Jay Badenhorst, director of pharmacy at the Pharmacists’ Defence Association (PDA), reflects on the HSC report in light of the recent French pharmacists’ strike action.

France, in the news this week with the announcement of a snap election, saw a one-day walkout by pharmacists at the end of May to highlight concerns about some issues that are all too familiar to us in the UK.

There are differences internationally in employment, industrial relations, contract law, culture and the purpose and structure of pharmacy organisations. For example, in France, all community pharmacies must be owned by a pharmacist, and each pharmacist can only own one pharmacy - but can invest in up to two more. This compares to the UK where ownership is flexible and can include individual pharmacists, partnerships of pharmacists, or corporate bodies.

While the French and UK pharmacy systems have their unique characteristics, the recent strikes in France and the concerns raised in the UK's Health and Social Care Committee (HSC)'s Third Report of Session 2023–24 (Pharmacy) do identify some common issues.

Pharmacists in France are deeply troubled by the persistent issue of drug shortages disrupting patient care and pose significant challenges for healthcare professionals relying on a consistent supply of medications.

In the UK, the HSC recognised that medicine shortages cannot be ignored and should not become the norm. It recommended that regulations be updated within three months to allow pharmacists in community settings to make suitable substitutions for out-of-stock medicines.

Over the past 10 years in France, approximately 2,000 pharmacies have closed nationwide, leaving around 20,000 still in operation. This trend is particularly severe in rural areas, but even towns and cities are grappling with economic hardships due to the disappearance of pharmacies.

Here, the HSC reports that NHS England data (February 2024) showed over 1,110 fewer pharmacies since 2015 and a net loss of almost 400 community pharmacies since the start of the 2023/24 financial year. Between 2015 and February 2024, 34.9% of closures occurred in the 20% most deprived neighbourhoods.

With every French pharmacy owned and managed by a pharmacist, with additional pharmacists often also employed, pharmacist-owners are advocating for better pay and improved working conditions for themselves and their teams.

In the UK, government will face the problems identified by the HSC regarding community pharmacy contract funding. The solution could involve a complete overhaul of the funding framework to close the gap experienced throughout the current framework and ensure enough funding for both dispensing and clinical services while allowing for demand flexibility. So, the abolishment of ‘flat funding’ models.

From our perspective, The PDA accepts some pharmacy businesses may be struggling, but also recognises that others could pay their pharmacists better. For example, two large pharmacy organisations recently reported surges in profits: one celebrated pre-tax profits of £2.3b announcing a £5.5m increase in their chief executive’s annual pay; another reported pre-tax profit rising by more than 42% to £237.6m but cutting the number of pharmacies, putting numerous pharmacists and team members’ jobs at risk. Often, very little, if any, of these profits permeate to pharmacists and staff members working in these and other similar organisations.

Plans in France to make it easier to sell over-the-counter medications online have raised the alarm. Pharmacists fear that this move could further endanger the existing pharmacy network.

Here, the MHRA found that online pharmacies pose ‘significant risks’ to the public, while survey results show that only 18% of the public used one recently. Further, as brick-and-mortar pharmacies decline, the number of Distance Selling Pharmacies (DSP) is increasing. Worryingly, the Competition and Markets Authority found that these two models are ‘substitutable’, which may further threaten the existing network of community pharmacies and allow for further expansion of DSPs.

Pharmacists play a crucial role in every nation’s healthcare system, ensuring the safe and effective use of medications. However, mounting workloads, inadequate pay, and stressful working conditions have affected their wellbeing. And it’s not just France – retail pharmacists in the US employed by CVS and Walgreens are taking action due to similar conditions. In Norway, pharmacists, part of the largest federation of unions in the state sector, went on strike on 27 May.

In the UK, pharmacy contractors have increasingly disputed the contractual and funding framework with the NHS. The National Pharmacy Association recently called a day of action by their members on 20 June to highlight the emergency across the community pharmacy sector. The NPA has proposed symbolic gestures, such as turning the lights off for a period, asking staff to wear black, blacking out windows, and other activities that do not affect core services.

The PDA agrees that the current framework and funding structure need an overhaul, but has raised practical concerns about the potential consequences of such actions on patients and pharmacists. In UK legal terms, contractors entering a dispute with their client (the NHS) is not a ‘strike’ or ‘industrial action’. Community pharmacy owners are contractors, not employees, and a ‘strike’ is an organised collective action by a group of workers, not by a group of businesses.

The right to strike is constitutional for French employees, whereas UK law makes it harder for employees to exercise it. Only trade unions can call strikes in both nations, but there are further requirements in the UK. For example, ballots must be held by postal voting. Read more from the PDA about why, how, and when UK strikes are called here. Notwithstanding, suppose there is a dispute with the NHS or any other employer, where the overall feeling is that industrial action would be supported to resolve that dispute, PDA members will also be balloted. Importantly, as the PDA is an organisation exclusively of pharmacists, only the pharmacists who are PDA members employed at that employer would make that decision.

This seemingly international crisis may also be a turning point for UK pharmacists, taking action to protect their rights and advocate for positive changes that benefit healthcare professionals and patients. Ultimately, the goal is to drive essential changes that safeguard patients, pharmacists, and the NHS. While the French and other pharmacists further abroad are already lining up at the picket lines, UK pharmacists are at a crossroads, continually balancing their commitment to patient care with the need for fair pay, treatment and recognition for themselves.