Malcolm Harrison says the Company Chemists’ Association had to stand its ground even though it meant a public dispute with the Pharmacists’ Defence Association. The CCA’s chief executive talks to Neil Trainis…

Malcolm Harrison is regretful but not that regretful. “I think it doesn’t serve anybody to have internal fighting within the sector, I totally agree with that,” the Company Chemists’ Association chief executive says as he considers whether, with hindsight, his organisation should have engaged in a public spat with the Pharmacists’ Defence Association over why branches belonging to large multiples were closing.  

The CCA insisted closures were down to a workforce crisis. The PDA rubbished that, claiming some CCA members had embarked on "orchestrated” closures across the UK and alleged one member, Tesco, demanded locums accept lower rates for shifts they had already agreed with the company or have their bookings cancelled. (Tesco said it introduced “higher” fixed locum rates in July.)

This year, the PDA used its survey of more than 2,500 pharmacists to try and dismantle the CCA’s argument that a shortage of pharmacists was causing closures. PDA chairman Mark Koziol claimed “many pharmacists who work for CCA members” made it clear during the survey that “job dissatisfaction, substandard pay and in particular work environments” was forcing them to leave their roles and, in some cases, the profession.

“What many pharmacists seek is professional fulfilment, safer working environments, career development and more sociable working hours,” he said just after the study’s publication. Malcolm responded by insisting the survey’s results needed to be treated cautiously given it covered “less than five per cent of registered pharmacists.”

Around the same time, Koziol wrote to the government, NHS, chief pharmaceutical officers and pharmacy regulators demanding urgent action to prevent what he described as “unnecessary pharmacy closures” which were being announced as much as four weeks in advance. Accusing some large companies of trying to reduce pre-agreed locum rates, Koziol alleged closures were “caused by commercial considerations.” The CCA labelled the PDA’s claims “insulting.”

It is sobering to think that as the mud-slinging went on, the government and NHS England may have been watching on and thinking it was all playing into their hands.

“I’d like to think there are no instances where the CCA picks a fight with anybody,” Malcolm says calmly but as audibly as possible at a table in a coffee shop just off Regent Street as baristas bark out orders and punters natter.

“Most of the time we have a dignified silence when people are throwing muck about and there’s an awful lot going on. There are times though when things go a little bit too far and whilst we responded in public, the first thing I did was pick up the phone and arrange to talk to the individual to make sure we were very clear on where we were and where we weren’t.

“I don’t believe in having these spats in public but sometimes, things are said in public that either need to be retracted and if they’re not going to be retracted, they need to be clarified otherwise people are left unfortunately to assume.”

The individual in question was Koziol who has been in no mood to retract anything but certainly keen to clarify his views. Yet despite conceding it may not have been a good idea to air grievances in public, Malcolm says the CCA could not stay silent while its members were severely criticised. His organisation simply had to respond.

“I think it needed to be done. And as I said, I’ve also spoken to Mark and others at the PDA and we have an agreement on where we need to go and how we need to behave in future,” he says.

Why no legal action from CCA members?

The PDA has not been the only staunch critic of large chains. Tohidul Islam, who founded The Pharmacist Cooperative, has regularly used social media to jump on the multiples for refusing to “admit there is no pharmacist shortage” and alleged failure to pay locums higher rates. He has gone on record as saying pharmacies that close temporarily should be fined and repeat offenders should have their contract taken away. 

A thought springs to mind; why have we not seen any CCA member launch legal action in response to the allegations? Wouldn’t defamation proceedings at least demonstrate a strength of conviction in their position?

“I can’t comment on the legal activities of individual members. At the CCA, we represent their interests as a whole and we don’t comment on the individual actions of specific members,” Malcolm says.

“I’m aware of lots of reports out there and quite often, we need to be very careful about what is reported about the actions of individual branches and what are company policy decisions and relation between the two. I imagine all of our member companies take their brands very seriously and things which are alleged would be considered.

“What action they take I don’t know. I couldn’t tell you what the interaction between our members and the PDA is.”

Malcolm is asked if legal action has ever been mentioned by any company, for instance during CCA meetings.

“I think they find (the allegations) very hurtful and that was reflected in our response about the fact they were quite insulting too. What the PDA are very quick to point out is when things fall down. Ok, fair enough, I’m sure there’s fact in what they say, that pharmacies are being closed temporarily.

“But what they don’t talk about and what isn’t widely reported is the huge amount of effort that is put into keeping pharmacies open. ‘Pharmacies stay open’ doesn’t sell headlines. ‘Pharmacy closes’ does.

“Unfortunately, for every 100 situations, if 98 of them are resolved and they manage to open on time, unfortunately the one or two they don’t get are the ones that get reported on. For the PDA to sit there and say that we’re orchestrating, creating a problem, is disingenuous. They know that’s not the case.”

Closures are not exclusively a CCA problem 

Malcolm insists closures are not solely a CCA problem but one that impacts pharmacies in all sectors. He cites an All-Party Pharmacy Group inquiry into workforce challenges in February when independent contractor Anil Sharma talked “very emotionally” about the difficulties he had staying open. Koziol was also at that inquiry.

“(Sharma spoke about) how he was having to open a pharmacy in the morning, close it at lunch time, drive five miles to his next pharmacy and open that one up. So, it’s not a CCA issue. It’s across the board. When we’re struggling to find pharmacists, it’s because there is a shortage of pharmacists out there.”

The PDA’s claims of orchestrated closures still rankles. Malcolm insists that when a branch belonging to one of his members closes (he indicates these are isolated incidents), their business as well as patients suffer, so in his eyes, orchestrated closures does not make any sense.

“I don’t think there’s an orchestrated plan to close pharmacies routinely or anything. Don’t forget, closing a pharmacy means the business cannot trade and more importantly, it means patients go without medicine. That is totally against everything that our members are trying to do.

“I’m aware that sometimes our members will actively, as Anil did, trade off having to close two pharmacies on a part-time basis rather than leaving one completely closed and one community completely unserved, and so they’re risking getting breach notices in two locations rather than one location because they don’t want to leave communities underserved.

“These are situations that are happening and being driven by shortages in the labour workforce. They are isolated in so much that for every one that closes, there are dozens and dozens that stay open due to the hard work of our member companies and the people who work for them.”

Malcolm says he cannot put his finger on why the PDA has been making their claims although he suggests they “will have their own agendas.”

“If I put myself in the shoes of somebody running a union, one of my prime objectives is to drive membership of the union and to drive membership of the union is to try and sell the strength of the labour force united as a union versus the employer, and so anything one can do to discredit the employer, I’m sure he sees as a legitimate opportunity to try and drive his own membership.

“That’s just me surmising. I don’t know. All I know is that this particular issue, we disagree strongly on what they’re doing and I’m very, very confident that there is no conspiracy to close pharmacies amongst our members or any pharmacies.”

Far from seeking to discredit anyone, the PDA have said they are addressing very real issues. Workforce is an emotive and multi-faceted subject. Koziol also claimed some CCA members were “seeking to misdirect healthcare systems into believing this ‘national shortages’ façade can be used as a legitimate pretext to make a change to pharmacy regulations” demanding a pharmacist must be in the pharmacy for it to operate safely. Malcolm flatly rejects that.

“We recognise that currently, you need a pharmacist in a pharmacy to operate it and that’s what we’re struggling to do at the moment. We’re working as hard as we can to ensure there are pharmacists on the premises so we can trade,” he insists. He suggests Koziol “wants to try and conflate different issues.”

“I have spoken to Mark about that and it’s not something I can talk about on the record because there are other issues we are trying to work through,” Malcolm continues. 

“When it comes to supervision, I know that we, the CCA, the NPA, AIMp, RPS and various others, including the PDA, are trying to work through what could professional practise look like in future and what regulatory and legislative framework do we need in order to be able to ensure that?”

Malcolm is adamant there is “no drive” among CCA members to employ pharmacy technicians instead of pharmacists even though they might demand lower salaries. However, he says there are roles pharmacists fulfil that pharmacy technicians are “perfectly capable of safely doing.”

But he is clear. “There’s no plan to replace one with the other, it’s about how we empower one to do stuff so the other can do more stuff.”

Independents are growing market share of items - multiples are not

Workforce, of course, is intrinsically attached to funding and community pharmacy has had little joy in that area in recent years. All pharmacy sectors have felt the impact of frozen central funding and increasing overheads. Walgreens Boots Alliance reportedly announced in January that it had closed nearly 200 “loss-making” Boots branches. Malcolm is asked if the public can expect more branches belonging to CCA members to close in the coming weeks and months. 

“It’s a matter of record that CCA members have divested of pharmacies at a greater rate than non-CCA members. That’s been reported on over the years in terms of the high street, whether Boots have closed, whether Lloyds have closed, whether Rowlands have closed, a lot of them have closed pharmacies and that’s the nature of business. You look at your portfolio and make sure it’s doing the right thing and so on.

“I don’t think there’s an active programme of closures that I’m aware of but all of them will look at their portfolios and make changes as any business would. But whilst a lot has been spoken about how difficult it is for independents, it is just as difficult for a multiple as well, if not more so.”

He suggests matter-of-factly that independents “are growing market share of items whereas multiples are not” and when it comes to the profitability of most of his members, “none of it is particularly rosy.”

“If you look at (an Ernst & Young report) that was conducted recently, two-thirds of multiples are running at a loss and I don’t think that’s changed. So it is very, very difficult,” he says.

“Obviously, they are restricted in what they can say because some of them are listed companies and you can’t just be blurting out about their company performance because that will affect share price and investors and we’ve all seen recently what happens when somebody in power says something they shouldn’t say … Mr Chancellor… and what the markets do.

“Unfortunately, you don’t hear often from CCA members because they are restricted in what they can say due to the nature and shape of the business. It doesn’t mean they are not feeling the pain.”

Twelve years of Conservative rule has inspired no confidence that the party values community pharmacy. Perhaps the only way it will ever get fresh funding is if Labour get into power.

“I don’t think I can make a political comment on that. I think whichever government is in, they need to wake up and see the value that is sitting there,” Malcolm says.

“When the NHS is facing huge backlogs and patients aren’t able to see their GP and they’re sitting in ambulances, not even the luxury of a trolley in a corridor in a hospital, there are serious issues. I would encourage this government and any future government to take a long, hard look at what they are doing.”

Reversing the cuts wouldn't be enough

When he was shadow health secretary, Jonathan Ashworth promised Labour would reverse pharmacy’s funding cuts if they got into power. Malcolm looks unimpressed.

“That wouldn’t be enough would it. If you look at where we were in 2016 when they made the cuts to where we are now, just reversing it wouldn’t be enough. I read that in real terms, the £2.592 billion is only worth £1.7 billion now.

“We’re just shy of a billion pounds short. It’s not even going to touch the sides. There needs to be a wholesale review of what it costs to supply the nation with medicines. Salaries have gone up, pension contributions have gone up, national insurance contributions have gone up, there are so many costs, business rates, fuel.

“It’s wrong to think we can just turn back time to 2016 and everything will be ok. It won’t.”