It is time for members of the public to understand the future of community pharmacy and play a role in shaping it. After all the NHS is owned by the population, paid for by the population and serves the population. And we should all have our say.
I use the John Lewis or Jessups as a simple way of describing one risk to community pharmacy – the internet. As the electronic transfer of prescription project accelerates, we will all be able to manage and order our medicines from home – and I for one will use it the moment it is available. Yes I may choose my local community pharmacy, but it is more likely I will choose a faceless internet pharmacy so my medicines pop through my letterbox the next day.
However, I still want to visit a pharmacy from time to time. To ask a question, to buy some medicines, to get my flu jab or gluten free foods.
You see I want it all and it just might not work that way. And that is the reason why we need the debate now.
Community pharmacy still relies on dispensing fees and something called retained profit. This is the money between the price that the NHS reimburses and the price that the community pharmacy pays for prescription medicines. It is a system of long standing, where the community pharmacy is rewarded for fantastic procurement. And believe me, community pharmacists have delivered millions of pounds of savings to the NHS – and still the government wants more. The NHS wants the community to work harder for less money – I understand that. And to deliver clinical services that patients want – I understand that too. But, even today, the growth in clinical service payments is far too small to match the loss in dispensing and procurement income. There is also uneven distribution so pharmacies are able to deliver different services in different parts of the country. I understand that too – the need for local initiatives to deal with local problems. But times are really tough and many pharmacies are tight on their cash-flow.
So if we, the public, also want to move prescriptions to faceless dispensing factories for our convenience, then something has to give.
And this is the dilemma – I want the convenience of internet based supply – and I want the access and value of a community pharmacy on my high street.
The comparison with John Lewis and Jessups is easy. Both have staff that can offer you great advice on a camera, but a percentage of customers then go and buy on line. John Lewis thrives – I am told that 30% of sales are on line – and I have bought on-line within their store. Their stores are rapidly becoming the shop front of their internet business. I like this model as I dislike pure on-line stores where you can’t see it, feel it or talk about it, but John Lewis is not like that. And quietly Jessops went to the wall.
I must add that Jessops is up and running again, bought by a consortia led by the dragon Peter Jones. But instead of the 187 stores, he started the new Jessops from the internet and has built the stores up to – is it 30 now with a model perhaps more like John Lewis.
The Government and the population need to think about what they want from community pharmacy and decide. Do you want community pharmacy on the high street and in the shopping centre, offering professional advice, medicines and a range of services? If so then we need to talk seriously about increasing services to the community and including community pharmacy within integrated models of care such as for out of hours and care of the elderly. Making our high streets work again and keeping the community pharmacy as the anchor.
I am reminded that community pharmacy is big business and there are a few very large players. It is not like general practice which is 85%+ owner proprietor based. These big players own more than half of the community pharmacies. They will manage through their wholesaling and purchasing power and their ability to control overheads to stay in profit long after some of the small independents have hit the wall. But be sure they are all businesses and the large players will restructure and lose their non-profitable premises. As a matter of interest, I am told that only 5% of community pharmacies are owner proprietors.
So will we do something or just let the cards fall? If community pharmacy disappears from the high street into some hidden internet based supplier, then don’t be surprised. And don’t grown when you look at pictures on the screen and want to ask a simple question – are those medicines going to help me and not clash with my other prescription medicines.
You have your chance!