 Ask any pharmacist how many people visit a pharmacy every day and they
are likely to say without hesitation “six million”. The figure
has been regularly quoted by members of the profession and the organisations
that represent them for more than two decades. But where does it come
from and is it accurate and if it ever was accurate, is it now out of
date?
Opinion about the origin 20 years ago of the “six million” figure
is mixed. Depending on whom you talk to, it was either scribbled hastily
on the back of an envelope during a meeting of the Council of the Royal
Pharmaceutical Society, or somebody at the Council meeting did some quick
sums on the back of a cigarette packet in the Adams Room at the Society’s
headquarters. Another possibility, hotly contested by the National Pharmaceutical
Association, is that one of its members stood outside its local Boots
branch in St Albans, Hertfordshire, and spent 10 minutes counting the
number of people who crossed the threshold, and worked the number up
to reach six million. Whichever story you choose to believe, none is
based on any robust research and all should be rejected by a profession
which is a firm believer in an evidence base. But pharmacists seem to
have an affection for the figure that is difficult to budge — even
if no one will lay claim to its origins.
First appearance in the 1980s
The six million may have first appeared in the early 1980s. Alison
Blenkinsopp, professor of the practice of pharmacy in the department
of medicines
management at Keele University, remembers seeing it then in a Department
of Health patient information leaflet which was part of the Government’s
Pharmacy Healthcare Scheme. She says: “I was evaluating the scheme
when I was at Aston and the figure was definitely bandied about then.”
Judy Viitanen, head of public relations at the NPA, shares that memory.
She adds: “When I joined the NPA 14 years ago the statistic was
part of pharmacy folklore even then. At the time the NPA, like other
pharmacy organisations, used this figure, but we viewed it as an anecdotal
rather than a hard statistic.” She rejects the suggestion that
the “six million” began its life at the NPA. “It’s
absolute rot to suggest that somebody from the NPA stood outside Boots
and counted footfalls. I deal with all advice and PR campaigns on behalf
of the NPA and there is no information which shows that the six million
comes from us.”
The NPA accepts that its members will know how many people visit individual
pharmacies every day, but that was not information the organisation was
interested in collating. A spokeswoman explains: “Our members run
their own businesses and it’s in their interest to know how many
customers visit their pharmacy, but that is not the kind of information
they would give us. What we do know though is that the number is high.”
However, the high street multiples have no accurate figure on the number
of people who visit their pharmacies every day. They argue that the piece
of research is too huge to undertake and would not reflect a true picture.
What they rely on instead are the number of dispensed prescriptions and
the total of sales. Chris Street, head of health and pharmacy advice
at Moss Pharmacy, says he is familiar with the “six million” figure
and adds: “Our understanding is that the figure came from the NPA,
although we aren’t aware of how they calculated the figure or what
assumptions they made or averages they used.” The problem Moss
has in working out visits per day is that it does not collect information
on what it describes as “discreet” customer episodes. He
explains: “A customer could buy something when they drop off their
prescription and again when they pick it up. Is that two customers in
the day or one or even three? Because of that we don’t as a rule
collect this data. We tend to use measures such as number of items dispensed
and total value of sales, but neither link the figures to any particular
number of customers.”
Boots the Chemists also rejects the idea of taking on research to discover
how many people visit the pharmacy because, according to a company spokeswoman,
it would be a huge piece of work. Like Moss, Boots relies on using the
number of items dispensed and the number of medicines sold to give it
an idea of how many customers the pharmacy has. Boots says around 90
million items are dispensed in a year from its 1,374 pharmacies across
the UK and the Republic of Ireland, and the value of medicines sold is
around £700m. The spokeswoman adds: “These are the figures
which are important to us. The six million has just come out of folklore
and is just used to illustrate scale. We’ve no idea where it comes
from originally and we don’t use it.”
Like the high street multiples, the Pharma-ceutical Services Negotiating
Committee is only interested in the number of prescriptions and items
dispensed.
Godfrey Horridge, its financial executive, says he knows about the “six
million” figure but adds: “I don’t know how accurate
that is. We don’t use that figure and I can’t think of many
occasions when we would need to. Our work is concerned with the NHS so
we do know the number of prescription items every month, which is an
accurate figure, and that is what we focus on, rather than the number
of people coming into a pharmacy.” The latest figures the PSNC
has are for the number of dispensing fees paid to the profession in the
last financial year. There were 658.3 million fees — which includes
the standard dispensing fee as well as the special dressing and oxygen
fees. It estimates that the number of prescribed items is roughly 2.5
per cent less which would be around 640 million items. Appearance in “Vision for pharmacy”
The Department of Health also relies on hard statistics to inform policy
decisions but a spokesman confirmed it does use the “six million” figure — it
appeared last year in its “Vision for pharmacy in the new NHS” document.
But a Department spokesman adds: “We don’t use the six
million for number crunching. It’s not used for the creation
of policy. We use it as a pointer, for discussion. The figures which
we do rely on are those we have proof of, which are the number of prescriptions
dispensed and the number of pharmacists on the register — stuff
you can see.” Although the Department uses the “six million” figure,
it insists the statistic is not Whitehall’s. The spokesman adds: “It’s
a Royal Pharmaceutical Society figure. It first appeared in its discussion
paper ‘Pharmacy in a new age’, which was published in 1995.
That was where we first noticed it.”
“Pharmacy in a new age” was a discussion document that triggered
the debate about the future of the profession in the 21st century. The
document stated that about six million people visit a pharmacy every
day. Although it did not give the number a reference, it is a figure
that the Society has been reluctant to give up.
Only months after the PIANA report was published, it commissioned research
from the British Market Research Bureau — into how many people
use a community pharmacy — to help inform the debate about the
future of the profession. But it decided to stick to the “six million” figure
after the study suggested that only 1.8 million people use a pharmacy
daily. The Society’s head of practice research Sue Ambler, who
analysed the BMRB results, says the bulk of the information the study
produced was useful, but the 1.8 million was an unpopular figure. She
says: “Because it was less than the six million it never got used.
It seems that we just can’t wean people off the six million figure
because I think it’s a figure which everybody knows. It’s
bizarre because as evidence-based PR it’s rubbish, but it’s
just that once these things become fixed, they become apocryphal.”
Dr Ambler’s research focused on the number of people who visited
a pharmacy for one of five health-related reasons. It was based on the
results of face-to-face interviews with 517 people. Forty-six per cent
of them were in the pharmacy seeking either specific or general health
advice. If the numbers are extrapolated to population figures, the research
shows that there are 260,000 visits a day to a pharmacy for health-related
advice. Dr Ambler says: “Now that figure is based on genuine research
so perhaps the profession should start using that statistic instead of
the six million.”
The reluctance of pharmacists and others to let go of the “six
million a day” figure is also strange because it is likely to be
too low if it is meant to reflect modern-day practice. Dr Ambler is convinced
it is too low if it takes into account all pharmacy visits.
Academic pharmacist John Marriott from Aston University agrees, but points
out it was never an accurate figure in the first place.
Dr Marriott, a senior lecturer in pharmacy practice and director of postgraduate
studies for life and health sciences, says: “Six million is quite
an impressive figure and I think it was something which was scaled up
from quite a small project. It’s probably a highly inaccurate figure,
but it was seized upon by many in pharmacy to evidence how helpful pharmacy
was as a local health care issue.” No longer reflects reality
Whatever the foundation of the figure it no longer reflects what is
really happening in pharmacy, he says. “One million people might be
going to Sainsbury’s every day but that doesn’t mean they
are all going to visit the in-store pharmacy. Also you could just as
well go into Boots today to buy your sandwiches rather than get a prescription
filled.”
Both Dr Ambler and Dr Marriott are interested in trying to find an
up-to-date and robust statistic for the number of people in the UK
who visit a pharmacy
every day. Professor Blenkinsopp also thinks it is a good idea from a
public health perspective. “From a public health point of view
you would be interested in finding out how many people cross the threshold
of the pharmacy every day. If you had a campaign about influenza vaccinations
or emergency contraception it would be interesting to know because it
means you could target healthy people, not just those who go into a pharmacy
to get a prescription or other medicines because they are ill.”
Professor Blenkinsopp admits the “logistics” of the research
would be “challenging”. She adds: “You would need to
work a representative sample of pharmacies, then decide how long you
would need to capture the data for it to be statistically representative,
and then you would have to count everybody who came to the pharmacy.
Then what do you do with those people who just use the store as cut-through
to another part of the shopping centre?”
The statistician at the Prescription Pricing Authority, Sue Holdsworth,
says there were no shortcuts in finding an accurate figure. She said: “If
that kind of data can’t be found from any other source then there
is no option, if you want an accurate figure, other than to survey every
pharmacist across the country and ask them to record each visit. That’s
a massive job and a tedious one.” |
The
Pharmaceutical Journal