manifesto from survive to thrive 2013

8/13/2019 Manifesto From Survive to Thrive 2013

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From Survive to Thrive

A statement of the needs andaspirations of independent

community pharmacy in the UK

A Manifesto for IndependentCommunity Pharmacy


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Independents are delivering a valuable

service against the odds.

Many of them feel that they are running

faster and faster just to stand still.

This document demonstrates how

life could be very much better for

independent pharmacists and for patients.

It describes the journey the independentcommunity pharmacy sector needs to

take, together.


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From Survive to Thrive is the first part of our Manifesto for Independent Community Pharmacy.

Other documents to complete the set will be released shortly.

At the heart of the Manifesto initiative are two core beliefs. The first is that independents are

essential to a strong pharmacy sector overall and to the health of the nation. The second is that

independent community pharmacy can thrive; challenge and change is inevitable, decline is not.

The themes are likely to resonate across the whole community pharmacy sector, but we take as

our start and end point the needs of independents and the communities they serve. We intend

that the Manifesto will lead ultimately to a position where more independents are fulfilling their

potential. As a result, patients and communities will benefit.

We wish to say thank you to those who have contributed to the development of this document,

right across the UK, by sharing insights and experiences generously.

Our Manifesto commitments to our members:

3 To resist the tide of red tape getting in the way of time to care

3 To address the excruciating frustrations of being at the sharp end of a dysfunctional

medicines supply chain

3 To seek a level playing field for independents when it comes to contracts, funding and

commissioning

3 To develop capability and leadership throughout the independent sector

3 To work in a true partnership with our members to deliver results.

Foreword

3

Mike Holden

Chief Executive,

National Pharmacy Association

Claire Ward

Chief Executive,

Independent Pharmacy Federation

Colin Baldwin

Chief Executive,

Association of Independent

Multiple Pharmacies


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Why a Manifesto for independents?

The National Pharmacy Association (NPA), the Association of Independent Multiple Pharmacies

(AIMp) and the Independent Pharmacy Federation (IPF) together concluded that the opportunities,

threats and choices for the independent community pharmacy sector are of such magnitude that

a strategic review of needs and aspirations is required.

From Survive to Thriveis a product of that review, which began in March 2013 and continues. We

think of it as the first part of a Manifesto for independent community pharmacy. It will provide

a frame of reference for all our forthcoming activities to represent and support independents.

It articulates what we have heard during a widespread consultation with our members.

You told us:

1 Independents are essential to a strong pharmacy sector overall and to the health of the

nation.

2 Independents are not confined to the business of pharmacy, they are in the business of

health, wellbeing and social care where there is room to grow considerably.

3 Independents face daunting pressures. Many feel time challenged, financially stretched,

isolated and pessimistic about the immediate future.

4 The top three problems for independents relate to a deficient medicines supply chain,

squeezed income and tightening margins, and a heavy burden of red tape which eats

into time to care.

5 Independents have roots in their local communities and other strengths which givethem resilience and a platform for sustainability, innovation and maximising

their potential.

6 Policymakers, regulators, the NHS and others could do much more to free the

independent network to fulfil its innate potential.

7 Independents must continuously challenge their own performance and behaviours,

recognising that professional excellence is a requisite for sustainable commercial success.

Being clear about what good would look like for the independent sector in the future is critical.

Three building blocks of care support a future model which can flex to reflect local needs:

keeping people safe by helping them make best use of their medicines; supporting people to

stay well through healthy lifestyle interventions; and helping people live independent lives in the

community through supported self care. Success is not just about being able to struggle through

the current difficult conditions with a view to coming out the other end unchanged; it is about

adapting to the environment and fulfilling the potential of the sector. This is what it means to

thrive, not merely to survive.

A number of conditions necessary for success (we identify 20 in this document) need to be

in place, aligned and mutually reinforcing. We will develop new work streams and accelerate

existing ones to achieve that position.

Where we can make improvements ourselves, we will do so urgently. Where we are in a position

to influence others, the needs identified by our members (as described in this document) will be

at the forefront of our agenda.

We have worked hard already to achieve progress, but we will now be able to pursue ourmembers interests with better articulated ends and means to guide us.

Executive Summary

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Building the Manifesto fromthe ground up

From Survive to Thrive is about the journey from where the independent community pharmacy

sector is now to where it needs to be. It constitutes the initial output of our Manifesto for

Independent Community Pharmacy initiative, which has the following purposes:

To improve the position of independents and thereby patients and communities.

To guide independents and those who have an interest in the success of the independent

sector; for those of us who represent independents, the Manifesto gives us an anchor

for our approach overall and for each individual decision we take.

To strengthen the elbow of those representing independents, because we will be able

to argue from a position of widespread acceptance about the way forward.

To improve accountability our members can hold us to account about the commitments

we make.

From Survive to Thrivedescribes:

Where we are now: Section One includes a description of the characteristics of

independents, and what is special about the offer to patients, public and the NHS.

It also summarises the current position on the ground, covering all aspects of the

environment and how these impact independents. This environment consists of a

supply chain, NHS policies and health service managers, professional regulation, the

attitudes of fellow healthcare professionals, public perceptions and many other

elements.

Where we want and need to be: Section Two describes where the sector needs to

get to in order to maximise its potential and to be sustainable.

How to get from here to there:Section Three.

This document provides a frame of reference for all activities to develop, represent and support

independents. It is both a guidebook (to us as representatives and our members), and a contract

with our members.

It will be followed by a series of action focused theme papers, a number of which will address

factors specific to Scotland, Wales, Northern Ireland and England.

What is From Survive to Thriveabout?

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Building the Manifesto from the ground up

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The NPA, AIMp and IPF launched a consultation on the Manifesto for Independent Community

Pharmacy in March 2013. The three month consultation involved engagement activities across

the UK, with 750 pharmacy owners taking part, representing over 2500 pharmacy contracts.

With this level of engagement, we are confident that From Survive to Thrive is a robust frame for

our public policy programme and our wider programme of support for independents.

We will continue to engage our members in the delivery of the Manifesto project as it proceeds

(see p22).


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Wherewe arenow

Section One

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What is an independent community pharmacy? Is a pharmacy an independent only if it has no

more than, say, six branches? If so, does it become a multiple when it grows to seven branches?

Or is the defining characteristic of an independent its ownership structure? Or its geographical

footprint? Or its flexibility as a business? Probably it is a combination of factors, and it seems to

us that the list above is insufficient, and is missing something crucial about relationships. Here

are some characteristics which have been suggested during the Manifesto consultation you will

notice above all the theme of connection- a bond between the owner, the business, the staff,

community and patients:

An independent serves the local community and is both a stabilising asset to the

community and an advocate for the community and its population.... a known face and

integral to that community.

Most independents are small businesses that have become embedded within the

community they serve.

Part of the community for a long time. Relationships strong and personal. We have a

stake and a standing in the community.

Long-term continuity benefits the independent in the eyes of the patient and helps to

build up relationships with both patients and GPs.

Community action, social capital, very high trust.

Passion, for our patients and the profession.

Local familiarity usually results in the pharmacy fine tuning its services to better suit

local needs.

Independents are special since they are often well established in a neighbourhood andthe pharmacist is known by the locals.

New services are likely to be offered in response to patient need, rather than to meet

targets.

An independent community pharmacy offers a bespoke healthcare service and goes

that extra mile to ensure the patient experience in that pharmacy is of an exemplary

standard.

An independent can respond quickly and flexibly to local demands and patient needs.

When asked during the consultation, what are your most important assets?

our members focused above all on people and the continuity of their connection:

My staff; the goodwill of my local community.

The long-term experience and local knowledge of staff.

Local knowledge, good links with other professionals. Continuity of named pharmacist.

Our pharmacist knowledge base, our highly skilled teams and our patient relationships.

Longstanding staff with the correct attitude. Includes pharmacists and dispensary and

counter staff.

Longer-term patient and professional relationships.

Excellent working relationships with long-serving staff. We work as a close team and

empower the staff to input into stock ranges and development of the business.

The relationships between myself, my staff, my patients, doctors and suppliers.

Our people... loyal and motivated staff.

What is special aboutindependent community pharmacy?

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The NPA operating environment survey has been run every other year since 2009. It asks

pharmacy owners what factors are most helping them and most hindering them to provide an

efficient and effective service. The graph below reports the domains that NPA Members feel

are contributing positively to their ability to operate and sustain a successful pharmacy business.

Human relationship factors are by some margin the strongest.

POSITIVITY INDEX (EXTRACT FROM NPA OPERATING ENVIRONMENT SURVEY MAY 2013)

In summary, independent community pharmacy is:

Essential to the health of the nation and a lifeline for many individual patients

Responsive to need sensitive to what patients want and capable of implementing

change swiftly.

Committed to patients who may well be known personally to the owner

Community focused - a community asset which adds to the social capital of

neighbourhoods.

Characterised by strong relationships, connecting the business owner to patients.

Independents have strong relationships between patients, public, staff and the

communities they serve; the pharmacy owner is him or herself meaningfully part

of these relationships.

All about people.

What is special aboutindependent community pharmacy?

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We are responsive and caring.

We offer a very personal service

and build personal relationships.

We are a constant where patients

feel comfortable because we have

invested time in them and they

trust us.


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There are approximately 7500 independent community pharmacies, including independent

multiples, in the UK. The long-term trend has been for national multiples to grow market share,

in terms of the number of branches and overall prescription volume. Regional independent

multiples too have grown as a proportion of the pharmacy market. In the most recent years, a

number of independents have entered the market through control of entry exemptions pertaining

in England until 2012.

It is important to acknowledge that the position of independents cannot be viewed solely in

relation to other pharmacy providers. Community pharmacies are now providing a wider range

of professional services than was common even five years ago. Evidence for this is that fact that

nine in ten pharmacies now have consultation areas. We are not confined to the business of

pharmacy, we are in the business of health, social care and public health. In this wider market,

independents have room to develop considerably.

We asked our members if they agreed with the statement, being pro independents does

not mean a default position of anti multiples - indeed there are many fundamentally shared

interests. There was general, albeit not unanimous, acceptance of this view. The majorityopinion is encapsulated in this comment from a member in England:

Both have common competitors and an interest in retaining the delivery pathway on the high

street....If you asked an independent and a multiple to write a wish list for pharmacy 95% of it

would be the same.

Yet there was also a widespread recognition that the characteristics, experiences and needs of

independents were significantly different from national multiples in some important respects.

This apparent paradox can be explained in the following way:

Environmental conditions may be shared the same contractual frameworks, same regulations

and professional ethics, same NHS managers, same health department budget, same norms in

society and so-on. Yet, the impact of those conditions is different on each pharmacy, varying

according to its characteristics. Meanwhile, the capacity of each pharmacy to respond to the

conditions will also vary. For example, excessive red tape affects pharmacies big and small. But in

the case of most independents, there is limited opportunity for shifting business and commercial

workload as well as regulatory tasks away from the frontline, perhaps delegating to an area

manager. In many cases, the pharmacy owner him/herself has to keep all the plates business,

regulation and practice - spinning.

Market Position

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Independent pharmacies are not all in the same position. Their situation varies according to their

geography, demography, business and service models, the stage of their development and many

other factors. Factors specific to England, Scotland, Wales or Northern Ireland will be

summarised in theme papers to be released soon. However, the Manifesto consultation has

revealed a significant degree of commonality.

Many independents are concerned about their current position and some are very pessimistic

about the immediate future. They feel

nancially challenged income streams are squeezed and cash ow is difcult to

manage.

time challenged increasing volume of prescriptions, new services, supply problems

and accumulation of red tape mean some independents are running faster to standstill.

the medicines supply chain is not functioning in the way that it should to allow them to

provide a reliable and efcient service to patients further increasing costs and time

pressures.

the health service commissioning environment is uncertain and changing.

red tape is weighing heavily on their shoulders and getting in the way of time to care.

isolated from each other and from others in the health service.

According to some industry analysts, the economics of community pharmacy are under such

pressure that the business model, especially for independent pharmacies, is at a tipping point.

ATKearneyi

points to five forces impacting profoundly on community pharmacy and which mayin combination be especially challenging for independents:

a squeeze on healthcare budgets.

intensifying competition (including supermarkets).

transformation of the supply chain.

the emergence of alternative supply channels such as internet & mail order.

changing consumer expectations.

Current Challenges

In relation to the final bullet point, it is worth reflecting on

the fact that the service delivery model in pharmacy is by and

large characterised by face-to-face interactions at the point of

supply. This puts community pharmacy in a prime position toimprove the publics health by making every contact count. We

need to respond to rapidly evolving consumer behaviours, but in

such a way as to maintain the face and place characteristics of

independent community pharmacy described at the beginning of

this section.

In each year of the NPA operating survey, including the latest,

spring 2013, the top three problems for independents were

found to relate to: a deficient medicines supply chain, squeezed

income streams, and a heavy burden of red tape which eats into

time to care.

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Current Challenges

CURRENT CHALLENGES (EXTRACT FROM NPA OPERATING ENVIRONMENT SURVEY 2013)

The graph shows the results of the NPAs operating environment survey in 2013. Members were

asked to grade the challenge each domain presented to their ability to operate and sustain a

successful pharmacy service. The maximum score of 6.0 indicates that this issue was having

a critical impact on all pharmacies. A score of over 2.0 is regarded as indicating a significant

problem across the profession. Problems with the medicine supply chain have consistently topped

the poll, generally followed by financial issues and regulatory/administrative burdens.

Asked, what is the biggest single threat to independent community pharmacy over the next five

years? our members told us:

More money being squeezed out of the system.

NHS focusing on cost instead of value.

Aggressive competition from larger companies with more levers than we have.

Burden of red tape overwhelming my capacity.

Getting overlooked by new commissioners who dont know enough about us.

Lack of time for reflection and new activities.

Apathy. Waiting for things to happen to us.

Yet independents have a number of strengths which give them resilience and a platform for

sustainability and maximising their potential.

The enthusiasm amongst many independents for the Healthy Living Pharmacy (HLP) initiative

demonstrates a determination to develop the whole pharmacy team and services and to invest

for the future. A majority of the 500+ HLP pharmacies are independents, which clearly indicates

innovation and flexibility in decision making. Whilst HLP began in England, its principles arenow being applied elsewhere in the UK and offering independents a framework for long-term

excellence and an opportunity to grow their business professionally and sustainably.

While the challenges are daunting, the opportunities are considerable and exciting,

as described in the next section.12

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5


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Wherewe wantto be

Section Two

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Here we describe where the independent sector wants and needs - to get to in order to maximise

its potential and to be sustainable for the medium and long term.

In a snapshot survey, online and at the NPA national conference May 2013, independents

were asked if they agree with the statement, Independent community pharmacy can thrive.

Challenge and change is inevitable; decline is not. Almost 90% agreed. Indeed, throughout

the Manifesto consultation, pharmacy owners expressed their determination to move forwards.

Their aspirations are described in this section.

Listed here are some the comments given to us during the Manifesto consultation from members,

in answer to the question,where do you want your business to be positioned five years from

now?

Professionally: A centre of excellence delivering the highest-quality, evidence-based

care for patients and the public. Financially: a robust business with an acceptable,

sustainable ROI model.

Service based.....but we must not fall into the trap of giving up the dispensing role.

Seen as a healthy living centre providing a range of clinical services supporting long-

term conditions management.

A vital cog at the very heart of NHS patient care, and recognised as that rather than

being viewed within government and health as a secondary entity to GPs.

Health screening, prevention and providing pharmaceutical input into management of

long-term conditions.Providing some private services and better integrated in patient management with

doctors and nurses.

Delivering high quality care in a seamless environment.

Still dispensing scripts, our core role, for our local population but also extending the

use of NMS and MURs to improve medicines adherence...

Integrated part of primary care..... IT connectivity and referrals to & from GPs and

secondary care.

At the heart of the community with respect from both patients and other healthcare

professionals and recognised as being an integral part of primary care.

Getting even closer to the patient, increasing patient adherence in all pathways, and

being the first port of call in minor ailments, and public health.

With a secure financial base to operate and invest from.

Learning. Being part of a learning culture.

Growing, with an enhanced service delivery model and engaged successfully with all

commissioners of health.

Local, wherever we are, but growing.

Where we want to be

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When asked, what is the single biggest opportunity for independent community pharmacy over

the next five years? the replies from pharmacy owners included:

The opportunity really opens [in public health] since experience with local authority

commissioners is that they seem to get community pharmacy.

The move of money into public health. This must allow pharmacy to be seen as the

source of healthcare, self-treatment, healthy living, health prevention and public health

services.

Seizing the medicines optimisation agenda; and Healthy Living Pharmacy.

Long-term conditions management. The population is continuing to age and needs to

be cared for in the community.

The pressures on the NHS and the GP system is an avenue where pharmacy can take

on more services.

Getting even closer to the patient, increasing patient adherence in all pathways, and

being the first port of call in minor ailments, and public health.

To create partnerships with other healthcare professionals and lever our medicines

expertise so we are recommended by others in the NHS.

Registration in Scotland. Nomination in England with patients, especially those with

long-term conditions.

The long-term relationships that independents have with patients means registration

can work for us and our patients.

Managing and monitoring patient repeats through CMS in Scotland and developing

communication methods to GP surgeries and secondary care on the back of this service.

Our consultation has confirmed that, despite all the current pressures on the public purse,

independent community pharmacists still see opportunities for improvement and growth within

the NHS and public health. Squeezed public finances may in some circumstances even be a

spur to public investment in those services which help individuals live independently in their

community thereby avoiding higher costs elsewhere in health and social care.

Where we want to be

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The input from pharmacy owners during our consultation was remarkably consistent across the

UK. We have formed the following aspiration statements to capture succinctly what we have

heard from our members in Scotland, Wales, Northern Ireland and England:

What does success look like?

Independents want to be spending more time with patients - and rather less time with

suppliers, regulators and paperwork.

Independents want to be investing in premises, staff and services.

Independents want to be fullling their potential as healthcare professionals.

For owners who are active practitioners, professional satisfaction is at least as important

as business success.

Independents want to integrate service and supply, delivering a range of professional

services which improve health and wellbeing. Independents can build on the strength

of their relationships, with patients and others locally, to offer a fuller package of care.

Independents want to be delivering high quality, compassionate care consistently.

Independents want to be at the heart of the NHS and public health systems as well as

providing services outside the NHS.

Independents want to be the rst port of call for health and wellbeing support in the

community.

Independents want to be in control of their own destiny to a much greater degree than

they are now. Currently suppliers, commissioners and prescribers are in a position to

change conditions drastically and suddenly. Independents want to maintain a strong presence in the pharmacy market as part of a

vibrant mix of contractors.

Where we want to be

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Gettingto wherewe want

to be

Section Three

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How we can get from here to there

The approach we advocate is consistent with the ideas laid out for the entire sector (including

national multiples) in the Pharmacy Voice Blueprint for Better Health (2011)ii. However, certain

aspects of what has to be done are especially relevant to the needs of independents.

What others must do

Here are some of the comments given during the Manifesto consultation, in answer to the

question, what could the NHS, regulators or others do to help you deliver even better patient

care?

The NHS should ensure a level playing field for reimbursement and remuneration.

Be consistent in their approach to all pharmacies no matter who owns them.

They should utilise the local knowledge independents have.

Reliable cash flow.

Reduce red tape....Remove the bureaucracy that meets the needs of regulators but fails

the needs of patients.

Vastly improve PMR systems with much greater clinical interfaces.

A contractual framework predicated on the right things and providing an adequate

return.

Allow access to patients current and past medical histories.

Stabilise supply and reverse the dominance monopoly/duopoly that has developed inthe supply chain.

Understand pharmacy better. Too many of the LHBs see pharmacy as just out to make

money. They dont understand that we operate in a very competitive environment

unlike GPs who have registered patients.

The regulators can make the practice of practicing less cumbersome without affecting

patient safety and respect for the profession.

Support service delivery in joined up manner.

Better supply chain arrangements to avoid constant sourcing of loss-making branded

products.

Trust us more!


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What we must do for ourselves

Many of the participants in the consultation made the point that in order to improve their

position they continuously challenge their own performance and behaviours. Even in the face of

immense pressures, independents must continue to innovate and strive to deliver and evidence

high quality care consistently. Independents should continuously assess the fitness for purpose

of their premises, processes, skill-mix, local engagement and strategy and act accordingly to

maintain an exemplary service. Those representing and supporting independent community

pharmacy must be absolutely committed to supporting this process.

Conditions for success

Summarising what we heard from members about what

conditions must be in place to help independents maximise their potential:

Capability

1 Independents need effective leadership at all levels in pharmacy within pharmacy

teams, across the NHS and amongst pharmacy representative bodies.

2 Independents need further development of the skills and role of the whole pharmacy

team. At the same time, the professional status and accessibility of the pharmacist must

be enhanced.

3 Independents need fit for purpose IT to support the delivery of services, including the

transfer of information to other healthcare professionals and for payment and audit

purposes. Community pharmacy must itself direct the development of IT to meet the

sectors needs, within the context of a changing NHS.

4 Independents need to embrace new technologies, including occupying more online

space, but in such a way that does not divert footfall and the delivery pathway away

from pharmacy in the community.

5 Independents need practical support and ready-to-wear solutions to enable them to

meet new patient and consumer expectations and compete with other providers in

pharmacy and the wider healthcare arena.

Culture

6 Independents need there to be within the sector a general acceptance that professional

excellence is a requisite for sustainable commercial success. Meanwhile, commercial

success permits investment to deliver excellent care.

7 Independents need the right culture of care in and around the sector compassionate,

patient-focused and just.iii

8 Independents need a learning culture to flourish in the sector. This has to includereform of sanctions for dispensing errors.

9 Independents need GPs and community pharmacists to regard each other as part of a

team, with eyes fixed in the needs of patients. The two professions and the patients

served by both need to have a shared expectation of what community pharmacy can

deliver.


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Commissioning, Contracts and Funding

10 Independents need contractual arrangements and NHS behaviours which reflect the

fact that financial risk cannot always be spread across a large estate. SEE BOX A.

11 Independents need a level playing field, with each other and with non-pharmacy

providers. Commissioners, the supply chain and healthcare providers should not

discriminate.

12 Independents need a funding and commissioning environment which is conducive to

investment. Funding needs to be more reliable and sustainable, as well as giving a fair

return for the services provided.

13 Independents need conditions which allow us to link supply and service to meet patient

needs. This has to involve fit for purpose national pharmacy contracts and improvements

to local commissioning.

14 Independents need to be integrated in NHS, public health and social care pathways.

15 Independents need everyones approach including policy makers, NHS leaders and

negotiators to reect a clearly and commonly understood purpose: to keep people

safe (safe supply and use of medicines), to keep people well (including self care), and

to help people make best use of medicines, especially to achieve effective management

of long term conditions and help people live independently in the community.

16 Independents need encouragement and practical mechanisms to work together in

pursuit of success. This might need to include collaborative platforms which allow

independents to match the scale and processes of emerging NHS and public health

commissioning units.

The medicines supply chain

17 Independents need an efficient supply chain and a relationship with the pharmaceutical

industry based on better mutual understanding. Independents have limited ability to

move stock around branches if supply is interrupted, but this is only one aspect of the

present difficulties. Independents feel they are bearing the brunt of the problems of a

seriously dysfunctional supply chain.

Red tape and time to care


20

18 Independents need confidence to invest and time tocare. Without this, independents cannot fulfil their

potential.

19 Independents need the regulatory frameworks

affecting pharmacy to be flexible enough to

accommodate varied approaches to delivering high

quality care. Variety and responsiveness to local need is

a characteristic of the independent sector.

20 Independents need practical support to fulfil

administrative tasks which are necessary i.e. clearly in

the patient interest and support to push back on

requests by the NHS and others which appear to add

no value.

We need to be in a position where all these conditions for success are aligned and mutually

reinforcing. In simple terms it may be said that: commissioners/funders need to be willing and

able to commission services that meet needs at the same time as pharmacy providers are willing

and able to provide those services, at the same time as patients are willing and able to access

them.


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Box A - Financial risk cannot always be spread across a large estate

Dispensing at a loss

Pharmacies receive a standard discount clawback on all items they dispense, regardless of the

level of discount available on individual products. In some cases, the clawback exceeds the

discount, and the pharmacy is required to dispense a medicine at a loss. Across the board, there

is an adjustment which means that pharmacies will make a slightly higher profit on other lines to

compensate for this loss. However pharmacy businesses operating across a small geographical

footprint and impacted significantly by localised prescribing patterns may not benefit from this

adjustment commensurately to their losses.

Changes to local prescribing policies

If local commissioners or practices change prescribing policies without adequate warning to local

pharmacies, pharmacies can be left with stock for which they will no longer receive prescriptions.

To avoid writing the stock off, independents must first track down a pharmacy that needs the

stock, and then comply with onerous regulations on the transfer of stock between different legal

entities. In either case they will suffer a financial loss.

Price rises linked to product shortages

Periodically, the supply of a generic product will not meet demand, and the price of this product

will rise. The NHS will often respond by agreeing a temporary concessionary price, but many

pharmacies will not be able to source the product at this price and will make a loss. Whilst the

system of averaging will ensure that the pharmacy network as a whole doesnt lose money,

individual independents who receive a lot of prescriptions for these particular items will not be

recompensed commensurately for their loss.

Branded generics

Manufacturers who produce branded generics market them at just below the drug tariff price.

Prescribers may be persuaded by manufacturers and sometimes local NHS managers that they

will save money on their drugs budget by prescribing these products instead of true generics.

Pharmacies cannot purchase the product with sufficient discount, so lose out on the retained

purchase profit. This is a problem for independents and multiples, but especially for small

businesses that cannot buy large quantities and drive the price down and cannot distribute stock

around a large estate.

Payment errors

Underpayments by the payment agencies can cause independents financial hardship by adversely

affecting their cash flow. Independents need to keep a close watch on their returns to ensure

they are being reimbursed correctly. Audits will pick up any trends and lead to an averagerecompense to be paid to everyone. Meanwhile, in theory, for most underpayments there will be

an overpayment, but this is less likely to equalise across a pharmacy business with only a small

number of contracts.


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Making it happen

It is our intention that the Manifesto for Independent Community Pharmacy initiative will live,

breathe and bear fruit for years to come. Using From Survive to Thrive as our frame of reference,

the NPA, AIMp and IPF will:

Take action to bring into being all the conditions for success listed on p19-20 of this

document. We have already worked hard on many of these issues, but we will now

be able to pursue our members interests with more clearly articulated ends in mind.

Establish task groups to develop the Manifesto work streams, which are:

Capability, Culture and Leadership

Medicines Supply Chain

Commissioning, Contracts and Funding

Red Tape and Time to Care

The groups will involve pharmacy owners and others who share an interest in a

successful independent community pharmacy sector. They will have a local reach, so

that input can be drawn continuously from the pharmacy frontline.

Work constructively with each other and others representing independent community

pharmacy. We will also work collaboratively across the sector wherever possible,recognising that being pro independents does not mean a default position of being

anti multiples - indeed there are many fundamentally shared interests.

Publish a Manifesto progress report after 12 months (by summer 2014) and annually.

Our members will be given an opportunity to scrutinise these reports and to hold us to

account publicly.


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If you want to get involved in the Manifesto task groups, please email: [email protected]


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Manifesto for Independent Community Pharmacy action papers coming soon:

Independent community pharmacy: Capability, Culture and Leadership

Independent community pharmacy and the Medicines Supply Chain

Independent community pharmacy: Commissioning, Contracts and Funding

Independent community pharmacy: Red Tape and Time to Care

Independent community pharmacy in Scotland: What does success looks like?

Independent community pharmacy in Wales: What does success looks like?

Independent community pharmacy in Northern Ireland: What does success looks like?

Independent community pharmacy in England: What does success looks like?

iThe Future of Community Pharmacy: Building A Sustainable Industry. ATKearney. 2012

iiCommunity Pharmacy: A Blueprint for Better Health, Pharmacy Voice (2011), and Community Pharmacy: Our

Prospectus for Better Health, Pharmacy Voice (2012). See www.pharmacyvoice.org.uk

iiiIndependent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust January 2005 - March 2009

[The Francis Report]. House of Commons, 2013


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manifesto from survive to thrive 2013

Documents