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Talking Politics
583
Talking Politics THE DISAPPEARING SHOP
Cwmfelinfach in Monmouthshire used to be a place some substance: it was the home of Nine Mile Colliery, which staged a historic miners’ sit-in in 1931. Now the colliery is closed, and the reclaimers have moved in, with some success, to beautify the place. The population is dwindling. It is the old who remain, and notably the old miners, with their traditional legacy of the special diseases of the mining industry. Not long ago the chemist’s shop in Cwmfelinfach abandoned its long and unequal struggle with rising costs and cut-price competition and closed its doors. It was the second in the area to go in three years, and there are others for which the prognosis is not hopeful: they will not survive their present proprietors and will be lucky if they even last that long. Such shops traditionally cover themselves by selling shampoos, baby foods, cameras, and the rest, and the supermarkets down the road can always do that more cheaply. So for the people of Cwmfelinfach the completed prescription now lies a bus-ride away: a bus-ride which many find costly and inconvenient, and which some cannot manage at all. Neil Kinnock, Labour M.P. for the constituency, fears there will soon effectively be a two-tier system in his constituency: people in towns like Blackwood will get the proper N.H.S. service, while people in the declining pit villages are thrown back more and more on patent medicines. The problem is not confined to places like Cwmfelinfach. It is a chronic affliction of some big new housing estates: on the Penrhys, the great new estate on a hill above the Rhondda Valley, the local curate has of
organised a voluntary prescription delivery service for the old, the young mothers, and others who cannot get down into the valley towns: the estate has failed to attract a pharmacy of its own. Mr Kinnock has had appeals for help from people in rural areas where doctors do not dispense themselves, asking what can be done for them. There are parts of London too where high rents and rates and the pressures of competition have swept the High Street pharmacist away, leaving the old to make journeys into unfamiliar, even
frightening, territory.
Nor is there much hope of health centres to solve the problems of many of these places:. even if the money were there to build all the centres which have been applied for, it is unlikely that they would be justified in some of the remoter areas with falling populations. Mr Kinnock thinks the answer is to introduce mobile pharmacies, staffed by, say, two pharmacists with assistants, controlled by local authorities but paid for centrally; and he has written to Mrs Castle recommending their introduction. The Pharmaceutical Society, which looks after the professional interests of pharmacists, charts their dwindling numbers each year in its journa1.1 Nearly 3000 pharmacies have gone in the past ten years: last year there was a gross casualty-rate of 455 in Great Britain: some shut down only to reopen across the road, and closures were offset by new openings, but 1.
Pharmaceutical Journal, June 8, 1974, p. 525.
that still left a net loss of 251. And openings tend not to happen in places like Cwmfelinfach. True, many of these losses reflect the fact there have in the past been too many chemists’ shops; true, a multiplicity of shops is not a very economic way of running the service.But that is not much comfort for the old and ailing of Cwmfelinfach. The Society is not disposed to condemn the idea of a mobile chemist’s shop out of hand, but it sees some big practical snags. For one thing, you’d have to law rewrite the to legalise it, since probably the law clearly states that chemists are expected to operate from a fixed base. Even then, it would have to comply with the requirements of the Medicines Act of 1968 which tightened up standards for pharmacists’ premises, and there is some doubt as to whether these standards could be achieved on wheels. There is also, bizarre though it sounds, the risk of hijack: as the mobile pharmacy, piled high with its cargo of pills, sped through the quiet lanes, wouldn’t there be those who, for reasons of commercial gain or personal avidity, would plot to hold it up and rob it ? The practical answer, as the pharmacists see it, is that if the service is to survive it will have to pay better. For years now, they have been warning that if the public uses the chemist’s shop simply for prescriptions, while going elsewhere for all the other goods the chemist sells, then the chemist will go out of business. So if the public mourns the loss of the chemist’s shop, it has (they say) its own shopping habits to blame. The other culprit (as usual) is the Government. The profession has put in a 30% pay claim, costing about E22 million a year, which would raise the professional fee on the prescription from 17 to 24.4p, lifting the notional salary implicit in the hopelessly involved formula used for calculating the chemist’s reimbursement to E4500 a year. Chemists would rather see Mrs Castle spend the money that way than by putting pharmacists on wheels. The Government could also consider special grants and subsidies to help chemists set up and survive in areas where there cannot be any great hope of doing so on ordinary commercial considerations. It was this which led a Labour study-group to recommend nationalisation of dispensing as the only route to get a properly distributed network of centres throughout the country, but there is little chance of a Labour Government taking on that kind of commitment at present. For the moment though, places like Cwmfelinfach are more likely to be served by self-help arrangements already in use in some communities: there are places where you take your prescription to the post-office or police-station, and collect your pills and potions from the same centre later in the day. It would be possible, too, to extend the use of part-time dispensing, which is sanctioned already in some places, so that the pharmacist spends part of each day in each of a string of villages, on the model of the rural doctor or the rural priest. And since the places which lose their pharmacists are likely to be those which lose sub-postoffices too, there must be a case for looking at those problems together and coming up with a joint solution. DAVID McKiE. 2.
Lancet, 1974, i, 160; ibid. p. 465; ibid. p. 743.
Talking Politics THE DISAPPEARING SHOP
Cwmfelinfach in Monmouthshire used to be a place some substance: it was the home of Nine Mile Colliery, which staged a historic miners’ sit-in in 1931. Now the colliery is closed, and the reclaimers have moved in, with some success, to beautify the place. The population is dwindling. It is the old who remain, and notably the old miners, with their traditional legacy of the special diseases of the mining industry. Not long ago the chemist’s shop in Cwmfelinfach abandoned its long and unequal struggle with rising costs and cut-price competition and closed its doors. It was the second in the area to go in three years, and there are others for which the prognosis is not hopeful: they will not survive their present proprietors and will be lucky if they even last that long. Such shops traditionally cover themselves by selling shampoos, baby foods, cameras, and the rest, and the supermarkets down the road can always do that more cheaply. So for the people of Cwmfelinfach the completed prescription now lies a bus-ride away: a bus-ride which many find costly and inconvenient, and which some cannot manage at all. Neil Kinnock, Labour M.P. for the constituency, fears there will soon effectively be a two-tier system in his constituency: people in towns like Blackwood will get the proper N.H.S. service, while people in the declining pit villages are thrown back more and more on patent medicines. The problem is not confined to places like Cwmfelinfach. It is a chronic affliction of some big new housing estates: on the Penrhys, the great new estate on a hill above the Rhondda Valley, the local curate has of
organised a voluntary prescription delivery service for the old, the young mothers, and others who cannot get down into the valley towns: the estate has failed to attract a pharmacy of its own. Mr Kinnock has had appeals for help from people in rural areas where doctors do not dispense themselves, asking what can be done for them. There are parts of London too where high rents and rates and the pressures of competition have swept the High Street pharmacist away, leaving the old to make journeys into unfamiliar, even
frightening, territory.
Nor is there much hope of health centres to solve the problems of many of these places:. even if the money were there to build all the centres which have been applied for, it is unlikely that they would be justified in some of the remoter areas with falling populations. Mr Kinnock thinks the answer is to introduce mobile pharmacies, staffed by, say, two pharmacists with assistants, controlled by local authorities but paid for centrally; and he has written to Mrs Castle recommending their introduction. The Pharmaceutical Society, which looks after the professional interests of pharmacists, charts their dwindling numbers each year in its journa1.1 Nearly 3000 pharmacies have gone in the past ten years: last year there was a gross casualty-rate of 455 in Great Britain: some shut down only to reopen across the road, and closures were offset by new openings, but 1.
Pharmaceutical Journal, June 8, 1974, p. 525.
that still left a net loss of 251. And openings tend not to happen in places like Cwmfelinfach. True, many of these losses reflect the fact there have in the past been too many chemists’ shops; true, a multiplicity of shops is not a very economic way of running the service.But that is not much comfort for the old and ailing of Cwmfelinfach. The Society is not disposed to condemn the idea of a mobile chemist’s shop out of hand, but it sees some big practical snags. For one thing, you’d have to law rewrite the to legalise it, since probably the law clearly states that chemists are expected to operate from a fixed base. Even then, it would have to comply with the requirements of the Medicines Act of 1968 which tightened up standards for pharmacists’ premises, and there is some doubt as to whether these standards could be achieved on wheels. There is also, bizarre though it sounds, the risk of hijack: as the mobile pharmacy, piled high with its cargo of pills, sped through the quiet lanes, wouldn’t there be those who, for reasons of commercial gain or personal avidity, would plot to hold it up and rob it ? The practical answer, as the pharmacists see it, is that if the service is to survive it will have to pay better. For years now, they have been warning that if the public uses the chemist’s shop simply for prescriptions, while going elsewhere for all the other goods the chemist sells, then the chemist will go out of business. So if the public mourns the loss of the chemist’s shop, it has (they say) its own shopping habits to blame. The other culprit (as usual) is the Government. The profession has put in a 30% pay claim, costing about E22 million a year, which would raise the professional fee on the prescription from 17 to 24.4p, lifting the notional salary implicit in the hopelessly involved formula used for calculating the chemist’s reimbursement to E4500 a year. Chemists would rather see Mrs Castle spend the money that way than by putting pharmacists on wheels. The Government could also consider special grants and subsidies to help chemists set up and survive in areas where there cannot be any great hope of doing so on ordinary commercial considerations. It was this which led a Labour study-group to recommend nationalisation of dispensing as the only route to get a properly distributed network of centres throughout the country, but there is little chance of a Labour Government taking on that kind of commitment at present. For the moment though, places like Cwmfelinfach are more likely to be served by self-help arrangements already in use in some communities: there are places where you take your prescription to the post-office or police-station, and collect your pills and potions from the same centre later in the day. It would be possible, too, to extend the use of part-time dispensing, which is sanctioned already in some places, so that the pharmacist spends part of each day in each of a string of villages, on the model of the rural doctor or the rural priest. And since the places which lose their pharmacists are likely to be those which lose sub-postoffices too, there must be a case for looking at those problems together and coming up with a joint solution. DAVID McKiE. 2.
Lancet, 1974, i, 160; ibid. p. 465; ibid. p. 743.