Boots revelations are a bitter pill to swallow

http://www.theguardian.com/business/2016/apr/19/boots-revelations-are-a-bitter-pill-to-swallow

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The revelations (Watchdog steps in after allegations Boots is milking NHS, 18 April) following the Guardian investigation into Boots are symptomatic of the dynamic between the NHS and private business, some of which could arguably be regarded as exploitation. In our case we have identified a conflict of interest around the private laboratories appointed to manage NHS microbiology contracts and the latter’s urgent need to make significant cost savings in all areas of clinical medicine and patient experience.

On approaching one of the largest of these private laboratory groups to promote improved urine specimen collection and dramatically reduce retesting, we were told that this “would knock about £500,000 off our bottom line”. Our entreaty that right-first-time analysis, diagnosis and treatment would benefit patients as well as the NHS on a number of levels was dismissed in favour of shareholder interests.

Those in the NHS responsible for setting up volume-based compensation to private companies have singularly failed to protect their employer from what could arguably be viewed as exploitation. There are some NHS laboratories whose budgets also rely on the volume processing of specimens, without any reward or incentive for reduction in retesting.

This is a more serious issue than many will acknowledge given there are around 65m urine tests delivered to the NHS annually. Our own FOI research points to a national average potential retest rate of about 20% with some trusts showing 50% and in one case over 70%. That’s an awful lot of patients who cannot be accurately diagnosed at first test, which might also suggest a reason behind the wide prescribing of broad-spectrum antibiotics.Giovanna ForteFounding director, Forte Medical, London

• As a doctor and an NHS patient, I am disgusted by the corporate behaviour of Boots. This is obviously harmful to its staff and to public health and finances.

On a personal note, I was recently asked to return to my local branch for a medicine use review (MUR) which I neither needed nor wanted. Being unaware that this waste of my time and that of the pharmacist was a rip-off designed to extort £28 (for three minutes of unnecessary and somewhat embarrassed advice), I complied. I regret colluding inadvertently with this.

Two years ago it was revealed that (as a result of takeover by the US giant Walgreens) Boots had arranged its tax affairs via Switzerland to ensure it cheated the UK exchequer out of more than £1bn. This resulted in protests outside Boots branches by UK Uncut. In view of the Guardian’s revelations, it is time to repeat those actions on a larger scale with an emphasis on solidarity with the staff.

It is also time for the General Pharmaceutical Council and the health select committee to find out what incentives are imposed on Boots’ local and regional managers to drive them and their staff to undertake unnecessary MURs to extract profits from the rest of us.Dr Frank ArnoldBrighton

• This story reflects the modern nature of commerce, with the government encouraging the involvement of big business “for economies” of scale and then seeing vast tax revenue taken offshore. The pharmaceutical wholesale market is dominated by two players, is based outside the UK and could be classified ascalled “too big to fail”.

It is interesting to see the Department of Health in its latest stance against community pharmacy, wanting to close 3,000 pharmacies. This would affect the smaller independent pharmacies in order to save £170m but does little to address the loss of billions of tax revenue.Gursaran Singh MatharuMapex Pharmacy Consultancy

• Less obvious profiteering by Boots is instruction of their pharmacists on private prescriptions. I wrote one for a week’s amoxicillin, knowing it to be cheaper than the NHS cost of £8.40, and went to collect it for a patient. I was astonished to be told that all such items now cost the NHS price or higher. I went to Sainsbury’s pharmacy and found it for £4.45, which included the £2-plus dispensing fee.JK CruickshankProfessor of cardiovascular medicine and diabetes; Hon consultant physician, St Thomas’ & Guy’s hospitals, King’s College and King’s Health Partners, London

• I can testify to the truth of the allegations against Boots regarding the abuse of medicine use reviews. A few months ago I was subjected to one without being asked if I wanted it. Indeed, it was conducted in the manner of a test of mental capacity (I am of an age to receive free prescriptions) and was continued against my will, it being alleged that I was on the wrong medication. The frustration of the pharmacist when I refused to sign a document whose use and nature were unknown to me, and have remained so until I read your report, was very ill-concealed, and complaints both to Boots and to my local medical practice produced no satisfactory explanation. Dear old “Boots the chemist” is no more; the corporate machine that has taken it over is ripe for a full investigation.Simon NichollsLondon

• The culture at Boots illustrates why the private sector, with its first duty to shareholders, has no place in the NHS.Karen FletcherSheffield

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