Boots scandal highlights benefits of pharmacist ownership

Boots shopfront

Managers at Boots, the UK’s biggest pharmacy chain, have been pressuring their pharmacists to abuse Medicine Use Reviews, providing them to patients who do not need them or cannot use them, the Guardian alleges.

And Anthony Tassone, Victorian president of the Pharmacy Guild, says this sort of example is a good reason to keep pharmacy ownership in the hands of pharmacists.

MURs are carried out by pharmacists, who offer patients health, diet and medicines management advice.

The NHS pays £28 for each MUR carried out; MURs are capped at 400 per pharmacy to prevent abuse.

But Guardian reporter Aditya Chakrabortty writes that Boots stores have been found to be using that number as a target to aim for, rather than a maximum.

“The Guardian has seen a 2008 email from a senior manager for another region that states: ‘I personally don’t want colleagues to feel ‘brow-beaten’ but we do need to deliver our targets of 400 MCUs [medicine check-ups – another name for MURs] per store this financial year for two reasons:

“’1. Delivering 400 MCUs is a measure of Excellent Patient Care

“’2. The company can make £28 profit for each MCU, so each one we don’t deliver is a lost £28’,” writes Chakrabortty.

The Guardian also cites a survey, which remains unpublished, by Britain’s trade union for pharmacists, the Pharmacists’ Defence Association.

In this survey, more than 600 Boots pharmacists (a significant percentage as this is more than 10% of Boots pharmacists) responded.

More than 75% said that the statement “How often do you believe financial cutbacks imposed by your main employer have directly impacted upon patient safety?” was true around half or more of the time.

The pharmacists also reported being pressured into conducting MURs whether patients needed them or not.

Another article, also by Chakrabortty, went into depth about the strain placed on Boots pharmacists, particularly with the example of “Tony,” who has developed depression as a result of “virtually constant stress”.

The Guild’s Anthony Tassone said the Australian pharmacy model makes pharmacy owners more accountable.

“With deregulation, and big companies answering to shareholders before patients, there really is the risk of profits being the highest priority before patient care,” Tassone told the AJP.

“It’s always a risk when we have a shareholder interest being first and foremost.

“With restrictions in Australia to limit pharmacy ownership to pharmacists, they’re accountable to the public as they’re registered health professionals under a national scheme.”

Tassone said that Australian guidelines could offer protection to any pharmacists subject to similar pressure to provide services, should that occur here.

“We have a responsibility, with taxpayer funds, that they’re used appropriately in targeting the right patients to get the best outcomes,” he says.

“We also in Australia have Pharmacy Board guidelines on appropriate workloads and obligations of proprietors to ensure an appropriate working environment for pharmacists to practice in.

“Directing pharmacists to undertake, or be expected to deliver a certain number of reviews, irrespective of the suitability or eligibility of that patient, could possibly be considered incitement or directing unprofessional conduct under the national law.

“I think pharmacist ownership of pharmacies has the owners of the pharmacies accountable to the public and the registration board, and it’s a system that works and will continue to work, and is capable of doing more for the Australian health system.”

Since the publication of the Guardian articles Boots has made a statement to UK pharmacy publication Chemist + Druggist, saying that it did not recognise the claims made in the Guardian.

“Boots makes it clear to staff that services should not be carried out ‘inappropriately’, it stressed,” writes C+D.

“All of its staff are ‘empowered’ to use their professional judgement to assess the appropriateness of offering services, it added.

“The drive for strong financial performance has never been to the detriment of our constant priority on pharmacy and delivering the best healthcare services in the communities we serve.”

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  1. CWH is like Boots?

    In addition to above, I think the worse part of Boots from 2007-2014 when it was essentially owned by a private equity firm was that it appears to have effectively minimised its tax dues as in part the private equity firm that bought Boots put the cost of purchase as a debt liability on Boots’ books. The guardian estimated that Boots saved the private equity firm about $1 billion in tax liabilities. This is money that average Britons have had to cough up as Boots paid less tax.
    In Australia, most pharmacist owners don’t have the money to establish methods to minimise tax in the same way as Boots did. This could be our future if CWH Verrochii and Gance extended families are allowed to sell their stakes in all their CWH associated entities to one international company. If this was ever allowed, then Australian taxpayers may end up paying more like Britons did when Boots was sold to a group of private investors….

  2. Bruce Grove

    The catch cry “we have a responsibility to our equity holders” is a frequently used excuse to justify poor behaviour of large companies. It also means that it’s unlikely that any senior management will be held accountable.

    This article underscores the importance of limiting ownership to those who can be held accountable for their actions and helps maintain true professionalism.

  3. Angus Thompson

    I worked in the UK in this era and have had experience of pressure to do MURs, but let’s not be naive and this it was just ‘the big corporates’ – smaller groups that were owned by pharmacists behaved similarly. Irrespective of who ‘owns’ a pharmacy there is always going to be the potential for tension between a wholly ethical approach and need to make a business profitable. How many pharmacists working in Australia for ‘pharmacist owners’ would be looked upon well by their employer if they refused to snell the ‘snake oil’ that occupies large proportions of shelf space?

    • one foot out

      I agree. pressure to do medschecks and the such. I think rather than the business gets paid, the amount should be paid to the pharmacists themselves.

      A definite smaller amount, not $28 – that will encourage abuse. if they save someone’s life by being clinically relevant and up to date, why shouldn’t the professional be paid what he/she is due? In the end, if there is an audit or investigation into a service provided, it is the professional who is on the hook.

      the system will be fairer.

      If u look into the business side of things, it might well that giving pharmacists the right to open up a shop anywhere with pbs approval would lower the cost of business operation ( initial startup capital) and limit the chemists shops to a certain size will stop retailers from entering into a medical practice.

  4. William

    This article is trying to link a newspaper claim to its aim of stopping Boots and supermarkets to compete in Australia and take away pharmacists monopoly of pharmacy.
    There would be higher motivation to over service these reviews by stand alone pharmacists.

  5. Charlotte Hutchesson
  6. Peter Allen

    Fortunately nothing like this would happen here. Australian pharmacists are … hang on, we remember the memo from Chemist Warehouse head office, something like; ‘Congratulations to xxx branch having achieved ?thousand Clinical Interventions. Come on guys, who can beat that?’
    that was when some doubted the fair dinkumness of the clinical interventions involving changes

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