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PDA comments on CCA written evidence

The PDA is commenting on written evidence provided to the Westminster parliament’s Health Select Committee by the Company Chemists Association (CCA) which has recently been made public.

Fri 24th June 2022 The PDA

The CCA represent ASDA, Boots, Lloyds Pharmacy, Morrisons, Rowlands Pharmacy, Superdrug, Tesco, and Well, who between them own and operate around 5,500 pharmacies, representing nearly 50% of the community pharmacy network in England. You can read their submission to the select committee here.

Within the CCA submission they claim despite an increase in the number of pharmacists on the register, many contractors report an increase in pharmacist vacancies. They also note that the absence of sufficient other pharmacy staff is impacting upon the workload of pharmacists.

The PDA accepts the above and reaches our own conclusion, based not just on the submission from the CCA, but our casework and ongoing feedback from the more than 30,000 frontline pharmacists who are PDA members across the UK. Additionally, feedback from our many thousands of pharmacy student members who are planning their future careers in the profession.

Vacancies caused not by shortages, but by unacceptable working environments

The PDA conclude that the situation is that many pharmacists do not want to work in the conditions community pharmacy currently offers, especially that seen offered by the CCA companies.  We believe that as the group that represents the owners and operators of almost half of the pharmacies in the country, the CCA, should recognise how much responsibility for the overall inadequate working conditions and environments in community pharmacy they carry. The PDA also notes that although the evidence presented to the Westminster parliamentarians seems to blame in part the England Pharmacy contract, many of the issues including temporary closures, apply across the rest of the UK, where, because of more ambitious NHS contractual settlements the English funding contract should have no impact.

For example, based upon Freedom of Information data, the PDA discovered that in one month alone in Scotland, out of the 338 pharmacy closures 331 of them were from CCA member pharmacies, and only 7 were from smaller and privately owned pharmacy companies.

A pharmacist MUST continue to be available to the public in every community pharmacy

However, the PDA believes that the key sentence in what the CCA has written to this group of MPs is that Pharmacies are not allowed to open unless there is at least one pharmacist onsite. The PDA wonders how the CCA is hoping the politicians might respond to that statement?

The CCA members turnover billions of pounds each year and exist to create return for their direct shareholders or for their parent companies. Indeed, it was reported in May 2022, that the American owner of Boots had extracted more than $5.3 billion (£4.3 billion) of dividends from its UK holding companies.

The PDA has no doubt that if parliamentarians could be convinced to allow “pharmacies” to open without a pharmacist, that could help further increase short-term profits for those companies. However, such a development would represent a dangerous diminution of patient safety and the loss to the public of the most accessible healthcare professional. It is a development which simply must not be contemplated at all, and especially just so as to assist the multiples with their profit requirement.

The PDA believes there are critical facts which MPs and other decision-makers need to understand. The reason why a pharmacist must be present and in control of a pharmacy is to ensure patient safety and appropriate care. Pharmacists are highly trained, masters level qualified health professionals skilled in patient care. As knowledgeable scientists, they understand the effect of each medicine and combinations of medicines on the human body. Human beings are not machines built on a production line, each is an individual, so pharmacists are also trained to consider the impact on each patient that presents to them.

That a pharmacist must always be available in a community pharmacy to enable it to open, means that other parts of the NHS can have their capacity protected, as increasingly patients initially go to a pharmacy first, to consult with the pharmacist before they unnecessarily visit their GP or the A&E department of the local hospital. Furthermore, in recent years, several thousands of pharmacists are now able to prescribe medicines on the NHS.

That Pharmacies are not allowed to open unless there is at least one pharmacist onsite” should not be presented as some unnecessary bureaucratic restriction, but rather as an explanation underlining what a pharmacy is. Rather than “…not allowed..” this should be an affirmative statement; A pharmacy must have a pharmacist on-site to enable it to undertake an important role within the NHS. In reality, without a pharmacist, a pharmacy becomes just a shop. There is nothing wrong with shops and the retail sector is an essential part of our national infrastructure, indeed several CCA members also operate shops as well as pharmacies within their overall branch networks. However, medicines are not normal items of commerce, and they are not normally sold through a simple retail transaction but dispensed and otherwise supplied as part of the health service.

Employers should take responsibility for their own workplaces

The CCA written statement goes on to say: No pharmacy wishes to or sets out to close but closures are at risk of rising without Government intervention to address the workforce challenges and chronic under-investment in the sector over many years.

The PDA believes that the CCA evidence is striking in that it calls on others to act and does not suggest that the CCA members themselves could help improve the situation by adjusting their behaviour or other contributing factors which are fully within their control and that impact upon the workload and safety environment.

The PDA also believes that unnecessary pharmacy closures have become a symptom of how employers are handling a situation where many pharmacists are not prepared to accept employment in the poor working conditions in multiple community pharmacy. Even when some pharmacists are prepared to locum in such environments for rates of pay that are commensurate to the additional risks involved in working for some CCA members, those companies may refuse to pay these rates and choose to close the pharmacy instead.

Pharmacists are concerned by closures

When closures occur the PDA hears from members that are pharmacists employed by CCA members concerned about the impact on patients due to such closures, from locums who were available to work and had communicated this fact to the CCA member but were not engaged, from GP practice-based pharmacists concerned about how their patients will get their medicines and from pharmacists in opioid replacement therapy units concerned how their patients will receive their daily dose.

The PDA struggles to understand how the decision-makers within the pharmacy chains that choose to unnecessarily close pharmacies apparently are unable to grasp the connection between these decisions and the willingness of pharmacists to choose to work for their companies.

Employers could take action

Here are some other suggestions as to what CCA members could do to help reverse their recruitment and retention challenges:

  • Embrace and utilise the professional skills of pharmacists, making pharmacies more like healthcare settings and less like shops.
  • Provide a sufficient level of support staff to support the pharmacist to carry out their work in a safe and efficient manner
  • Sign up to the Safer Pharmacies Charter and consistently meet the standards it contains.
  • Stop setting unachievable targets for things like vaccinations and other items of service.
  • Introduce transparent pay systems and negotiate rates with employees’ independent representatives, so that each pharmacist can see how their current pay is determined and what they can do to help increase it.
  • Invest in the physical branch network, including the staff areas which patients cannot see, so that every branch is an acceptable working environment.
  • Provide reasonable adjustments for those that are unable to stand all day, so that pharmacists can work in the community pharmacy environment, regardless of any disability.
  • Introduce and promote a genuine zero-tolerance approach to violence and abuse towards employees.
  • Treat locums as self-employed suppliers, including allowing them the right to negotiate rates, to substitute and to have more control as to how they fulfil their contract to provide services. (this would also likely remove the concerns about IR35 which may be keeping some locums away from community pharmacy)

This is not an exhaustive list.

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