Commercial Pharmacy vs. Professional Pharmacy
By Dr. Terry Maguire, a Northern Irish Community Pharmacist, senior lecturer at School of Pharmacy (Queens University Belfast) and Belfast LCG member.
The central force shaping our profession is that created by the opposing tensions between commercial pharmacy and professional pharmacy. Over my career professional pharmacy often emerged as the stronger tension only to be kicked back when commercial pharmacy notes what is happening. Each of us contribute to the development of these tensions and we are seldom consistent on our views. We all want to have a successful and valuable businesses but that value is dependent on how sustainable community pharmacy is now and in the future.
While the Celtic Tiger roared in ROI, up North we weren’t doing too bad either. Pharmacy was making money and the economy was in great shape. My bank manager telephoned pointing out that the kids were soon off to University and I should be investing in property to see them through – there was so much equity in my business and buildings it would be a sin to miss it. No thanks I said and then suffered the wrath of a wife who was equally convinced we had reached the financial promised land. I had invested enough in the properties of my two pharmacies; these loans were challenging to service and I did get carried away and paid too much for the shop unit adjacent to my second pharmacy where I had rediculously grandiose plans to redevelop and had paid for the architect’s plans.
The down-turn set in and as part of that the DHSSPS swiftly sliced 10% off my profit margin at the same time as my counter sales were crashing with rare abandon. I was struggling to repay what I had borrowed and spent three years kicking vigorously to keep my head above the water. Other was less fortunate. Like everyone business wise I was flat-lining and now no one in their right senses would consider buying my pharmacies for the kind of money I would need to retire and get out. Yes, that time has come.
The fault was that we did not commit to a professional future for community pharmacy. Professional success; the satisfaction of doing something of value for my fellow man and woman – and getting a model to pay for it -was sorely lacking over my career. Back in the 1970s my inspiration was Professor Patrick D’Arcy head of school at Queen’s. His vision for pharmacy was clear and achievable. Creating the community pharmacist as the medicines expert, valued for his or her knowledge and advice on medicine; that was the goal. This vision was more accurately articulated later by Doug Helper and Linda Strand in their definition of Pharmaceutical Care;
” The reponsible provision of drug therapy for the purpose achieving definite outcome that improves the patients quality of life”
So eloqant, so clear, so inspiring. I have spent considerable energy pursing this idea over my career. It was however somewhat limited to drugs and medicines so I worked with a group to include public health within the definition and came up with Pharmaceutical Public Health.
- The active and evidence-based promotion of health, patient empowerment and the facilitation of lifestyle changes to ensure maintenance of good health, prevention of illness and assurance of disease management.
This is what we needed to make pharmacy sustainable for the future. But Tir Na Og has not been reached in spite of the Pharmaceutical Society of N. Ireland’s Vision 2020 and the Government strategy for pharmacy Making it Better (just re-launched in April 2014) there has been little modernisation in community pharmacy practice. Up North, one of our flagship service developments currently is Health +(plus) Pharmacies a quality platform on which public health services will be rolled out and paid for through the pharmacy network. This is a great example of how we as a professional always get it wrong; how commercial pharmacy kicks out and we are held back. With Health + Pharmacy out negotiators, CPNI, don’t like the idea because they see it as a restriction on merchandising. They are refusing to sign up.
I have tried satire, I have tried reason, I have tried dialogue but CPNI are having none of it. Pharmacy must be able, they insist, to sell Mars Bars and bottles of SPF 2 sun-creams or the Health + Pharmacy might be brought to an abrupt end. A five page letter received by contractors up North attempts to garner support for CPNI’s objection to this very small part of the Health + (plus) Pharmacy scheme; merchandising standards for accredited pharmacies.
It’s not about raw commerce it’s about principle, CPNI claims. They feel that Pharmacy Alliance, the body brought together to set up Health+Pharmacy, has no rights to set standards. These restrictions are a dangerous precedent, CPNI says. What next, they moan, a ban on the sale of OTC medicines or nappies or hot water-bottles? You never know. Perhaps this scheme is just a big ploy to strip completely all commercial retailing from community pharmacies in N. Ireland. Perhaps.
But when you get under the bluster, paranoia and confusing fog of words, and if you have the endurance to read through this five page missive, you are left wondering what all the fuss is about. I have not sold low SPF sun-creams for over 20 years. My only non-medicinal sugar-based confectionary is Chuba-chups and I’m happy to lose these.
What distresses me most about this letter is how far apart my vision and aspiration for my pharmacies is from that of CPNI, the body who is supposed to represent me in contract negotiations. Can I be so out of kilter with the views of my fellow contactors? Am I a lone voice in the wilderness raging against the light and being gently encouraged to walk out into that deep dark night?
Above all we need to get some perspective on this issue or we risk damaging the reputation of pharmacy and its vital role in public health. CPNI’s implicit threat to withdraw from the scheme demonstrates a profound lack of vision and a paltering to vested interests that smacks of blatant commercialism. I live in the real world, I have been here for the last 30 years and I too have struggled through the recent very difficult times. But sales of low factor sun-creams and Mars Bars will not be my saviour; more properly paid services will.
The only group holding back community pharmacy, it seems, is community pharmacy itself.
