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The Pharmaceutical Journal
Vol 268 No 7185 p208
16 February 2002

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Why the big boys should be regulated

By Graham Southall-Edwards

How appropriate I thought it was, that the hopes and aspirations of present pharmacy students should be detailed (PJ, 5/12 January, p11) in the same issue of the PJ as the article by John Wilson regarding increasing locum trends (p14).We first were able to read the gloriously optimistic views of those presently undergoing education and then, a few pages later, we came across what many of them decide to do after they come back to earth, away from the imaginative ramblings of their academic tutors and others (including those in 1 Lambeth High Street) who instil into them their hopeless beliefs in a seemingly non-existent future.

A cog in a set of wheels

It took me back to my own halcyon days 26 years ago. Like most young pharmacists then, I was looking forward to saving up enough money to open and run my own pharmacy, say, 10 or more years later. These days, however, not long after qualifying and often sooner, the vast majority of new pharmacists realise that their future is to be a cog in an ever-faster set of dispensing wheels, turning at the behest of a corporate contractor. The only real interest these megaliths have in the future of pharmacy is that the business should provide ever-greater profits from ever-greater numbers of dispensed prescriptions, dispensed by overworked, impressionable, management-compliant, young pharmacists who are helped by an ever-decreasing number of less-well-trained staff.

Over the years, almost every pharmacy my wife or I have worked in has become part of a multiple chain; as early as the mid 1980s this had resulted in centralised management with pharmacist managers losing all power to manage and becoming merely the servant of the "senior assistant".

Why was all this happening? The answer is that limitation of pharmacies had started to drive the endless buying mania of the growing multiples; almost every private sale became a corporate acquisition and every small chain went to a larger one. Goodwill values soared and along with them went the loss of the main ambition of the young pharmacist ? future proprietorship.

The stark fact is that the rules on limitation of pharmacies, which were intended to ensure the survival of independent community pharmacy have resulted in an unstoppable flow of acquisitions by the corporate multiples. The result has been and continues to be the demise of independent pharmacy and a huge increase in the cost of ownership (look at the £60m+ recently paid out by Moss in the south west).

A future as a proprietor is about as likely as a win on the National Lottery. Indeed, the latter is probably the only way that most young pharmacists could ever hope to own a pharmacy ? and then they would have to run it at a loss to get any real job satisfaction.

What continues to surprise me is that these large companies have never been externally regulated. Of course there are internal checks and balances but there is no mechanism to ensure that their activities further the profession of pharmacy. They are often run by "risk-averse" individuals who, on their own, could never keep going for long. The senior management in these companies and their line managers therefore seek to secure themselves by endless rules, manuals, procedures, superintendent's bulletins, pharmacy log books, and general restraints on the exercise of personal professional freedom. It is what a well-known, successful, experienced pharmacist friend of mine has termed the "protocol for blowing the nose". Not an environment to experience job satisfaction.

In an effort to find some semblance of self-determination and avoid the "corporate dispensing rules", which leave young pharmacists the professional freedom to do only as they are told, they strive for freedom through self-employment as locums.

We must blame ourselves to a certain extent for this parlous state of affairs. Unlike doctors and lawyers, pharmacists have allowed themselves to become undignified shop-keepers with little or no professional self-respect. This is at its worst in supermarkets where pharmacists are expected to (and are often willing to) co-exist with the "fruit and veg" in the appalling, cramped, open and unprofessional places that certain chains now place them.

They are increasingly perceived by the public not as important health professionals and advisers of the future, as the theoreticians would have us believe, but as mere "yes men and women", serving their faceless corporate masters by sticking labels on boxes at an ever-increasing pace, while paying lip-service to professional roles.

One reason that pharmacy has reached this state is that there are few or no employee or locum pharmacists who are prepared to stand up for themselves and the profession by demanding minimum operating conditions. Pharmacists collectively need to take the necessary action to secure the future of general practice. We need an organisation which inter alia:

  • Sets mandatory requirements for proper staffing levels
  • Sets minimum staff pay levels which properly reflect training and responsibility and encourages continued employment
  • Sets limits on the number of prescriptions which any one pharmacist can safely dispense in any given period
  • Supports the individual pharmacist in his or her right to practise their profession free from corporate interference and rules
  • Makes it a requirement that multiples should have at least, say, 90 per cent of pharmacies supported by a permanent manager with proper authority to manage
  • Is prepared to take effective action against corporate superintendents where such conditions are not met, or where the conduct of the pharmacy is otherwise unprofessional, brings the profession into disrepute, or simply dangerous as many locum-run, "volume-dispensing hell-holes" presently are

The Society argues that such matters are not ones in which it should be directly involved. I submit that it manifestly is wrong to take such a view. One inspector I recently complained to about the question of pharmacies which were generally regarded as unsafe and an accident waiting to happen, said simply: "Vote with your feet; do not work there." But that is refusing to see the real situation, which is that most of the vacancies are with the multiples who are short of the managers who have left to become locums. These companies have the power to operate and do operate blacklists of those who step out of line.

Unscrupulous operators

There are unscrupulous HGV operators who, in the absence of tachographs and controls on hours, would work their drivers round the clock, at the risk of damaging drivers through tiredness and overwork and of damaging members of the public with whom they might collide. At the moment, pharmacy operators are able to act just like that and may be running just the same risks: damaging the pharmacists and the public whom they kill or injure through stress caused by a lack of properly trained staff, ill thought-out opening hours and a commercial desire for profit at almost any risk.

The answer is regulations which affect all and which will ultimately benefit all. The Royal Pharmaceutical Society, as the regulatory and enforcement body for pharmacy is in a position to act, but is unwilling or unable to do so. If the Society will not act, then the legislature should be lobbied to intervene directly before it is too late. Those who run large organisations (who through governance should identify risks), but who continue to run such risks unjustifiably for pure commercial reasons, do so at the risk of subsequently being held to have been "reckless". As a matter of law, if the death of an individual should result from such inadvertency or the unjustified running of such risks, those at the top could well find that they are liable to be indicted for manslaughter. With foresight, this could easily be avoided.

Mr Southall-Edwards is a pharmacist and a barrister

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