professional Secretary
United Kingdom Clinical Pharmacy Association

Freedom of choice must be based on evidence

From Mr R. C. Cooper, MRPharmS

During the outbreak of leapfrogging in the 1980s, I witnessed some appalling decisions which, although they made a few people a lot of money, did nothing to promote the profession, pharmacists or the service offered to the public. Decisions were made purely to maximise profit. Is it any surprise to anyone that the only companies to welcome the Office of Fair Trading report openly are grocery-based? The main point in favour of removing the control of entry regulations is to reduce the price of pharmacy (P) medicines. This is illogical and flies in the face of all of the reforms that have taken place within the NHS over the past few years.

What happens to the "new NHS" when the grocers decide that perhaps there is not enough profit in pharmacy and decide to sell wool instead? Most of the proprietor-owned pharmacies would have been driven out of business and there will be no one to pick up the pieces, except of course companies owned by general practitioners, who will take full opportunity to get rid of pharmacist owners, which is what they have been trying to do in rural areas for years. How will these GPs react when the grocers decide to have surgeries within their premises? Grocers have killed off newsagents, greengrocers, butchers and now they want pharmacy.

Freedom of choice is a wonderful thing. In health care, freedom of choice must be based on clinical evidence, not market share. The new contract could be the lifeline for our profession. We have the opportunity to deliver more than boxes with labels on them. Those of us involved in training or management know how hard it is to find pharmacists who can talk to members of the public, advise them on their condition or medication and enjoy the encounter. There are too many pharmacies under the control of pharmacists who do not usually spend more than two days in the same place.

I agree that competition is necessary to prevent the profession from stagnating. I agree that pharmacies need to be more in tune with the needs of their patients. I do not agree that the profession is best served by flooding the market place with sub-standard services just to capture market share.

Who will open on Christmas day and bank holidays? Who will supply addicts, needle exchange, supervised consumption, trusses, hosiery, expensive items? Who will keep the unprofitable lines that people expect in pharmacies? Those of us who remain committed to our patients and the profession will.

We need to control the provision of pharmaceutical services. Primary care trusts have a legal and moral responsibility to ensure adequate provision within their area. If they think it necessary they can grant any application. Why do we need a free for all? Is it just to satisfy the City?

Robert Cooper
Elmswell, Suffolk

Ending control of entry cannot be allowed to proceed

From Mr A. B. Sutherland, MRPharmS

I draw to your attention a rather interesting article that appeared in The Guardian on 24 January ("Find a new prescription", p21). Did anyone notice the crux of the article, relating to the end of control of entry? I was quite impressed by Polly Toynbee's grasp of the issue, and wonder if the Royal Pharmaceutical Society's Council also realises the gravity of the situation. Put simply, ending control of entry cannot be allowed to proceed lest we see an end to local pharmaceutical services.

Market forces are all well and good in large markets, where staffing is not an issue. However pharmacy is a narrow and specialised market which at the moment cannot satisfy current demand for pharmacists. How will the profession cope with a massive proliferation of outlets all in need of a pharmacist, all in need of a few FP10s more, to make that target? What kind of quality of care will we see then? I dread to think.

Adam Sutherland
Pharmacy Department,
Nottingham City Hospital

Medicines are not ordinary articles of commerce

From Mr R. Blyth, FRPharmS

I was pleased, but not surprised, to see the National Pharmaceutical Association suggesting pro-supermarket bias on the part of the Director General of Fair Trading (PJ, 1 February, p139). I had previously suspected an anti-pharmacy bias in the mind of the director general, which was surely indefensible in someone entrusted with a task that demanded a balanced judgement.

My concern was a front-page report in The Times of 18 January, in which the director general claimed that the number of pharmacies had remained static despite increasing demand from patients. The average annual net entry had been just four pharmacies a year and that was against a total of 12,250.

There is more to it than that. After the 1939�45 war, pharmacy numbers peaked in 1954 at 15,413. The following year saw the start of a steep decline. Although only 11 closed in 1955, by 1980 the number had fallen to 10,623. A rebound occurred and by 1984 the number had risen to 11,107. When it became known that the government was proposing to limit the number of National Health Service contracts for pharmacies, the number of pharmacies bounced up to 11,974 by 1987 when limitation was imposed. Because it was Parliament's intention for economic reasons to stabilise the number of pharmacies by means of limitation, it is hardly surprising that the number of pharmacies is now only 12,250.

Incidentally, the reason for the large fall in the number of pharmacies after 1954 was the emergence at that point of cut-price competition from supermarkets. In August 1954 pharmacists were complaining about a new "supermarket" in Edgware, Middlesex, in which various branded articles were being sold at cut prices be Express Supermarkets Ltd. A system of discount houses (or cut-price shops) was already in existence in the United States, some 6,000 of them by 1954.

So, are we now to see the supermarkets completing the cull of the traditional pharmacies? Let us hope that the Government will think otherwise and decline to feed the "greedy grocers" (Patience Wheatcroft's apposite description in The Times of 14 January).

Magnus Linklater's trenchant criticisms of the "superstore oligarchy" and some of its malign effects upon the community in The Times of 15 January ended with a quotation from Tim Lang, professor of food policy at City University: "The Competition Commission needs to be given social criteria, not just narrowly defined economic criteria, by which to judge the public interest." For Competition Commission, read Office of Fair Trading. As Magnus Linklater concludes: "It is high time consumers asked themselves whether the superstores have passed their sell-by dates."

I would only add that medicines are far from being ordinary articles of commerce and that is why the pharmaceutical profession exists.

Robert Blyth
Milton Keynes, Buckinghamshire

John Vickers should have taken no part in inquiry

From Mr P. Jenkins, FRPharmS

The current Director General of Fair Trading, John Vickers, had been a paid adviser on mergers for supermarket groups in the 1990s (PJ, 1 February, p139). Although there is no suggestion of present financial links, his past connections must have given him a particular feeling for the directions in which the supermarkets wanted to grow their businesses. The results of the latest Office of Fair Trading report will facilitate these business opportunities.

It would have been proper for him to have taken no part in this investigation and this should have been obvious to all those concerned with setting it up. It is a slight to our profession that nowhere along the line did anyone raise this. It does not reflect well on the officials involved, since many of them must have known his previous career.

There was a glitch in the resale price maintenance investigation that resulted in a rerun of part of that case which cost pharmacy money at the time. Is this a variation on a similar theme? Surely it should be ensured that these inquiries, which affect many individuals' livelihoods as well as the health provision across the United Kingdom, should be conducted in a scrupulously fair manner and, equally importantly, be seen to be fair.

The National Pharmaceutical Association has commented publicly but there is, as yet, no statement from the other national bodies. Surely they will follow this up.

Already there are questions being raised as to the benefits to be gained if the report's findings are implemented in full. We cannot be sure any changes will be made to the report or that, if there are, we will approve of them, however the background of the director general must add to the questioning. There is no way that his opinions, coloured by his experience, could not have had an effect on the report's outcome.

Peter Jenkins
Cardiff

The economics do not stack up

From Mr N. Cumming

People should be aware that even if pharmacy is reduced to "simply a matter of supply, demand and pricing", the Office of Fair Trading's arguments still do not stack up. Market forces mean that consumers value "perceived benefits" and that markets can be manipulated to give perceived benefits which are of purely superficial value. For example, a pair of training shoes reduced from £200 to £150 is a perceived saving, encouraged by the free market, but it hardly reduces the cost of footwear.

The "benefit" most valued by National Health Service prescription consumers is location relative to the surgery or health centre. This stimulates a market response by pharmacies to get as close to the doctor's surgery as possible, and to cluster round health centres. To say this could be controlled through the remuneration system does not fit with any rational analysis of competition theory, or of the market forces affecting pharmacy. Contract limitation was brought in to control NHS costs. Its removal will inevitably lead to wasted resources and higher NHS costs.

The price savings from supermarkets are grossly overstated. The £25m saving is based on a "10 per cent to 30 per cent saving on all medicines, depending on the supermarket", but these price reductions only apply to a limited selection of "known value items", not medicines in general.

Economic and marketing theory tells us that increased competition will cause the market to grow. To think that playing with the NHS market in order to facilitate supermarkets taking a larger market share will bring consumer savings is to confuse promotional activity with real savings. It can be confidently predicted that more supermarket pharmacies will mean higher consumer spending on medicines. That the spending is more likely to be damaging than beneficial to public health is a health rather than an economic argument.

Nigel Cumming
Managing Director,
Lindsay & Gilmour Chemists

Services vetoed?

From Mr A. C. Gush, MRPharmS

Our local health group has rolled out a patient group direction across our local network of pharmacies. One large supermarket has decided not to participate in this service to patients. I am concerned that, if the recommendation in the Office of Fair Trading report were accepted in Wales, this liberalisation could not only reduce access to pharmacies, but services could be further restricted by supermarkets choosing to veto services after performing an impact assessment on their shopping trolley value.

Andrew Gush
Bridgend, Mid Glamorgan

Supermarkets should come under scrutiny

From Mr A. Patel, MRPharmS

It has been estimated by the Office of Fair Trading that the benefit to consumers would be around £30m per annum through deregulation. Indeed, if the OFT really has consumers' interests at heart and wants them to benefit even further, why does it not look critically at the excessive net profits made by large supermarket chains in the United Kingdom compared with those on the continent and in the United States? A figure of £30m seems insignificant compared to the billions of pounds of profits produced by these same supermarkets from these same consumers.

Ajay Patel
Potters Bar, Hertfordshire

Deregulation will not deliver the benefits promised

From Mr K. C. Patel, MRPharmS

So John Evans has written a myth-busting article in support of the Office of Fair Trading report (PJ, 1 February, p158). I am not convinced that this article represents his owns views, rather they are the views of Asda management who have lobbied hard in favour of deregulation. In my view, deregulation will not deliver the benefits promised in the OFT report and will ultimately prove detrimental to all pharmacist.

First, doctor dispensing will increase substantially. Any practice generating a large volume of prescriptions will be tempted to set up a pharmacy. Once this occurs, even those pharmacies that are adjacent to a health centre will notice a difference.

Supermarkets have lobbied successfully to remove resale price maintenance. They were keen for the OFT investigation to take place and they stand to benefit hugely from deregulation. The next item on their agenda is the removal of the requirement for supervision by pharmacists; plans no doubt are already in place. After all, pharmacists are the most expensive part of the dispensing process. Once supervision is removed only trained technicians will be needed in order to dispense. Those surgeries that have established dispensaries within their practice will welcome this move since they will no longer have to employ a pharmacist and those surgeries that have not done so may be tempted.

It is in the interest of all pharmacists to lobby effectively and make their views known if they are opposed to deregulation. The National Pharmaceutical Association has sent out letters outlining action that can be taken. Protect you jobs, your livelihood and your profession. No one else will.

Kiran Patel
Rayleigh, Essex

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