The future of community pharmacy is in the balance. Should it be dispensing-led or service-led? It is a decision with huge consequences – and one that you cannot afford to ignore...

We are faced with a choice between a dispensing-led future or a service-led model. This has been the case for as long as I can remember, but now is the point where we must choose.

Why is this, I hear you ask? The truth is that you probably don’t have to choose if you have endless resources, but for the rest of us, the business choices are diametrically opposed between being a low-cost provider of medicines or a high quality provider of care. For option one, we need to strip out cost; for option two it is about investing in facilities and people.

It is absolutely clear from the attitude and approach of NHS England that there is no additional money for dispensing. Now, some contractors do quite nicely out of the current system; others don’t. The problem we have is that, in a system of averages, everyone thinks they beat the average, but I hate to break it to you – half of you are losers.

I’ve often been told that community pharmacy isn’t interested in clinical services yet the response of the independent sector towards the Covid vaccination programme has been particularly telling. Thousands of pharmacies sought to be a part of the third wave of the vaccination programme, even though only a handful were chosen to go forward.

Independents led the way

Of the top 100 pharmacies who have provided the Covid vaccination service, what proportion do you think are independents? By rights, this should be somewhere between 40-60 per cent depending on how you define independent – so it might surprise you to hear that 94 out of the top 100 pharmacies are independents, with the most successful CCA pharmacy coming in at a lofty position of... 39.

So what does this tell us? In essence, that independents have been able to adapt their offer to incorporate new clinical services, at scale, when the incentives and service design are right. The multiples, however, have been much less willing or able to adapt and incorporate these services.

In a new world where services are designed and commissioned according to local need, it is independents who hold the key to success because they can adapt and respond to the local needs of the NHS much more quickly.

Dinosaurs? I don’t think so....

For so long the ‘big boys’ have considered the independent sector dinosaurs as they look to make the most of their scale and power, but I genuinely see them as the Tyrannosaurus rex minutes before the impact of the asteroid. Fearsome, but too big to adapt, and ultimately guilty of playing yesterday’s game of chasing prescription volume and dispensing margin. If independents continue to play that game, they will go the same way.

Independents need to break the millstone of a volume and margin driven contract and focus on face-to-face services. To do that we need a negotiator that isn’t tied to that structure. Will PSNC ever sanction a change of funding model? Doubtful. Will it abandon margin in favour of a more equitable mechanism? I’m not seeing it.

So, stop dabbling in services and make it your main thing. At my pharmacy we’ve done more flu jabs than ever before and the Covid vaccination service has been a revelation. I haven’t had this much fun in pharmacy in ages.

Yes, I’m knackered, but it feels so much more healthy to set a positive vision and set about achieving it, than waiting to be ‘done to’ by external factors. Think about which side you want to be on...and how history will remember those who did nothing.

*Alexander Humphries is the pen name of a practising community pharmacist. The views in this article are not necessarily those of Pharmacy Magazine. Services or dispensing — how do you see the future? Email pm@1530.com