Big Interview: ‘The cuts have gone too deep’

The first thing I notice about Malcolm Harrison is that he has a black eye. But not one to pry, I refrain from asking him what happened – although, of course, I’m desperate to know.

Not long into the interview, Harrison says he suffered an unfortunate rugby injury that rapidly developed into an eye infection.

On the hunt to find an eye ointment, Harrison was ironically faced with an obstacle so many have been forced to confront in recent times – not one, but two of his local pharmacies were closed.

“I had to drive 12 miles to the next town to find an open pharmacy,” he says. And with that anecdote, Harrison so concisely sums up one of the many issues that plagues the pharmacy sector – closures.

Read more: Pharmacy First ‘enormously successful’, says CCA

“What we’ve seen over the last five years is a net reduction in the number of pharmacies, and that’s not unique to our members,” he says.

“But our members are choosing to close, and they’re closing because the financial model requires them to do so – that is, to be able to continue and have a future. If you only own one pharmacy, you can’t close part of it, whereas larger businesses do have the ability to do that, if they have to”, he explains.

Despite these closures, he stresses that there is still a future for large businesses in the pharmacy sector, describing them as the “bedrock of the network.”

“Sticky time”

Unsurprisingly, Harrison won’t “detail of specific company closures” but he notes that “a review of a portfolio is a healthy thing for any large organisation to do”.

When pushed on the rise in multiples closures in 2024 – taking Boots as an example – he says that “other businesses are being hit hard too, but just not in a public way”.

“When large organisations, like some of our members, take these decisions, it makes headlines, and that’s not the case for some smaller pharmacies,” he says, although he acknowledges that the “impact for them is just as big”.

“All pharmacy businesses are struggling, it just manifests and presents itself in different ways for different scales of businesses,” Harrison adds.

Read more: Lincolnshire Co-op set to join CCA

As chief executive of the Company Chemist’s Association (CCA), Harrison oversees the business of pharmacies from Boots and Superdrug to Asda and Tesco.

And, of course, LloydsPharmacy was a member of the CCA before it went into liquidation at the start of last year.

“Lloyd’s was a sticky time for the CCA, it was a bit of a shock,” Harrison says. “But it forced us to look at who we are and how we do things, and it’s led to some positive changes”.

“It’s never easy going through things like that, both for the people and for the sector, but I think we’ve come out of it stronger, and we’ve got a really robust plan going forward,” he adds.

“Stabilise the network”

The crux of the issue in the pharmacy industry is underfunding, and without additional funding, nothing is likely to change.

“An extra billion pounds a year would be lovely,” Harrison jokes when speaking about the current contract negotiations. “But do I think there’s an extra billion pounds sitting down the back of the government’s sofa – no.”

But if this government is “serious about addressing health inequalities, then something needs to be done,” he says.

“All of the nice things that the NHS and the government want pharmacy to do can only happen if there is a network that is funded correctly,” he adds.

Read more: CCA: 540 years needed to meet NHS pharmacy workforce targets

“Something needs to be done to stabilise the network,” he says, “and not just stopping the rot, there needs to be an injection of funding to enable businesses to be able to deliver”.

“The cuts have gone too deep. Businesses aren’t just struggling anymore, now they have a lack of trust and confidence in the government.

“I’d like to see something coming out of the current consultation that ensures there is some sort of index linked increase for pharmacies going forward, because the concept of agreeing flat funding for five years is unthinkable,” he says.

“Rotten” foundations

With the recent milestone of the Pharmacy First service’s one year anniversary, it seems like the perfect opportunity to pick Harrison’s brain on what its future could look like.

“We believe there’s potential to do more, but that can’t be done if the foundations are rotten,” he says.

One of the issues with Pharmacy First making those foundations wobble, apart from a lack of funding of course, is that some GPs are reluctant to engage with the service.

Last May, the CCA called for GPs to “refer more patients into Pharmacy First”, stressing that “there is an urgent need to ensure these referral routes work optimally”.

And Harrison said at the time that GP surgeries needed “targeted support” to encourage doctors to make more referrals to the service.

But when probed on the topic this week, Harrison seems to have somewhat changed his tune.

Read more: Proposals to reduce CCA power in CPE committee voted down

“Obviously, it would be a perfect world if general practice was confident to refer all eligible patients to Pharmacy First,” he says.

“But I do get that as soon as a patient is sat in front of a GP there’s absolutely no point in referring them on. They might as well deal with them there and then, because that’s what’s in the patient’s best interests.

“We need to be realistic too,” he says, speaking about the sometimes fractious level of cooperation between GPs and pharmacists. “Do we think we can change that significantly? I’m not sure that’s possible in the current climate.”

“What’s important is that we focus on what we can do, which is building on the great start we had with Pharmacy First and trusting that it will grow.”

Weight loss drugs

Of course it would be remiss not to question Harrison on weight loss drugs before the interview draws to a close – a topic that has dominated both the mainstream media and the pharmacy sector for over a year now.

“There’s a lot of interest in them and, let’s be honest, there’s a lot of money there too,” he says.

Earlier this month the General Pharmaceutical Council (GPhC) published updated guidance on how online pharmacies should prescribe weight loss drugs, which said all online pharmacies in Great Britain will “have to strengthen safeguards.”

It explained they “cannot” prescribe based on online questionnaires alone, and must “independently verify” patients’ weight and height before prescribing weight loss drugs.

Read more: New online pharmacy regs ‘effective immediately’ amid weight loss risks

So what does Harrison have to say about it?

Ever the diplomat, he stresses that the CCA “absolutely agree with the GPhC’s position that they want to support businesses to innovate and to prescribe medicines online in a safe and effective way”.

Does he believe the GPhC’s previous guidelines on online prescribing – updated in March 2022 - went far enough?

“We believe the guidance that was in place before, if applied properly, is sufficient to safeguard the supply of medicines,” he says.

“There is a danger with over-regulating this market,” he adds. “And if someone can’t get the medicine they want through legitimate means, then, unfortunately, they will go to unregistered sellers to get what they want”.

“Evolution of healthcare”

Wanting to press Harrison, I ask whether the CCA believes the updated guidance is unnecessary.

“I couldn’t possibly say. I think it’s a tough one,” he says. “What’s interesting here is we are observing the evolution of healthcare, there are novel medicines coming out that are able to do things that have never been done before, specific to weight loss”.

“There’s huge interest and huge demand in weight loss drugs, and it’s come at a time when the way in which people access medicine has changed. So how do you get ahead of the curve,” he asks.

“The reality is, things don’t always map out the way you think they will,” he says. “The evolution of regulation and guidance is not black and white, but we’ve got to accept that there are processes and systems in place that are designed to ensure we get the best outcomes from regulation”.

Read more: ‘Superior weight loss’ drug: Mounjaro squashing rival Wegovy

“All I can hope for is that legitimate, registered pharmacies are able to meet the needs of patients so that people can access medicine safely and efficiently,” he says.

And with that, Harrison gives us an insight into the complexities of the weight loss drug debate. No matter how their prescribing is policed, both now and in the future, people are always going to want them or have something to say about them. Are they controversial? Absolutely. But like it or not, they are here to stay.