I was both surprised and pleased that Clare Gerada, Chair of the RCGP was brave enough to call for a re-evaluation of the current independent contractor status model. She was right to do so and her profession would be wise to listen and think about it before jumping to say no.
I was a mere child when I locumed for a community pharmacy owned by Alan Lloyd. He owned a couple, but at that time most community pharmacies were owned and run by individuals. Pharmacy was a ‘good business’ and Alan Lloyd moved from a single pharmacy in Polesworth to own over 900 when Celesio acquired the largest pharmaceutical wholesaler in the UK and the Lloyds pharmacy group over a couple of years and are now own over 1,600 pharmacies in the UK. Even so they are dwarfed by Alliance Boots who own over 3,000 pharmacies around the world and revenue at about a quarter of the NHS.
I say all this because ‘good business’ can so easily become ‘big business’. The world for GPs is changing. General Practice has always been ‘good business’. It is becoming harder to attract new partners who either wish to join a practice or have the funds to do so. ‘Big business’ is slowly creeping in and soon you will face some of the same issues that community pharmacy face.
For community pharmacy, most of the front line pharmacists are salaried employees. Approximately two thirds are in large organisations with at least 6 pharmacies and with a pre-defined career structure in place. There are only an estimated 5% of pharmacies which are owner managed.
The problems with this position are too many to mention in a single blog, but here are a few:
- The contract negotiation power lies within the owners and not the pharmacists
- The voice is fragmented and diluted with several ‘representative’ bodies
- Business has a shareholder requirement for profit which chases revenue and reduces overheads. Pharmacists are overheads and feel the effects of increasing workload and reducing rates.
- Co-operation between independents is impressive, but it can be difficult to encourage multiples to operate independently to suite local needs and in co-operation with neighbours
- Multiples have the capacity to run their own health campaigns
- Career structure encourages movement between pharmacies and does not incentivise retention in a single pharmacy
So let’s listen to Clare. I want community pharmacies and GP practices with both stability and close working relationships. I want to see the same GPs and the same pharmacists, working together and sharing expertise and running more local services in association with social care and the rest of the local authority. How can we solve the problems that our communities face if we cannot work together as a community?
I say well done Clare! I know the model that I want to see and I am not sure that the independent contractor status facilitates that move. The GP contract is archaic, based on a poorly defined capitation, but you do still retain mostly independent practices. The community pharmacy contract is archaic, derived to reduce the drugs bill and most of the pharmacies are within private limited companies. Wouldn’t it be nice to see us move together under a new contract that respects the GP and the Pharmacist as individuals, but encourages us to work together in groups serving communities?
It is not about scrapping the independent contractor status, but about moving it to something a little more modern and appropriate for the day and the current problems. Over to you Maureen?