|
The UK system
for the regulation of pharmacy numbers and locations, to this
point, has not been a great deal different to the Australian system.
However, the percentage of corporately owned pharmacies (mostly
under non-pharmacist control), compared to pharmacist controlled
pharmacies, in total, is higher in the UK than for Australia.
Regulations governing new pharmacies or relocations of existing
pharmacies, have ensured an equitable distribution of pharmaceutical
services, including services in some of the lesser populated areas
of the UK.
Australian pharmacists enjoy protection under the various State
Pharmacy Acts, that limit ownership to registered pharmacists
(even if the approval number system were to disappear).
This protection would not exist for UK pharmacists within the
changes proposed.
With no controls over new UK pharmacies, the sequence of events
will probably be:
* New pharmacies will be located in most supermarkets, putting
competitive pressures on those existing pharmacies located in
the same catchment. An imbalance of pharmacies not under pharmacist
control will quickly emerge.
* Already
scarce pharmacists will be head-hunted to operate more new pharmacies.
* Investment in privately owned pharmacies will sharply reduce.
* Pharmacies
located in rural, isolated or deprived areas will gradually disappear
as they come under pressure.
* Board
decisions made in respect of corporate pharmacies (not controlled
by pharmacists) will be increasingly made for maximum return on
shareholder funds, not for best outcomes for community health.
The recommendation
seems to cut across plans being jointly developed between official
pharmacy and the Department of Health, which are based on the
existing regulatory system.
At risk is NHS patient care and the UK government's long-term
primary health care plans, through instability that would be generated
within a wide range of community pharmacies.
The National
Pharmaceutical Association (NPA) has expressed anger and extreme
concern at the Office of Fair Trading's (OFT) decision.
Obviously, the Australian equivalent of the "economic rationalist"
is alive and well in the OFT.
"Without control of entry, consumers
will undoubtedly suffer from a reduction in access to the range
and choice inherent in the current pharmacy network. Moreover,
it will destroy the platform from which the Government intends
to launch a wide range of enhanced pharmacy services-as detailed
in 'Pharmacy in the Future- Implementing the NHS Plan'.",
said a spokesperson for the National Pharmaceutical Association
(NPA).
The NPA is arguing that there is a fundamental incompatibility
between a totally deregulated marketplace and the commitment of
the Government to deliver a well planned and managed NHS pharmacy
network.
In response,
the Department of Trade and Industry (DTI) said:
"We will be considering carefully the
report and its recommendations. The DTI is responsible for coordinating
a response across government, and will be working closely with
other departments and the devolved administrations. Views are
welcome. Should the Government decide to make regulatory changes,
there will be consultation on draft proposals."
The stakeholders involved in any draft proposals will be key interest
groups from pharmacy, GP's (particularly dispensing doctors),
the NHS and patients.
At least the process gives more breathing space than the events
in New Zealand 12 months ago, when legislation was introduced
over the Christmas holiday period, without any prior warning to
pharmacists.
Here, the Pharmacy Guild of Australia gave some very good advice
to the New Zealand pharmacists, who eventually succeeded in having
their legislation overturned.
However, it was not a complete success, and the New Zealand government
still has a loophole through which it can begin the process once
more.
If the UK Government eventually raises the stakes against private
British pharmacists, I am sure you will see the New Zealand Government
endeavour to follow suit, eventually followed by the Australian
Government.
Economic rationalism
is supposedly about competition, but it is really a code word
for globalisation.
So if the UK decision is followed through to its proposed logical
conclusion, as outlined and recommended by the OFT, you will see
more global entrants begin to set up pharmacies in the UK.
These entities will drive out competitors, through superior resources,
or engage in mergers and takeovers, concentrating pharmacy resources
in a few corporate (non pharmacist) hands.
There is a
further problem that is likely to occur with an open deregulation
of pharmacy in any country, and it goes to the heart of being
able to practice as a professional.
In March
2002 I published an article in i2P entitled "Beware
the Ides of March".
In this article I made reference to the loss of professionalism
and professional development that occurred within non-pharmacist
corporates in the UK and the USA.
The recent events in the UK suggest that this loss of professionalism
will accelerate, if the suggested legislation is passed.
So it is worth revisiting in the context of this current British
crisis.
I also highlighted some extensive comments made by a British pharmacist
turned barrister, Mr Graham Southall-Edwards. The following is
an extract and a quote (by Graham Southall-Edwards in inverted
commas) from my original article:
"
What continues to surprise me is that these large companies have
never been externally regulated. Of course, there are internal
checks and balances, but there is no mechanism to ensure that
their activities further the profession of pharmacy. They are
often run by "risk averse" individuals who, on their
own, could never keep going for long. The senior management in
these companies and their line managers therefore seek to secure
themselves by endless rules, manuals, procedures, superintendent's
bulletins, pharmacy log books, and general restraints on the exercise
of personal professional freedom. It is what a well-known, successful,
experienced pharmacist friend of mine has termed the 'protocol
for blowing the nose'. Not an environment to experience job satisfaction."
What
Mr Southall-Edwards is talking about is a critical loss of professional
discretion and an almost total loss of professional development,
because the only "external regulator" to these corporations
is the shareholder, to which all is sacrificed.
A similar situation occurs in the US, as reported by Pharmacy
Week, the publication of American Health System pharmacists. From
a poll of their own members taken on the 16th October 2001, they
asked the question:
"Have you ever had your professional judgment challenged
or overridden by management for the sake of 'customer service'."
The 'Yes' response was 68.8 percent, and the 'No' response was
31.3 percent, with a total of 64 respondents.
Now in the
extract above I refer to one of the more demoralising prospects
that can eventuate from a globalisation of pharmacy by non-pharmacist
controlled corporates i.e the loss of professional discretion.
Graham Southall-Edwards, on the other hand, talks about an extension
of this process where professionalism is destroyed by a manipulated
process remarkably similar to Quality Care Accreditation in Australia.
This
reference to the endless rules, manuals, procedures etc is a complaint
that I hear fairly frequently, and in fact, one of our writers
in this edition (John Skyllas) asks the question as to whether
Quality Care Accreditation is worth it.
Having had to endure similar demands within the NSW hospital system,
I am also ambiguous as to my feelings.
On one hand, in my consulting practice, I used to develop similar
survey procedures with my clients, but using a "bottom-up"
approach i.e explaining and agreeing with staff all procedures
and asking them to suggest something better, or refine the process.
Quality Care is a "top-down" inflexible process, and
you never feel you have the opportunity to own the process.
What is sensibly needed is a method to negotiate alternative procedures
that can be tailored to individual business environments, or appoint
a consultant (internal or external) to come through on a repetitive
basis and do most of the work for you.
Quality Care Accreditation comes at a cost, and the $7500 offered
in offset is not going to cover anywhere near the ongoing expense
involved.
In my original article referenced above, I made a suggestion that
Mr Southall-Edwards might be able to provide a useful service
for Australian pharmacists. At that time I was unable to provide
contact details.
However, he has contacted me recently and offered the following
for publication:
G. Southall-Edwards
MA(Law).,LLM., M.R.Pharm.S
E-Mail: barrister@netway.at
Telephone +447968529253
By coincidence,
he advises he will be in Sydney for a client UK company over February,
so if you would like to make contact, set up an appointment through
the above.
I am sure he will be kept very busy in the current UK climate.
In concluding
this article I suggest that UK pharmacists should contact the
Pharmacy Guild of Australia for advice on how best to combat this
threat by political means. The New Zealand Pharmacy Guild could
also offer some first hand experience.
My personal advice is to fight like hell, preserve your professionalism
at all costs, and keep out the excesses of globalisation for as
long as you can.
I sincerely hope that Australian pharmacy can hold out, if and
when it is our turn (again) to fight off the predators.
All I can say is that we must underrate our success as business
people, because everyone wants to own us world-wide.
|
.jpg)
NEIL
JOHNSTON