Boots has been accused of boosting its profits by forcing staff to abuse an NHS scheme intended to help sick patients.
Managers at Britain’s biggest pharmacy chain were found to be directing their pharmacists to provide medicine-use reviews (MUR’s) to patients who didn’t need them, in order to claim public money from the NHS.
The NHS pays £28 for each MUR, which is carried out by a pharmacist and intended to give patients professional advice on health, diet and how best to manage their medicines.
This service is almost identical to the service offered through Australian pharmacies called Medschecks, for a very similar cost to the Australian government.
Investigative reporters from the Guardian newspaper have found evidence that Boots managers have been directing staff to carry out MUR’s on each other, and for patients who don’t need them or can’t use them.
To prevent abuse of the MUR system in the UK, the NHS limits each pharmacy to a maximum of 400 per annum.
In Australia, the limit set for each approved pharmacy is 120 Medschecks per annum and this limit was set after an investigation into HMR’s (a similar but more elaborate service) suggested that abuse may have been occurring.
As a result, genuine providers had their incomes disrupted and internal political advantage was taken to limit expansion of the service.
There was also later evidence that large Australian chain pharmacies were abusing Medschecks in Australia, similar to Boots in the UK.
The Guardian found evidence that Boots staff are being told to take the number 400 as a target for individual stores to hit.
“400 MURs is an expectation now. We don’t need to tell you that”, was quoted as a statement made by a senior Boots manager on a recent training day.
It has been calculated by the Guardian that if each Boots store reached its target of 400 MUR’s, £30m would be subtracted from the NHS budget and form an equivalent profit for Boots.
The Boots’ official media line is that by achieving a target of 400 MUR’s annually, that becomes a measure of excellence for patient care, and a lost opportunity to not provide an MUR reflects unnecessarily on the bottom line.
Both Australian and UK pharmacists are opposed to the commoditisation of professional services because it is also a betrayal of trust – the type of trust built up between community pharmacies and its consumers over many decades of delivering services.
Industrial economists tend to brush away this type of concern and see it in terms of “collateral damage” that can be rectified through more regulation.
Community pharmacists see it in more interpersonal terms through developing real relationships with patients.
They know that the care component of a patient’s treatment is the most valued component by a patient – and the principal reason as to why patients want more access to pharmacists.
Access has been suppressed by the volume and detail of a now moribund PBS system that cares little for the patient but does everything for a drug manufacturer.
Corporate pharmacies are more responsible to their shareholders rather than their patients.
This has been demonstrated over and over again and the latest Boots effort is just another example.
The UK General Pharmaceutical Council (GPhC) has requested access and discussion with the Pharmacists’ Defence Association (PDA) over material it shared with the Guardian in relation to the newspaper’s allegations against the Boots’ chain group.
As well as to an unpublished survey conducted by the PDA that it claims was completed by over 600 Boots employees.
The regulator is also asking the PDA to provide it with “other relevant evidence”.
Meanwhile, the “spin” and PR division of Boots has swung into overdrive.
Boots has reminded its pharmacists of its guidance on providing medicines use reviews (MURs).
Its professional standards make it clear that services “must be for the benefit of patients, not the attainment of numerical targets”.
The company “doesn’t recognise” the Guardian’s claims, which it said are “not representative” of its 60,000-strong staff.
Boots makes it clear to staff that services should not be carried out” inappropriately”.
All of its staff are: “empowered” to use their professional judgement to assess the appropriateness of offering services.
“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”.
We all understand that a solution will be found that will contain this outbreak of unprofessionalism, but each time it happens, community pharmacists are on the back foot in having to rebuild a trusting relationship with their patients, whereas Boots will rely on the short-term memory of its customers and protect its “brand” through the constant washing of advertising and PR media releases, until all stains are deemed “removed”.
You will note that I have deliberately used the word “patient” for community pharmacy and “customer” for the Boots’ retail pharmacy chain.
As I have already noted, the “care” component that patients received is much diminished in an organisation like Boots.
In an Australian context the Boots-type conglomerate can bring with it economies of scale in its delivery of products.
While products make up a substantial component of community pharmacy activity, it is actually trying to rebuild its culture to build back the clinical service component of its core business.
This aspect is downplayed by pharmacy critics because it has been an “invisible” delivered by pharmacists at no charge – the charge always being covered by product margins.
That model has been overturned by pharmacists breaking away from the traditional model of community pharmacy – one extreme going north into a services only model, the other extreme going south and becoming a warehouse-type pharmacy.
Of course, pharmacists are free to follow their vision as to whatever business model suits them.
But care needs to be exercised where professional standards need to be defended because they are common to all models.
Unfortunately in the corporate retail model, professional standards are often submerged in the quest to maximise shareholder returns.
It is a balancing act that will keep repeating itself in various new media around the globe.
Balance must also be seen by governments when they pursue alternatives to community pharmacy in the delivery of health services.
Remember that community pharmacy got you to where you are now and by simply jumping ship or by weakening community pharmacy financially, you may not end up with the objectives promised by major retailers or even an actual benefit for health consumers.
For what they seek is care, supported by a product, if appropriate.
Not the other way around.
If Australia goes down the pathway to emulate the US health system (as it seems to be doing), then we can expect to become the world’s second worst health system.
Going from best to second worst is something that politicians will have to explain in their facing up to their constituents.
Health is a major political issue and will continue with the ageing population.
Keep this in mind before you completely destroy what is left of pharmacist creativity and innovation through the hatchet men of the review committee.
A better choice would be to provide support and encourage the existing people who have contributed so much effort to sustain Australia’s patients.