Pushing back against the idea of a commoditised medicines service

Part of my role as the Head of Corporate Affairs at the NPA is to scrutinise government policy, always with the end goal of helping independent pharmacies operate profitable businesses and provide excellent patient care.

By far the most dangerous policy idea circulating in government right now is that local pharmacies can be replaced by an Amazon style medicines service.

The cuts to pharmacy funding in England are, we believe, just one part of a plan to significantly reduce local provision and introduce a superficially cheaper medicines supply service based on centralised, automated dispensing hubs. The plan is predicated on the flawed view that pharmacy is just a distribution mechanism for product – rather than a valuable health and social care asset at the heart of communities.

The Department of Heath will of course deny that any such plan exists.  They will say that there is no intention to close local pharmacies and that it’s common sense to consider how technology can be deployed to improve services and create cost efficiencies.   I wish we could believe that their motives are so pure.  Unfortunately, at the NPA we have learned the hard way to trust our gut feeling and to push back hard at the earliest signs of poor policy being formulated.

Several policy strands are coming together to create the conditions for a commoditised, de-professionalised service.  This includes moves to remove the pharmacist from the pharmacy (‘clinical pharmacists’ in GP surgeries, technicians running community pharmacies); proposals for ‘hub and spoke’ dispensing; and of course cuts to funding of local pharmacies.

Overall, this is big ticket stuff!  Separating the medicine supply function of pharmacy from other services in order to cut costs will ultimately undermine the bridge between primary care and the patient.  Large scale dispensing and distribution by robots would bypass all the reassurance, advice and support that is a part of face-to-face contact with the patient. Commoditisation of the pharmacy service is a genuine threat, because elements within government seem to believe that all pharmacies do is provide a commodity product with no value added.

So whether by grand strategy or by the chance coming together of seemingly disparate strands of Health policy, the future could look utterly different – and infinitely worse – from how it is today.

When it comes to hub and spoke, the model the government has proposed is wrong on many levels. The plan is to use four huge warehouses to cover the entire country, which is problematic first of all because it could take 24 to 48 hours to get medicines from that warehouse to each pharmacy.  Neither have they considered that it reduces competition; leaving the larger wholesalers to control the market which will increase prices, reduce quality and actually increase price of medicine for the NHS too.

Could companies like Amazon play in this space?  Certainly the government – notably the Treasury – believes that things can and should look very different in terms of medicines supply routes.  They have so far failed to recognise that supplying medicines direct to people’s homes is expensive – some medicines must be stored in a fridge which is an expense that would have to be taken into account within the distribution network. Some medicines require a signature and safe storage because they are controlled drugs, which is something your average Amazon delivery driver cannot provide.

You may ask, if the model is so flawed, why not just stand aside and let this steamroller drive on until it falls over a cliff edge?   The risk of that approach is that by the time the whole crazy scheme unravels, the damage to the local community pharmacy network will have been done and may be impossible to repair.

One challenge for us as a sector is to better describe and demonstrate what pharmacies do, and especially to promote the benefits of local, face-to-face care.   Another is to continually adapt to meet the ever changing needs of society and rapidly evolving consumer behaviours.  Specifically, we should optimise the use of technology to strengthen pharmacy’s locally based service proposition. Independents must be progressive and modern, while at the same time being true to the historic values of community pharmacy as a personal, caring profession.

There are two paths the sector could go down. One involves mass automation, centralised dispensing and pharmacists working predominantly from GP practices or remotely. The other sees community pharmacies better integrated with other services, operating efficiently as ‘neighbourhood health and wellbeing centres’ and being a front door to the NHS.  We hope you will take the journey with the NPA, on the right path.

Author:  Gareth Jones