Drug supply: A pharmacy without a pharmacist – Lauterbach’s subtle plan

R“The employees are almost always aware of the complaints of the villagers,” said the owner of the St. Cosmas pharmacy in Pfull near Neu-Ulm in Swabia, which has been in business for 40 years. Franziska UtzingerThey watch children grow up and care for the elderly and lonely. Sometimes, customers just stop by to chat. “The connection with the people is very strong,” said the 43-year-old, who took over the pharmacy from a colleague a decade ago.

The matter has been closed since November. Utzinger had to close the St. Cosmas pharmacy, which has been empty since then. “It feels like a failure, like a huge disappointment,” says the Swabian, whose parents are also pharmacists. Reasons for the closure: lack of staff and financial problems.

This example fits a trend that has persisted for years: 20 years ago there were 21,400 pharmacies in Germany, while today the number stands at 17,500. The biggest losses occurred last year, when 559 pharmacies closed and only 62 opened. Not all of these closures are problematic; in metropolitan areas, the density of pharmacies is particularly high. In rural areas, however, closures can mean that patients are no longer receiving care and have to travel long distances to the nearest pharmacy – if they are still mobile.

Federal Health Minister Karl Lauterbach (SPD) therefore wants to reform the structure and remuneration of pharmacies The corresponding draft law The plan will be discussed in the cabinet next week. Pharmacist representatives strongly oppose the plan and are angry that the reform is a “serious violation of taboos”. Pharmacies will be downgraded to “the lowest level of dispensing points” and Germany’s drug supply will be “irreparably damaged.”

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What is the truth behind these allegations? What consequences will Lauterbach’s reform plan have for the population? Essentially, it should become easier to run a pharmacy in the future, so that if necessary, opening hours and equipment can be reduced. It should also be possible for management to be taken over not just by one person, but shared by two pharmacists. The bottom line is that pharmacies do not have more money, which is also due to the high deficit of the statutory health insurance.

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The staffing issue is controversial: branch network pharmacies in poorly supplied areas should be able to open even without a pharmacist on site; Pharmaceutical Technical Assistant (PTA). Contrary to pharmacists, they do not study, but have completed 2.5 years of training. PTAs already advise customers on how to take and dispense prescription drugs, but always under the supervision of a pharmacist who can help them with specific technical problems.

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Lauterbach says that assistants should be allowed to work alone in the pharmacy in the future, as long as they can be sure that they can contact the pharmacist at any time via “tele-pharmacy” (i.e. digitally). Personally, a pharmacy manager only has to be on site eight hours a week, for example to dispense strong painkillers under the Narcotics Act, which assistants are not legally allowed to do. For patients, this could mean that in the future they will only receive painkillers on selected days of the week.

‘The aim is not to destroy pharmacies’

Gabriele Overwiening, president of the Federal Association of German Pharmacists, rejected Lauterbach’s reform plan and called for higher pay instead. She warned: “To have pharmacies without pharmacists and to restrict pharmacy equipment and opening hours is a major detriment to consumer policy and will lead to cuts in services and a decline in quality for patients.”

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Christian Knobloch, director of the Center for Pharmacoeconomics Research at the University of Duisburg-Essen, refutes this view. “The aim of the reform is not to destroy pharmacies, but to keep them in rural areas,” he said. Even now, PTAs are not always supervised by a pharmacist in every pharmacy. Lauterbach’s plan would be justified if they could always call on a licensed colleague in the future. However, Knobloch said that this would only be the case in areas with poorer supply, where there are clear regulations. It is also questionable whether assistants would be willing to take on more responsibility due to the lower salaries.

Knobloch is critical of the radical opposition of the pharmacists’ association. “It is ineffective for pharmacists to reject all recommendations and simply demand more money.” Health economist David Matusiewicz shows more understanding for the professional representatives. “The aim of the system change is to make the supply of medicines more commercial,” he says. Currently, the pharmacy is “almost the only way in Germany to meet with academics in the field of healthcare without an appointment”. In the future, pharmacists in pharmacies should “rationalize walks” by means of video calls. Matusiewicz is convinced that the law cannot prevent the decline of pharmacies in rural areas.

There are also criticisms from within the Traffic Light Alliance. Andrew Ullmann, the Liberal health policy spokesman, said: “It is clear to me and our Liberal Democrat parliamentary group’s health working group that there can be no pharmacies without pharmacists. What we need is safe and reliable access to medicines and advice, not the relativisation of the liberal profession. “We cannot and will not agree to the law in its current form.”

Utzinger, a pharmacist from Swabia who had to close her pharmacy but runs two others, is skeptical of the law. On the one hand, it makes sense that in the future there should be more flexible opening hours and the possibility of handing over branch management to two pharmacists. On the other hand, Lauterbach’s legislative plans do not solve the economic problems of many pharmacies, says Utzinger, who is also a member of the regional council for the Swabian region of the Bavarian Pharmacists’ Association. In any case, even if Lauterbach’s reforms had come into effect, she would still have to close her St. Cosmas pharmacy.