Why partnerships may be a magic wand
Although the rising costs of healthcare seem to be the main driving force for change in the NHS, the need to adapt the health service to the changing needs of the population, who are increasingly more health-informed and busier, is another important factor. Since community pharmacists will be required to show their ability to deliver effective services in order to be given greater responsibility in the changing NHS, the impact community pharmacy ownership has on pharmacists’ ability to put together a convincing argument is one that can no longer be ignored. This article discusses how a change in ownership arrangements could create a win-win situation for community pharmacists and their employers.
Graeme Stafford, in his article — using the recent European Court of Justice ruling as a test case — highlighted some of the reasons why the ownership of UK community pharmacies should be restricted to pharmacists. It is important to note, however, that the situation in the UK — where pharmacies do not have to be owned by pharmacists — is not unique. In the US, large multiple pharmacy organisations are in almost full control of the nation’s community pharmacy services, with pharmacists often compelled to work in circumstances that are beyond their control (12- to 16-hour shifts).
In many European countries, for example, Italy and Germany, non-pharmacists are not allowed to own community pharmacy businesses, but the situation is slightly different in countries such as Canada and Sweden, where community pharmacists are often seen working in partnership with large multiple pharmacies through franchise arrangements.
Whereas the franchise arrangement in Canada (eg, with Rexall Pharmacies) seems to be driven by a business need within that country, the situation in Sweden is backed by a law that expects pharmacists to have considerable shares in community pharmacy practices. In both cases, the franchise arrangement allows the pharmacist (franchisee) to run the pharmacy business almost as an owner by developing a business plan as well as managing the pharmacy, while the company owning/controlling the rights to grant franchises (franchiser) concentrates on other areas of support such as branding, stocks and infrastructure. The present business-oriented pharmacy arrangement allows businesses to acquire as many pharmacies as they can which can later be sold off to the highest bidder, irrespective of whether the new owner is a pharmacist or not. Although this practice makes good business sense for the investor, it may be detrimental to a profession that wants to play a pivotal role in health care.
What is the situation regarding independent community pharmacies (in my opinion, the only hope left for the profession)? One might expect many independent owners to encourage their children to study pharmacy as well, as used to be the case and still is in many professions. Often, the contrary applies, however, as many parents may not want their children to face the same level of pressure and diminishing income they are facing themselves, with their pharmacies ending up in the hands of large multiple organisations, which are usually the highest bidders.
To my mind, the SalvaDore, the Independent Pharmacy Federation and other relevant stakeholders should be encouraging partnership arrangements to develop in independent pharmacies, and therefore help to preserve this area of pharmacy practice. The RPS cannot remain a strong organisation if its membership is constituted of individuals who are mostly employee pharmacists. Recent research seems to suggest that the use of independent community pharmacies is more cost-effective than large multiple pharmacies, and this finding could make a valuable addition to the debate.
This commercial orientation of community pharmacies has forced most pharmacists to become employees or locums, thereby eliminating pharmacists’ influence on the direction of the profession. This has huge implications for the responsible pharmacist debate. Historically, however, the profession has always faced challenges, and we need to look again at other professions (GPs, private clinics, solicitors, barristers, architects, surveyors, accountants, etc) to see the benefits of professionals being active partners in their practices.
In the legal profession, senior partners train and mentor newly qualified legal practitioners to become junior partners through apprenticeship schemes. A similar scheme is being encouraged by the Royal College of General Practitioners, whereby newly qualified GPs are offered the opportunity to become GP partners or offered initial employment as salaried GPs that can be converted later into a GP partnership. Similar partnership schemes also exist in the other professional groups listed above.
The advantage of allowing practitioners to join practices as partners is that it promotes commitment (something that may not be possible with employment arrangements) and enables young practitioners to manage their finances properly by investing gradually in a partnership. In a pharmacy practice, the patient is likely to benefit considerably, as the attitude of a pharmacist as a sole or part owner towards his or her customers is likely to be different from that of an employee pharmacist, whose actions are constrained by the protocols of the establishment.
For the organisation, it means that some of the money saved from salaries can be ploughed back into the business for other developmental projects, bacause partners’ remuneration is based on the profitability of the organisation.
Given the envisaged changes in the NHS, which will allow GPs to be the major players in healthcare commissioning and delivery, it is widely agreed that pharmacists will need to become closer to GPs in order to play a greater role in patients’ healthcare provision. The question we all need to be asking ourselves is why we think that GPs would want to work with pharmacists whose motives could be perceived mainly as enriching multiple organisations. Since GPs are also trying to protect their incomes, the profession must devise a better way of making community pharmacists more acceptable to GPs. A slight change in the ownership arrangements of UK community pharmacies could be the magic wand required.
Citation: The Salvadore URI: 11092342
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