Think deregulation will improve wages and conditions for pharmacists? Think again, writes Natalie Gauld
The worst thing we can do is put pharmacy into the control of retailers, according to Professor Carlo Marra, a Canadian pharmacist academic who is the new head of the School of Pharmacy at Otago University of Otago in Dunedin, New Zealand.
And he should know, given his research regarding working conditions for pharmacists. This is particularly interesting in New Zealand where deregulation of pharmacy ownership is under consideration within an overhaul of medicine legislation.
A decision on pharmacy ownership requires consideration of the evidence of risks and benefits. What will it mean for consumers, the government, pharmacists and other pharmacy staff?
Professor Marra’s research in British Columbia, Canada, found that pharmacists working in chain pharmacies were twice as likely to report not having enough time for their job than those at independent pharmacies.
Chain pharmacy pharmacists were also more likely to report a work environment that was not conducive to safe and effective patient care, and inadequate pharmacist, technician and assistant staffing to provide safe and effective patient care.
Quotas for advanced pharmacy services were more common at chain pharmacies than independent ones, and pharmacists working under quotas raised more concerns than pharmacists not working under quotas, including a work environment that was not conducive to safe and effective patient care, and not having enough time for breaks and lunches. Young pharmacists were more likely to report insufficient break time.
Commentators have talked of the reduced autonomy of pharmacists working in corporate pharmacy versus independent, including a prediction of de-skilling and low remuneration. They have also mentioned the responsibility to shareholders being greater than that to patients. A UK supermarket chain reportedly stopped supplying the emergency contraceptive pill to people under 16 years without a prescription owing to customer concern.
Earlier this year an exposé in the UK’s Guardian suggested that pharmacists at a particular pharmacy chain were under pressure to deliver medicine reviews, reportedly sometimes conducting them on people who “did not need or want them”. Just last month, Raidió Teilifís Éireann from Ireland reported that a pharmacy chain there repaid €12m for dispensing fees incorrectly charged, following an investigation.
The Japan Times reported in 2012 that a supermarket chain was suspected of falsifying documents for 200 of its employees to take an exam to sell non-prescription drugs, becoming a “registered person” without fulfilling all of the requirements for such status. In Japan a “registered person” can sell many of the non-prescription medicines without a pharmacist present, so there are potential implications for consumer care if such persons have had insufficient training.
One anticipated benefit of deregulation would be the idea of increased competition and lower prices of non-prescription medicines for consumers. However, research from Europe from Vogler et al suggests limited competition and no price reductions after ownership deregulation. And they also found pharmacist workload increases, which has implications for patient care.
This evidence is consistent with reports from pharmacists I have known who worked in chain pharmacies in the UK. When I was at the International Federation of Pharmacy (FIP) Congress recently, Argentinian pharmacists volunteered their difficulties of working in pharmacies with non-pharmacist owners given their lack of understanding of professional ethics.
Medicines are not ordinary items of commerce, and need to be treated carefully. The NZ Minister of Health’s initial view is that pharmacist ownership is not necessary for pharmacy, and the Ministry of Business Innovation and Employment, our medicines funding agency (Pharmac), and Treasury have supported removing the restrictions on pharmacy ownership.
So far the benefit-risk balance does not look particularly favourable for this action.
Dr Natalie Gauld is a NZ pharmacist who works internationally in widening consumer access to medicines, including through down-scheduling. Possible conflicts of interest: Natalie is a member of the executive of the Pharmaceutical Society of NZ, and her clients include Green Cross Health. The opinions expressed in this column are the author’s, and not as a representative of any organisation.