I have been working with the Independent Pharmacy Federation and independent pharmacists for almost a year now and I have learnt a lot about the sector, despite not having a pharmacy background myself. In my former life as an MP, I was aware of many of the issues facing pharmacy and of course, I understood the vital role they played in the community in serving patients. But it is only at close hand in the last year or more that I have seen the real value of the independent sector.
Independents make up around 40 per cent of all pharmacies. Sadly, that is a decline from its dominant share over the last few years. But despite this, independents remain an important part of community pharmacy. Out of the 11,500 pharmacies, around 4,000 are categorised as independent – where the contractor owns fewer than five other pharmacies. Most of the IPF members are single contractors, but there are a significant number that have two or three retail outlets and a handful with more than that. Despite their multiple ownership and their eligibility for membership of AIMp (Association of Independent Multiple Pharmacies) they operate their pharmacies on an independent model, where each pharmacy is run as if it were independent. They are supportive of the aims and objectives of the IPF.
For many patients, what makes an independent different is the continuity of service and the personal relationship that many will have with the pharmacist. In the multiples, pharmacists will often shift between stores, coupled with a frequent use of locums and other employees. But for the independent trader, it is the owner contractor who is the familiar face in the dispensary. That is something which makes the independent pharmacist hugely valuable to patients.
From apothecaries to medicines experts
Pharmacy has come a long way over the last few centuries. From the days of the apothecaries making potions and ointments, they have been at the heart of the community. It was not the GPs that people turned to for advice and medicine, but to those who were the providers of the preparations that would make them better.
As time rolled by, influenced by the Victorians and the Industrial Revolution, pharmacists became the first place that people went to for advice. When I speak to my parents’ generation, their attitude is that the chemist is the place to go first for health advice. They are the generation, born before the creation of the NHS, who did not think of going to the GP with any small health problem because they could not afford to pay the fees. Pharmacists or chemists might have been the poor man’s doctor but they were respected and they were valued. They were predominantly independents, whose individual personalities and approaches were what brought their customers back, time after time.
The establishment of the NHS in 1948 and eventually pharmacy contracts changed the way that many patients began to see the pharmacist. They no longer had to fear the cost of a visit to the doctor and they went to see the pharmacist with the prescription they received, free of charge. Slowly, the perception through the generations began to change. More began to see the GP as the source of health advice and the pharmacist as merely the dispenser of medicines.
In the last 30 years, independents have faced competition from multiples, the pressure from health centres and a variety of changes to contracts and working practices in addition to growing patient choice. These are some of the factors which have influenced the reversal of the independent’s dominance in the pharmacy sector – shifting from 60 per cent of the market to around 40 per cent.
The next 30 years for pharmacy
So when we look at the next 30 years for pharmacy – the sector needs to think about the core role of pharmacy throughout its existence. Pharmacy – like everything else that survives – has a DNA and although that might adapt over the generations it won’t change beyond recognition. It won’t become something completely different.
Independent pharmacists need to re-evaluate the core role of their business. If we look back through the generations, pharmacy was not just about dispensing – it was about providing an accessible place for those seeking health advice. It was and must always be about services and patient relationships.
There are a generation of pharmacists who have built a successful business on a busy dispensary and the margins that they have been able to make on the generics. But that is changing. There are now dispensing machines that can provide the physical dispatch of drugs with a pharmacist on teleconference link. For many independents this will be a threat but actually it should be an opportunity. Rather than worrying about multiples bringing in this technology, independents should consider how they can harness technology and use it to their advantage.
Successive governments have presided over a shift in the payment mechanism for dispensing services in favour of a range of public health services – smoking cessation and weight management to name just two. The margins on drugs are also diminishing due to a mixture of direct to pharmacy schemes and category M clawbacks. The financial returns possible in generics and specials are getting smaller because of changes to the market and the introduction of tariffs. All of these factors mean than pharmacy needs to look again at its core role and adapt in a changing environment. As Charles Darwin said: “It’s not the strongest species that survive, nor the most intelligent, but the ones most responsive to change”.
Responding to change
As the NHS undergoes seismic change, it must be the pharmacists who provide continuity of care in an accessible way. Over recent years we have seen the introduction of MURs and more recently NMS. There is no doubt that the payment structure around NMS is not yet up to standard. Why should pharmacists perform these services and then not be paid for them, simply because they have not reached the monthly threshold? It is a ridiculous way to operate and we must see some radical amendments quickly. But the principle remains that these services are good for patients and good for pharmacy. Many independents have embraced the service delivery.
Despite all these challenges the future can be bright for community pharmacy, especially the independents. But there are a number of things that they need to do to ensure that positive future. First of all, they need to be confident about the future and willing to be proactive in starting discussions with the commissioners of services. Of course, that can be difficult with such changes taking place. However, commissioning will soon be transferring to CCGs and Health and Well Being Boards. Pharmacists in the majority have been too reserved when this is the time that they and their LPCs should be involved in discussions with the key commissioners. The IPF wants to see more LPCs taking a lead in promoting the value of community pharmacy.
Independents are often in the best position to be innovative in the services they perform. Unlike the multiples where layers of decision making can take months, independents can make fast decisions. Contractors are not just the face of their pharmacy – they are the chief executive, chairman and shareholder of the business. So they need to be agile to adapt to the opportunities that will be available from the new commissioners.
Despite the huge value that independent pharmacy brings to community health, my frustration remains that the sector undervalues itself. Independents need to be more vocal about the changes taking place that will affect their business and profession. A key example is the existence of 100 hour pharmacies, which continue to drive a coach and horses through planned pharmacy provision. At the IPF we are campaigning for the government to end this exemption as soon as possible – we want to see a moratorium on any new applications.
Most independents have seen the value in working together with it comes to commercial decisions. The buying groups have proved how effective some collective decision making can be for independents. But we need the same approach to the big issues that are being debated in parliament, by the government and other decision makers. That is why we continue to urge independents to join the only exclusive voice for the independent pharmacist – the IPF. By joining together we can make that voice louder and ensure that it is heard and respected.
Claire Ward is Executive Director of the Independent Pharmacy Federation