Death by a thousand cuts in the country

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Record learning outcomes

Last year, three out of seven pharmacies closed in our area, either permanently or temporarily. A year on, we’re back up to six, although a couple are maybe on their fourth owner in three years.

Naturally, some are very keen to rebuild patient numbers from virtually nothing, so it is inevitable there will be local friction – and so it has proved.

Local difficulties

The pharmacies that stayed open throughout this local crisis suffered enormously as large numbers of patients were dumped on them. They had to take on more staff, increase their stockholding and put the services that made them sustainable on hold while they focused on keeping up with dispensing.

In our case, when people from the next town came to us in droves, some of our regular patients disappeared to online pharmacies because of the queues. We will be dealing with the long-term consequences of that for years.

So it is good news for patients that nearly all the pharmacies are open again. In the long run, it will help all of us too, because some teams were carrying unsustainably high workloads they were never designed for.

Service levels have also started to improve, so we can begin talking to practices again about Pharmacy First and contraception referrals. We might even be able to rebuild some of the public trust that was lost during this turbulent time.

Nomination nonsense

The not-so-good news is that we are already seeing nomination shenanigans: patients mysteriously switching to reopened pharmacies they have not requested. We are also seeing the re-emergence of monitored dosage systems, something that’s not happened since Covid, with new providers trying to build their businesses on the back of MDS and weekly prescriptions, which is against our local guidance.

I can understand the temptation, but it is truly a fool’s errand. Far from ‘giving back’ to the community, this is taking people for a ride.

These devices are associated with worse outcomes for patients and higher costs for the NHS, all for the convenience of the provider.

No more free advice

Just this morning, I was approached by a patient who wanted to talk about the side-effects of fluorouracil cream dispensed by a leading online provider. While I had every sympathy, I refuse to provide free advice to every online pharmacy patient. My goodwill extends to OTC medicines and lifestyle advice, not to managing side-effects for POMs I had no role in supplying.

In my view, patients should go back to the pharmacy that dispensed the medicine for after-care advice. Large-volume online providers are not built for this, but that is not my problem.

If our new patients from neighbouring towns drift back towards the pharmacies that have reopened, while our regulars have disappeared online, we are going to have a real problem as this all unwinds. Pharmacies in rural regions are closing at a higher rate than in urban areas, and part of that story is about the predation of online pharmacies.

Dispensing doctors have controlled localities where you cannot open a pharmacy. Perhaps the time has come to throw a ring around some of our most vulnerable pharmacies to protect them.

This would, of course, be considered controversial or anti-competitive, but what is the point of a Pharmacy Access Scheme if pharmacies cannot afford to stay open even with the additional funding? We are heading into crisis territory in rural and coastal areas, with pharmacist and locum shortages making it even harder to run viable businesses.

Pressure point

Meanwhile, recent changes to the hypertension case-finding service have not gone down well with colleagues in my area, with many declaring the service “dead” after the introduction of a cap of one BP check every five years. Incidentally, this is not what the NICE guidance says. NICE recommends at least one check every five years, not a maximum of one every five years.

While I agree that some contractors have taken the mick with thousands of BP checks, surely there are other ways of managing this problem. Give everyone a cap of, say, 500 checks a year, and that would provide enough scope to capture those at risk. Something needs to be done.

* Alexander Humphries is the pen name of a practising community pharmacist. The views in this article are not necessarily those of Pharmacy Magazine. What contract reforms would you support? Email pm@1530.com