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Insight: It’s time to charge for consultations

The economic model for OTC medicines is well and truly broken. With the advent of universal pharmacist prescribing on the horizon, we need to have a fundamental rethink about what the future of self care in pharmacy looks like...

“Can I see the pharmacist?” is the refrain repeated dozens of times a day in every pharmacy in the land. This is closely followed by: “I can’t see my GP for weeks”; “I don’t have an NHS dentist”; or “I can’t be bothered to wait in A&E”. 

My team, trying to be helpful, always say “yes” – and so my day gets eaten up by (sorry) the wrong people, who will quite happily take up half an hour of my time to ask for general health advice, or have me look at something entirely innocuous on their big toe/left arm/right eye... 

“But that’s what we’re here for!” some of you will say. Well, yes and no. Pharmacists have become the bottleneck in pharmacies as so many services require our direct presence or oversight. 

Back in 2016 when the funding cuts removed our fixed funding per pharmacy, we had to become a bit like Easyjet: everything beyond the basic service needs to be funded – and 15 minutes giving general health advice just doesn’t cut it anymore. 

Time wasting

Let me start with the lady who came in to show me some “spots” on her face, arms and legs after she had been “bitten by a spider”. After five minutes of thorough examination, I could find no evidence of said spots. “I think it’s a tapeworm”, she offered. I assured her this was very unlikely. After 20 minutes of further theories, the only thing I could do to get her to leave was to tell her to use some hydrocortisone on the so-called spots to help them go away. 

I estimate that the cost of pharmacist time at the moment is at least £1/minute with salary and on-cost (pensions, national insurance, etc). That’s without considering premises costs. So, economically, the business lost at least £25 by me seeing this patient. Not to mention the opportunity cost. I could have checked 30 prescription items, which would have earned around £60 in income – so the real loss from this 25 minutes could be as high as £85. 

“Pharmacists have become the ultimate bottleneck in pharmacies”

Later the same day, I showed another lady into the consultation room. “Firstly, can you show me how to use this?” She handed over an emollient pump dispenser with the safety collar still on. “Did you get it from us?” I asked. “No, I got it in Boots.” I removed the safety collar and explained how it worked.  “I’ve got a lot of other questions,” she said, so I took the lady’s name to look her up on our records. There was nothing.

“Do you get your prescriptions from us?” I asked. “No, I get them from Boots, but they’re so busy” she replied. “I think it would be best for you to speak to your regular pharmacist as they have more information about your medicines than I do,” I suggested. “I’ve tried but I didn’t really get any help...” [metaphorical face-palm]. 

“If you aren’t getting the help you need from your regular pharmacy, perhaps you should consider changing your pharmacy” was my retort. “They are a good pharmacy; I don’t want to change”. 

“Being honest with you, we only get paid for dispensing prescriptions,” I told her. “I’ll buy whatever you think I need,” she said. My response was harsher than I intended but nonetheless true. “To be honest, that wouldn’t cover the cost of my time”.  

Subscription model?

I think it is inevitable that we will have to start charging for consultations. Maybe we need to look at a subscription or membership model to help underpin the cost of providing pharmaceutical care at the point of demand. 

If changes to supervision mean that there might be reduced access to pharmacists in some pharmacies, the pharmacies that do keep their pharmacists cannot subsidise those that don’t by seeing their patients for free.

Do you think pharmacists should charge for consultations? Email

*Alexander Humphries is the pen name of a practising community pharmacist. The views in this article are not necessarily those of Pharmacy Magazine

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