The Big Debate

Join the debate today - we'd love to know your thoughts.

The Big Debate #9: Do online outlets pose a threat to community pharmacy’s reputation?

Started 11 days ago

Welcome to C+D's ninth Big Debate. 

Tonight’s discussion will focus on the question: “Do online outlets pose a threat to community pharmacy’s reputation?”

Some online pharmacy businesses are flourishing, with the pandemic further priming the field for distance-selling outlets.

However, the General Pharmaceutical Council last month revealed it had  187 open fitness-to-practise cases linked to 83 online pharmacies and, last year, it said it was considering “differentiated fees options to cover the increased regulation needed for online pharmacies”.

So, should community pharmacies embrace the digital model and can these different models coexist? What safety improvements should online pharmacies implement? 

Could community pharmacies learn something from online outlets?

We’ve got three speakers lined up to share their views tonight, but you can also let us know your thoughts by commenting and asking questions. The “live” part of the debate will close at 8pm, but feel free to continue to exchange views for as long as you like.

C+D has introduced a streamlined functionality that allows users to mention each other in a comment. Simply use ‘@’ and type in the person’s name.

This debate will start at 7pm.

Good evening all! Thanks for tuning into C+D’s ninth big debate. Tonight’s topic is: “Do online outlets pose a threat to community pharmacy’s reputation?”

Yes you are @Ian Strachan ! Lovely to have you.

We’ve got three speakers lined up tonight. Just a head’s up, you might need to refresh the page to see new contributions to the discussion.

I am here too

Hi @Ian Strachan! Yes you are, thanks for joining us

Thanks for joining us @Stuart Gale !

Your very welcome . 

Kicking the discussion off is @Ian Strachan , pharmacist and owner of Strachans Chemists in the north west of England. Over to you, Ian!

I can't seem to connect 

Looks like you're with us @Shailen Karia ! I suggest refreshing the page to make sure you're seeing the latest additions to the conversation

Here's what @Ian Strachan has to say on online pharmacies: 

 Distance-selling pharmacies (DSPs) are not only a risk to bricks and mortar, but they also undermine the very vision for integrated care and place-based healthcare that has been central to the new health bill.

Integrated Care Systems (ICSs) evolved from many of the aspirations of the long-term plan. Namely, bringing providers closer to patients to improve outcomes. Secondly, to maximise efficiencies and productivity within the NHS. Nothing exemplifies these values better than the trusted convenience and accessibility of community pharmacies. So why is the government ignoring the real dangers that DSPs bring to bricks and mortars, whose cost base is largely fixed and disproportionately higher than internet operations? 

The answer for me was apparent in the statement by the former CEO of NHSE, Simon Steven, who described the sector as grossly inefficient and in need of a shakeup. This statement depicts the real intent to streamline dispensing through large scale robotics with fewer providers ignoring the capability, the resilience and very attributes the government claim it’s looking for in making delivery of care more accessible and convenient to patients’ homes. 

The existing funding model cannot support the continued sharing of funding within the Community Pharmacy Contractual Framework. Bricks-and-mortar pharmacies require the headroom to not only invest and prepare but deliver to anything like the quality which will be required to meet the capacity challenges within primary care.

My guess is additional funding of £400 million each year is needed. Without that investment, I see the entire vision for pharmacy being compromised. Build those aspirations across the network and not at the expense of failing the stated ambitions for community pharmacy. 


Apologies is there a live stream or just the debate

It's a text based debate @Shailen Karia 

Many thanks, @Ian Strachan . Interesting points about which directions pharmacy needs to advance in so that patient care can be improved, and the need for further investment.

It would be great if you could expand on what you think the “real dangers” DSPs pose to bricks and mortar pharmacies are. Do you think bricks-and mortar pharmacies can learn anything from the online pharmacy model, especially if the sector is in need of a shakeup?

I believe both online and traditional walk-in pharmacies have different roles to play and can co-exist side-by-side, but rogue operators of both types of pharmacies are a threat to our reputation and so regulators must continue to improve standards for patients.     Some online pharmacies are becoming more visible with their proactive advertising, but remain fewer in number so should be straightforward for the GPHC and CQC to monitor and act where appropriate. It is my view that certain categories of medicines with potential for abuse such as sleeping pills and painkillers, aren’t appropriate for an online setting and I’d like to see these stopped.    As a fast-growing sector of pharmacy, online is not going to go away. It should be embraced - while encouraging the regulators to work closely with experienced providers to understand the process and issues involved so UK pharmacy retains the highest standards, while continually improving accessibility for patients.

Firstly it isn't the legitimacy of online that we are questioning. They are valid businesses and have a right to trade.For me the question is really wether the CPCF can support this mixed bag of business models. My argument would be it can't . The bricks and mortar model is under funded and this only lowers the headroom to deliver even more. Remember there is a FIXED COST to operating a bricks and mortar as opposed to pure online which has not really been thought through. 

I see what you mean @Ian Strachan ! And thanks for your contribution @Stuart Gale 

For reference, Stuart Gale is Chief Pharmacist, owner and manager of Oxford Online Pharmacy (part of the Frost Pharmacy Group which includes local community pharmacies).

@Ian Strachan you seem to be suggesting that DSPs do not have the effect of “bringing providers closer to patients”.  I think our next speaker has a different opinion!

Over to you @Giulia Guerrini about whether you think online outlets pose a threat to the reputation of community pharmacy.

Should local pharmacies rely on NHS funding to exist? If funding is fixed then should it not consider innovating by offering private services like dentists ie travel vaccinations etc.

@Ian Strachan Hi, Giulia Guerrini here, Superintendent Pharmacist of medino (online pharmacy). I would have to argue against online pharmacies 'undermining the vision for integrated care' and bricks and mortar providing convenience. We maintain a quality of service that is focused on safety online and offering a 360 degrees approach to healthcare: we do not just push medicines that are not necessary or suitable for our patients, and we follow up with strict internal SOPs and approval of this medication, alongside information tailored to the patients needs including researched articles to help patients. We also offer a lot more convenience than bricks and mortar pharmacies can offer. For example, through covid-19, we were able to continue delivering medicines and products that elderly, disabled or fragile patients could not get at their local pharmacies or were not able to go to local pharmacies for. We continue to do this and for some, this is a lifesaver. 

Online pharmacies also have fixed costs. We have a warehouse to cover, we have staff that pick, pack and dispense as well as pharmaceutical staff who must ensure safety standards are high and dispense medication. During pharmacy hours, we have all the same kind of staff that bricks and mortar pharmacies would have and we abide by strict NHS rules and regulations.

I would very much agree with @Stuart Gale . Online pharmacies are not going to stop trading and it would be really beneficial for us to work together to provide the best healthcare we can to all the patients that require it.

Also, I do not feel as though we are a threat to bricks and mortar pharmacies. Obviously all commerce is going to go towards eCommerce, it's the case for all sectors, but it's all about offering choice. Patients should have choice to either be able to buy online if they do not have the time to go to local pharmacies or cannot go for other reasons – this shouldn't impact their health. Local pharmacies do need to embrace the fact that many are moving to an online first mindset.

We do have very, very strict safety rules at medino. We regulate OTC  medicine purchases and refund/deny the sale of 50% of medication requests as we do not prioritise business profitability over patient safety. The checks we have in place to ensure this are much stricter and safer than you might find in a community pharmacy (I know, I have worked in them!).

Some excellent points @Giulia . Thanks for outlining the safety measures you implement as an online pharmacy

@Giulia you make a good point about pharmacies providing accessible care to patients who don’t want to leave the comfort of their home, I know this must have contributed significantly to the growth of online pharmacy business at the start of the pandemic. 

I wonder if you could and other speakers could say how you think online pharmacies might fare as we further emerge from the pandemic?

@Richard Dale makes an interesting point on pharmacies offering services. Do you think offering medicines online could free up in-branch pharmacists to take on more of these private services?

@Giulia - I agree the standards we operate to in an online setting are far more onerous than in a community pharmacy. I think there is no way online will go away in any market now so we have to embrace it. We have been encouraging the GPHC for years to regulate the online pharmacies that do actually pose a threat to our reputation by supplying sleeping tablets and high strength codeine. These are the ones causing the headlines and they should never be allowed to operate like they do in my opinion. 

So many of  the challenges facing a depleted overstretched NHS will require an accessible network of community pharmacies improving patient outcomes, innovative delivery models whilst making access more convenient. Bricks and mortar lacks the resource to deliver on that vision right now   to meet the aspirations laid out in the long term plan. That is why the question of DSP and its place in the existing funding umbrella  is so critical. 

And @Stuart Gale you made some excellent points about the GPHC and CQC’s role in monitoring online pharmacies.

What sort of standards would you like to see the GPhC develop? And why do you think medicines with potential for abuse should no longer be dispensed by online pharmacies?

The online channel saw a major boost in the pandemic but then so did most community pharmacies. I think it sped up the maturing of the online sector with many more new patients turning to it for the first time and they liked it. We have seen them returning to us because they enjoyed the service and convenience. 

I would like to see the GPHC engage with online providers and understand what good looks like. They have been playing catch up trying regulate the poor performers. I wish they would adopt the same approach as the CQC. They were very late to regulate online. 

@Eliza Loukou For us personally, I can say that we have only grown since then as I believe it enabled patients to see online pharmacies as a more legitimate business model. If you look at fashion and other sectors, they have a very high eCommerce presence compared to the high street. As with all sectors, it's happening with pharmacies too. Just as some people may want to go to shops and buy clothes, and some may prefer to fit in shopping around their schedule by shopping online, the same is true of online pharmacies. I believe in this same way, both can co-exist and consumers will enjoy having the choice. As many pharmacies became online and switched to an online model, we have got the attention of the GPHC and other regulatory bodies and we work closely to make sure the process is safe for everyone, and we don't see this as a negative – it's a positive. It's helping customers to change their point of view.

We offer really fast delivery, including next day delivery. For a lot of people, they just can't get to a pharmacy and put off getting their medication or everyday essentials for ages as they don't have the time. Pandemic or not, that need isn't going away so I believe we will continue to grow now that there is more knowledge around online pharmacies.

@Beth Kennedy I definitely could agree with this. There are obviously some services that we cannot partake in as we are not face to face with patients – for example, the vaccine services, though we do promote them as part of the NHS. So in this way, it would be very beneficial for us to take on the areas that we have streamlined, such as dispensing medication, and leave those services that people cannot get online to local pharmacies. 

@Stuart Gale I think you're right to point out the GPhC might be slightly overwhelmed with the sudden need to regulated online pharmacies. Although they do seem to have an idea of "what good looks like", as the GPhC did share examples of notable practice related to online pharmacies at the Clinical Pharmacy Congress

@Stuart Gale I completely agree, but in my opinion the solution is not to not sell them – it would be a simplistic way to avoid the problem, as people will still get them. Certain medications, including OTC sleeping tabs and codeine products, cannot be sold online as they are sold in a pharmacy. We need strict standard operating procedures and identity checks if products such as these are sold, which we do implement. As I say, we honestly do refund most of these requests that come through (our Phenergan refund percentage is 68%, for example), and believe me, this is something we spend a lot of time on improving the processes for and we would also like to have more guidelines and support from the GPHC on this. 

To be honest, someone could go into multiple local pharmacies and purchase these products over and over again. It's not solely an online pharmacy problem, a lot of those headlines are clickbait (but obviously not all).

@Eliza Loukou well that does sound good however I don't think they are getting it right yet. 

I think it’s about positioning. Understanding the strengths and weaknesses of both types of pharmacy. Each playing to their strengths whilst minimising their weaknesses so both can work alongside and complement each other. Eg community pharmacy have face to face relationships with their patients that online can’t compete with. How can they maximise that relationship profitably?

I like you question @Richard Dale . Can the rest of the speakers respond to how online pharmacies maximise relationships with patients profitably?

I would agree with you Stuart on that but I do I think the access and convenience of traditional pharmacies without appointment  has always been our strength. The reassurance support advice which accompanies that role but especially that  behavioural support has been hugely beneficial for patients and the well. Eg smoking cessation, hypertension etc. 

@Ian Strachan absolutely - there are great things community pharmacy can do. We just need to be paid properly for them!

If our patients want to talk to someone, they absolutely can. But if they just want to make a fast purchase, we have that streamlined service for them too.

We ask patients to fill in thorough but quick questionnaires that contain open questions where the patient has room to ask us anything they wish to. These are reviewed by pharmacists and we often call them if we need clarification or have to deny the sale. In this way, they can fill out the questionnaire easily at home in their own time, and we can process their order quickly but safely. Whether the medication is approved or not, we do also provide information to them that can help. We explain the reasoning behind our decision and provide alternatives where possible, and we offer health and wellbeing advice through phone calls, articles on the site and emails. We may not have face-to-face time but we do have personal interaction time and care that is accessible for patients in their own time. This saves patients from unnecessary waiting time and wasted time out of their day. They also usually have the information over email or in a written form, which means they also can refer back to it again and again.

I also really agree that community pharmacies are great for being able to offer information without an appointment, and we do the same thing – that's something I think we all work together well on and is a strength for all forms of pharmacy! @Ian Strachan @Stuart Gale 

Thanks for all your contributions speakers! The "live" part of the debate is drawing to a close but you are welcome to carry on discussing as long as you like

One last question from me: What can community pharmacies learn from online outlets?

I've really enjoyed the discussion here .  Thank you C&D 

I think in general, local pharmacies can not get to our level of digitalisation but they can focus on where they can thrive. We can never replace the face to face interactions that local pharmacies offer, and that's a great thing, so we believe that's where they should maximise their focus. We really can co-exist together – we have different strengths and should utilise them. 

Great discussion – I look forward to the next one! Thank you C+D.