Sticking the boot in
pharmafile | April 18, 2016 | Feature | Sales and Marketing | Boots, Cost, Guardian, NHS, prescribing, scandal, unfair
A recent exposé has shone a light on the practices allegedly enforced at the nation’s largest pharmacy. So what exactly is going on at Boots? Here’s what you need to know:
Pharmacists as salespeople
The most striking claim to come from the exposé was the alleged misuse of medicine-use reviews, which are paid for by the NHS. According to the Royal Pharmaceutical Society, a medicines use review (MUR) is “an opportunity for you to discuss your medicines with a pharmacist, to understand how your medicines should be used and why they have been prescribed, as well as solving any problems you may have with them.” Sounds reasonable? Of course it does. And it’s free service for patients. The only catch? Each MUR costs the NHS £28. To limit potential abuse of the MUR system, the NHS set a limit of 400 MURs a year that pharmacies can offer. The problem with Boots is that, according to reports, 400 MURs aren’t simply a limit, they’re a target – and one that they expect all pharmacies to meet.
When you crunch the numbers, the benefits to Boots of doing this are clear. On this one NHS programme alone, if every Boots pharmacy achieved 400 MURs a year, it would be worth an annual £30 million to the company. One Boots pharmacists described to the Guardian that he and his colleagues had been told: “400 MURs is an expectation now. We don’t need to tell you that.” Pharmacists as sales people? It seems they are one and the same in a Boots pharmacy.
A 2008 email sent by a Boots area manager is also doing the rounds, which reinforces this stance. It says: “I personally don’t want colleagues to feel ‘brow-beaten’, but we do need to deliver our target of 400 MCUs (a synonym 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.” In their 2013/14 Annual Report, the company said that it was “providing customers with excellent value” and that “customer care is at the heart of everything Boots does.” If this is indeed the case, it may be at the taxpayers’ expense.
Staff are said to be under pressure to meet these MUR targets, and plenty more besides. Dispensing more medicines and meeting sales targets is paramount. Bill Scott, former chief pharmaceutical officer for Scotland, says: “There a huge number of very good pharmacists at Boots. But if my bonus is dependent on the business targets I’ve been set, you are taking away from me my ability to practice my profession for the patient. And that’s got to be wrong.”
Background on Boots
Found on virtually every high street across the UK, Boots employs over 60,000 people across Britain and Ireland. Its roots date back to the mid-19th century but its recent history is what matters most to the current scandal. In July 2006, wholesalers AllianceUniChem merged with the pharmacy chain to form Alliance Boots. This was followed, in 2007 with the worldwide economic downturn lurking just beyond the horizon, by the £11 billion buyout of Alliance Boots by private equity firm, Kohlberg Kravis Roberts and billionaire Stefano Pessina.
As the Guardian reported in 2012, in a few short years Pessina turn his £1.25 billion investment into a £2 billion profit. Boots was able to boast phenomenal results and remain immune to the economic slowdown felt in other industries which, in part, led to American drug retailing chain, Walgreens, purchasing the company in a deal that totalled £16.2 billion. With such astronomical figures involved, it seems that Boots could hold itself up as a real success story.
However, underlying this success, according to emerging reports, is a culture of fear among staff and a relentless prioritisation of profits over safety on a corporate level.
Patients at risk?
Amid job cuts and increased workloads, as well as the pressure on staff to meet workloads, then there is a fear that the public could suffer. The results of an up-to-now unpublished survey from members of the Pharmacists’ Defence Association shows that more than 60% of Boots pharmacists said that “commercial incentives or targets have compromised the health, safety and wellbeing of patients and the public, or the professional judgement of staff” was indeed the case half the time or more. Tired pharmacists are of course more liable to make mistakes, just like tired doctors or tired train drivers are. In a letter sent in from an anonymous worker to the Guardian, they said that “self-checking is expected and relied upon substantially and the common practice in most stores open on a Sunday is for a pharmacist to work without a dispenser.”
A lot is said of the medicines prescribing system in the US, with “price gouging” the phrase du jour and making national news in the country. Doctors, pharmacies and pharma companies are under severe scrutiny in the US to a degree they are not quite in the UK. With the nation’s biggest pharmacy driving profits to such a large extent, and said to be putting patients at risk in the process, questions need to be asked. The NHS must place such a large amount of faith in the dispensers of the medicines that it pays for, and with budgets of the public funded health system squeezed to an extent that they have never been before, news that money is being unnecessarily taken from the taxpayer will be startling to many.
For its part, Boots has rejected these claims, telling The Drum that: “The health and wellbeing of all our colleagues is, and always has been, a priority for the business. Offering the best care to patients is at the heart of everything we do and this includes offering pharmacy services that are relevant to the changing needs of patients and healthcare systems. Our pharmacists are empowered to use their professional clinical judgement to assess the appropriateness of a clinical service, and we make it clear to our colleagues that these services should not be undertaken inappropriately.”
Will this grow to become a bigger scandal, or will the PR machine of one the country’s biggest retailers churn on and bury the story to a mere footnote? What has come forth is certainly worthy of more investigation and the NHS certainly cannot afford its resources being wasted, no matter how small the amount. Britons trust Boots. If they have been abusing that faith, it’s a matter of public interest. In matter of such importance, it is tempting to think that this will not be the last we hear of this in the next weeks and months.
Sean Murray
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