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  • Divesting high street pharmacies?

    It's very likely hub and spoke model will be the only sustainable means of running a PROFITABLE operation for the multiples because NHS will continue to decrease reimbursement does this mean the multiples will divest a significant portion of their bricks and mortar pharmacies if they move onto hub and spokes? If you at the cons they are far and few:

    1) Retail: Boots.com is a very popular site and people have become very confident in purchasing online and this means its possible to stock inventory in one or fewer sites. Therefore savings are significant for retail pharmacies if they sell via online medium. In addition physical stores are unable to compete on price against supermarket or hypermarkets either.
    2) Many people have become used to mail order retail, therefore, it would be possible to convince people to use a mail order pharmacy service. If fewer pharmacies are operated this would allow the multiples to invest more on delivery runs but it increase their profit margin because they no longer are involved in operating so many physical stores.
    3) The sites they may divest themselves of may end up being sold to the independent sector if anyone is willing to invest so much cash in a sector riddled with uncertainty or the multiples may ask the PCT that the pharmacy be taken off the list.

    As inconceivable as it sounds you only have to look at the retail bank sector to demonstrate the plausibility of this happening. 17 years ago you could find a bank within 20 minutes walk and you always had someone to wait on you now branch numbers are reduced and the service they provide within a branch is so mediocre it acts as an incentive to use their online site which is far more efficient and user-friendly.

  • #2
    I have been looking at this scenario for some time. In addition there will not be any:

    1) High Street level business rates

    2) Expenses involved with premises such as repairs, routine maintenance, decoration, heat and light, security....

    3) No need for an extended peripatetic management chain.

    4) Reductions in staff costs, training etc.

    Looking at 1) above I have been wondering how Local Authorities will be replacing the income from UBR on retail premises. My own feeling is that they will gradually increase the domestic Council Tax.

    Comment


    • #3
      Things will become even easier for the hub when the NHS forces its doctors surgeries and other out of hours sites to use EPS.

      Banks is an interesting one to mention. I would mention libraries and post offices.

      Libraries are basically still there at all because they are required to be by law. Compared to 10 years ago many had their hours cut by a lot. Many have closed as well. Where there used to be packed 10 years ago with people using computers now they are mostly empty. All lending is done by a self scan computer. There are librarians but lower staffing levels and if you sit and study all day in a library you will see that librarians are spending their time dealing with issues, referring people to drop in clinics that use the building etc. I think we could become the healthcare equivalent.

      I do think about a third of the 10,000 pharamcies will go in the next few years. I think those that survive will also have their staffing levels cut by a third and ramp up other new services.

      A lot of people are quite anti-EPS and anti-delivery but I think this proportion will decline rapidly when the system goes totally electronic and the doctor tells them if they haven't got a smart phone to get a token it needs to be sent somewhere.

      Comment


      • #4
        Originally posted by mcitr View Post
        Things will become even easier for the hub when the NHS forces its doctors surgeries and other out of hours sites to use EPS.

        Banks is an interesting one to mention. I would mention libraries and post offices.

        Libraries are basically still there at all because they are required to be by law. Compared to 10 years ago many had their hours cut by a lot. Many have closed as well. Where there used to be packed 10 years ago with people using computers now they are mostly empty. All lending is done by a self scan computer. There are librarians but lower staffing levels and if you sit and study all day in a library you will see that librarians are spending their time dealing with issues, referring people to drop in clinics that use the building etc. I think we could become the healthcare equivalent.

        I do think about a third of the 10,000 pharamcies will go in the next few years. I think those that survive will also have their staffing levels cut by a third and ramp up other new services.

        A lot of people are quite anti-EPS and anti-delivery but I think this proportion will decline rapidly when the system goes totally electronic and the doctor tells them if they haven't got a smart phone to get a token it needs to be sent somewhere.
        We live 6-7 miles from our nearest Public Library. Cost in time, convenience, travelling expenses and having a permanent record to refer to it's actually cheaper to buy books on Amazon.

        They do, however, take up space. Earlier this year I took several boxes of books to a local Hospice Shop.

        And, of course, you can guess the rest: there are now several titles I regret parting with and will probably replace.

        I wonder where the Hospice Shop sends them?

        Comment


        • #5
          Originally posted by Mutley View Post

          We live 6-7 miles from our nearest Public Library. Cost in time, convenience, travelling expenses and having a permanent record to refer to it's actually cheaper to buy books on Amazon.

          They do, however, take up space. Earlier this year I took several boxes of books to a local Hospice Shop.

          And, of course, you can guess the rest: there are now several titles I regret parting with and will probably replace.

          I wonder where the Hospice Shop sends them?
          Having been in several reading groups over the years this is what a lot of people do. Others feel they should use libraries. I use two libraries for peace and quiet and struck very much how computer use has declined in them rapidly more recently. Like libraries a large part of why my pharmacy survives in its current form is the law and regs. It's very inefficient.

          The voluntary circles I move in tells me a lot of charity shops sell a good proportion of the books on amazon and ebay and the like as I'm sure you are aware. I frequently see volunteering ads for people who will do this and is stated explicitly in the advert.

          Comment


          • #6
            Originally posted by mcitr View Post
            Things will become even easier for the hub when the NHS forces its doctors surgeries and other out of hours sites to use EPS.

            Banks is an interesting one to mention. I would mention libraries and post offices.

            Libraries are basically still there at all because they are required to be by law. Compared to 10 years ago many had their hours cut by a lot. Many have closed as well. Where there used to be packed 10 years ago with people using computers now they are mostly empty. All lending is done by a self scan computer. There are librarians but lower staffing levels and if you sit and study all day in a library you will see that librarians are spending their time dealing with issues, referring people to drop in clinics that use the building etc. I think we could become the healthcare equivalent.

            I do think about a third of the 10,000 pharamcies will go in the next few years. I think those that survive will also have their staffing levels cut by a third and ramp up other new services.

            A lot of people are quite anti-EPS and anti-delivery but I think this proportion will decline rapidly when the system goes totally electronic and the doctor tells them if they haven't got a smart phone to get a token it needs to be sent somewhere.
            I never thought about libraries or Post office but if you also look at the number of police stations in operation it has dropped significantly and that is an essential service. If the government show no hesitation to counter the reduction of these services I believe they will do little to sustain branches which the multiples wish to close. This may create opportunity for the entrepreneurial pharmacist but given the dependency on NHS income I would rather get a McDonald's franchise then throw my lot in pharmacy.

            Comment


            • #7
              Yes, standard mark up on food is that for something costing £10, ingredient cost is £4.
              johnep

              Comment


              • #8
                Originally posted by jzd4rma View Post

                I never thought about libraries or Post office but if you also look at the number of police stations in operation it has dropped significantly and that is an essential service. If the government show no hesitation to counter the reduction of these services I believe they will do little to sustain branches which the multiples wish to close. This may create opportunity for the entrepreneurial pharmacist but given the dependency on NHS income I would rather get a McDonald's franchise then throw my lot in pharmacy.
                You would be miserable managing the staff in McDonald's.

                Best way to make money is hard work and be ruthless. Or corrupt. There are loads of corrupt pharmacy contractors around.

                Comment


                • #9
                  Originally posted by willerz86 View Post

                  You would be miserable managing the staff in McDonald's.

                  Best way to make money is hard work and be ruthless. Or corrupt. There are loads of corrupt pharmacy contractors around.

                  I would take McDonald's any day far more honest than being a pharmacist or contractor. Also McDonalds is a far better business to invest in here are the following points:

                  1) Limited range of products offered therefore the chance of variation is minimised and it is easier to achieve consistency and so therefore both train staff and keep customers happy.

                  2) In McDonald's incorrect order being given to customer does not translate into potential fatality.

                  3) McDonald's offer affordable product which is not at the mercy of the economy so will always be profitable. Also its important to remember if necessary it can hike up its price to cover any excess costs.

                  4) Staff are easier to manage in McDonald's than a pharmacy because staff do not have to learn all the legal and clinical reasons pertaining to OTC and POM and the assembly line is relatively fool proof McDonalds have seen to it to make it as easy and efficient possible to deal with difficult staff.

                  5) Franchise make a decent profit Google it

                  6) McDonalds out of GPhC jurisdiction

                  Comment


                  • #10
                    Don't knock the honesty of the majority of independent contractors. There are always bad eggs whatever the industry/service. The 'Single Handers' and small groups need to work together/consolidate and provide a public and private multi-channel service especially as it is likely more austerity is on the cards because of government ideology and the ridiculous tax regime in UK. There needs to be a 20% flat corporation tax rate for all transaction profits that take place in UK. No negotiation, no allowances, no wiggle room = tens of billions extra tax revenue.

                    Comment


                    • #11
                      The dishonesty is with ALL politicians who have self-interest at the top of their agenda, whatever their politics.

                      Comment


                      • #12
                        Originally posted by BrianA View Post
                        Don't knock the honesty of the majority of independent contractors. There are always bad eggs whatever the industry/service. The 'Single Handers' and small groups need to work together/consolidate and provide a public and private multi-channel service especially as it is likely more austerity is on the cards because of government ideology and the ridiculous tax regime in UK. There needs to be a 20% flat corporation tax rate for all transaction profits that take place in UK. No negotiation, no allowances, no wiggle room = tens of billions extra tax revenue.
                        Hi Brian I dont know about the majority but in my area where I locum a significant portion of the independent contractors are behaving with little ethics. The fundamental job of a community pharmacy is the accurate preparation of prescription and providing safe advice on managing minor ailments. I now see little sign of either activity.

                        The safe preparation of prescription is impossible in most pharmacies these days because funding from NHS is so dismal that to make profit a pharmacy has to be run on a shoestring budget! Therefore thats an example where many contractors show little integrity they are putting profits before safety. My second example of poor working practice is the provision of OTC service staff are woefully educated in this area many have no knowledge or others have been fed incorrect information. If BBC were to do an expose it would make to the front page of a national paper as a scandal. I have lost count of the number of times I had to intervene and my action was not appreciated by the staff or the contractor however I admit the problem is even worse in multiples.

                        This brings to my point that the contractors in my area show little integrity if safety was their first priority they would increase staffing level but profit is their first priority so they sacrifice safety for profit. IMHO pharmacy needs to be guided by safety and profit but as this is not possible, if contractors were honest they would have sold up. However I have not seen mass change in ownership of independents in my area,

                        If I were to make an educated guess I would say this holds true for other areas of UK and this bring me to my conclusion that the pharmacies which have been sold was due to retirement rather than based on ethical objection of the sector.

                        Comment


                        • JohnEllis
                          JohnEllis commented
                          Editing a comment
                          You cannot extrapolate your own experience as a locum to an entire sector, if you have any genuine concerns about unethical/illegal/unsafe conduct it is your responsibility to report them. I've been qualified as a pharmacist for over 15 years, as a locum and as an employee and in my experience, pharmacists have always worked ethically and safely with the patients best interest at heart. If anything, it is the huge foreign companies that own our biggest multiples that should be questioned about unethical monopolies and tax evasion.

                      • #13
                        Hi, John, I have raised my concerns to Superintendent when the situation warranted, fortunately, I have not seen anything illegal which would have mean GPhC. I have discussed this issue with PDA and have been told that was the correct thing to do as the first port of call is the superintendent who has a responsibility to resolve issues.

                        However operating on bare staffing level is no big secret most pharmacies face this situation because margins in pharmacies have been continuously squeezed the question is do you continue to plod along and provide service in a haphazard environment or call it quits. Those who willingly work in such environment are equally responsible as the politicians who have created this mess. I agree that I cannot extrapolate poorly trained staff from my observation of pharmacies but it is a fair observation to say that most pharmacies are operating in a dangerous manner in terms of staffing level.

                        As a locum, I see myself responsible for this system when I work in such pharmacies which is why I plan to exit.

                        Comment


                        • dosage
                          dosage commented
                          Editing a comment
                          I have seen you and many of other locums constantly refer to poor staffing levels at both multiples and independents. Could you clarify how many support staff you feel are required at any one time dependent on level and type of work?

                        • jzd4rma
                          jzd4rma commented
                          Editing a comment
                          Most pharmacies I have worked in do 300 plus items on a low day and on a good day 400 + for that we have one member in the dispensary and one counter staff this seems to be the arrangement most of the stores I have worked in.

                          If all the counter member of staff had to do was serve customers and the dispenser had to do dispensing then that would have been fine.

                          So just to breakdown the role of the counter assistant:

                          1) Serve customer (already established that in previous point)
                          2) Change price for promotions of goods this happens quite regularly in multiples
                          3) Take prescription request from customers sort out daily collection of prescription and go on collection round for prescription (this often leaves the pharmacist + dispenser to serve in between working in the dispensary)

                          This brings my attention to the dispensers duties:

                          1) Dispensing prescriptions
                          2) Chase outstanding orders from wholesaler
                          3) Chase up prescription queries with regards to repeat request
                          4) Serve counter when counter assistant is away on collection round

                          The pharmacist duties:

                          1) Check prescriptions
                          2) Help put the order away which arrives once in many of the stores I work because my dispenser is literally buried under her own unrealistic workload
                          3) Sort out clinical issues with GP regarding prescription
                          4) Carry out BP checks and MURs and OTC advice.


                          Just to put this in context of being a dangerous workload when I worked in a multiple/independent we had same staff levels but we only did around 200 items back in 2007-2008 as a pharmacy student. Therefore I believe my observation are correct regarding staffing levels.

                          Realistically speaking in pharmacy you need to keep additional capacity to deal with unexpected volume however I could not say how much because its not like organizing staffing for a football/concert where you have a rough idea because the venues have a maximum capacity.

                          In the pharmacies I have worked in you really should have two dispensers just to deal with normal workload and additional dispenser who could float between dispensary and counter. The other alternative is a complete re-haul of the dispensary if we have to keep such staff levels i.e. for chronic medication patients should expect at least 24 - 48 hours time frame and a "just in time" system for acute scripts. This means multiples can use hub facility to have chronic scripts completed. I personally think this would also help a pharmacy capture more repeat prescription and allow a more streamlined dispensing process.

                          I hope this answers your question.
                          Last edited by jzd4rma; 18th, August 2017, 08:22 PM.
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