What does the ‘French pharmacy model’ really mean? Costanza Pearce reports on the latest from the Pharmacy Show 2019
Health secretary Matt Hancock has made multiple comments about the ‘French pharmacy model’ and how he would like UK community pharmacy to be more like it.
In July, he said that he wants the UK ‘to move towards the French model, where they offer a wider range of services and play a stronger role in the community’ when announcing the new pharmacy contract.
Speaking today (7 October) at the Pharmacy Show 2019 in Birmingham, the National Pharmacy Association’s (NPA) Gareth Jones and Olivier Picard unpicked what community pharmacy in France actually looks like.
Here are four things the health secretary could have meant when he said he wanted us to be more French.
1. More pharmacies per inhabitant
Despite talk about clustering - the belief that there are too many pharmacies near to each other on English high streets - the UK has many more inhabitants per pharmacy than France, NPA head of corporate affairs Gareth Jones said.
In the UK, we have around 4,500 inhabitants per pharmacy, while France has around 2,800 people for every pharmacy. In this context, the UK does not have an excess of pharmacies, Mr Jones said.
He said: ‘We do get questioned quite regularly about the number of pharmacies that we have across the UK and the assumption that we maybe have too many. But actually, when you look at the international figures, we have almost the least pharmacies [per inhabitant].’
2. A trend of closures
Olivier Picard, pharmacist and manager at Newdays Pharmacy in Berkshire and NPA board member, explained that the community pharmacy sector in France is seeing lots of closures linked to consolidations.
He said: ‘The trend is only going one way, and that’s the way of closures.’
In 2018, there were 21,966 pharmacies in France, compared with 22,500 pharmacies in 2015. This represents a reduction of 2.4%, according to the NPA. Across a decade, the French network lost 1,556 pharmacies, going down from 23,500 to just under 22,000 today.
Mr Picard said: ‘We hear a lot in England about pharmacies closing due to lack of funding. If you put that into context in France, 240 pharmacies closed in the last year, that means over four per week.’
However, Mr Picard added that 50% of these closures are linked to pharmacies merging with one another and – most importantly – patient access is still high.
He said: ‘Despite the reduction in numbers, the French population still has the benefit of a pharmacy within a few minutes of where they live, wherever they are in France.’
He added: ‘By keeping the funding where it is, the French Government is committed to supporting the 21,966 pharmacies in the country at the [current] level. It is not looking to reduce the number of pharmacies and pharmacy reductions are generally through [decisions] to merge with the local competition.'
3. More money
France spends around 30% more of its GDP on pharmaceuticals than the UK, spending around 1.5% compared with around 1.1% in the UK, Mr Jones said.
French pharmacists receive payment for drug margin as well as five different dispensing fees. These include a basic fee of €1 per box excluding tax and €2 per prescription that includes at least one medicine from a specific category – such as antibiotics or immunosuppressants – rising to €3.50 by 2020.
Mr Picard said: ‘The fees can soon add up. When I saw these numbers, I thought, ‘why can’t we have a slice of that? If we were all being told that tomorrow we’re going to [get a similar increase], we’d all be jumping up and down for joy. I don’t think that’s what Matt Hancock meant when he said that he wants the UK model to look like the French model.’
What’s more, between January and December 2018, French pharmacists received a total of €6.591bn in remuneration, an uplift of €88m compared to 2017.
Mr Picard added: ‘I hope [Matt Hancock] will be putting his hand in his back pocket to show us the dollars that will allow us to develop our premises and services further.’
4. Minor ailments service ‘plus plus plus’
French pharmacy also has a minor ailments service in the pipeline, due to be launched on 1 January 2020, but it goes far beyond what has been seen in the UK so far, Mr Picard said.
He said: ‘We’ve all heard about a minor ailments service, but this is a minor ailments service plus plus plus.
‘[French community pharmacists] will see a patient, will be paid for the consultation and, more importantly, will supply a product.’
Under the service, pharmacists will be able to dispense some prescription-only medicines (POMs) for minor ailments such as cystitis and angina.
Meanwhile, the English community pharmacy consultation service (CPCS) – which will see pharmacists paid £14 for each consultation resulting from an NHS 111 referral for minor illnesses or urgent prescriptions – is due to launch on 29 October.
So there we have it. And – for better or for worse – the health secretary may be looking to emulate one or more of these elements.
The jury remains out on which, if any, it could be.