France's disappearing pharmacies

“Funny ... I thought there was a pharmacy on that corner”. So what’s happening to those green crosses?

PharmacyWell, that pharmacy on the corner – like 125 other officines across France, to use the professional term – put up the shutters for good last year rather than being sold on as a going concern which has been the tradition. That just shows how fast economic change can occur.

When I last spoke to a pharmacist some ten years ago – that was Pamela Benoist in Cannes, now retired – she told me that her calling offered “a good living, security, a certain prestige and a lot of personal satisfaction”. That judgement was modified somewhat when I talked to Fatiha Djegaoud at her pharmacy in the Moulins district of Nice. She recently became, by the way, the best-known pharmacist in France.

A profession in crisis

Although by no means a pessimist, Mme Djegaoud admits that things have changed and that her profession is in crisis. For me, that’s no great surprise since, like many foreigners, I’ve been puzzled by the number of shops you pass displaying that distinctive green cross. When I enquired a decade ago France had one pharmacy for every 1600 inhabitants – compared with one for every 5000 Brits and one for every 15,000 Danes.

“That must be very hard on the elderly,” remarked Mme Djegaoud, “who’ve got a long trip to pick up their pills.” But why does France have so many pharmacies? “Several reasons, I’d say. The French have always cared a lot about their health and they like medical services to be close at hand and, of course, over the past 60 years the Sécu has subsidised these preferences. Until recently to be a pharmacist did offer the satisfactions Mme Benoist talked about.”

So what’s happened?

Essentially there’s a financial crisis. As Jean- Marie Soyer, president of the pharmacists’ association in the Alpes- Maritimes, told Nice-Matin recently, “Of 466 officines in the department some two-thirds are facing financial difficulties.” What’s brought this about? Explains Mme Djegaoud, “To start with around 80% of our turnover comes from the sale of prescription items. Their prices are fixed by the government and they've movedup very slowly. It’s generally agreed that since the Nineties our margins have fallen by about 50%.

And then in their effort to reduce the deficit of the Sécu the government has been putting pressure on doctors to prescribe less and at the same time on some products the rate of reimbursement has been cut or even eliminated and so demand goes down. On top of that you’ve got a fall in the number of GPs. The ideal site for an officine is close by a cabinet de généraliste. If a doctor retires and isn’t replaced the local pharmacy sees a drop in turnover.”

New kinds of competition

And, of course, there are now new kinds of competition to be faced. “That’s right. For example, we can’t rely on para- pharmacy to boost our turnover. That’s been largely taken over by the supermarkets who can discount heavily. Then there’s the internet. Frankly, it’s a menace and primarily for people’s health. It’s just not on to buy medicines online with no proper advice and often no quality control.”

And what if the supermarkets get into the core business, as they hope to do? “Again, not a good development. Whatever they say now, they’d end up treating pharmaceuticals like groceries. And there is a difference.”

Does she see any reason for optimism? “Oh, yes. Take generics. At the beginning there was a lot of consumer suspicion and the pharmaceutical companies still try to pressure GPs into prescribing branded products but the proportion of generics within our sale of prescription medicines is now over 40% and rising. That’s good for the Sécu – they’re cheaper – and for us because we get better margins on them.

At a different level many pharmacists – once fiercely independent – have seen the advantage of cooperation and have come together in what we call groupements de conseils which offer advantages in areas like bulk buying and marketing. It doesn’t always work out. I used to be in a groupement sponsored by Boots – your readers will know the name – but I’ve since moved on.”

One criticism I’ve heard of pharmacies concerns a wide disparity in the pricing of over-the-counter products. A PACA survey found that a box of Strepsils could cost anything between €3.50 and €6. “Maybe in the country where there’s less competition you can get away with a bit of gouging. In town you have to charge what the market will bear. There’s a trade website that indicates what’s currently being charged for many items and that has to be your guide.”

The human side makes it rewarding

It’s always interesting to ask any professional if they’d like their children to follow the same career. How did Fatiha Djegaoud respond to this? “They’ve answered that for me. No way would they like to be pharmacists. They’ve seen how hard I work –I’m here more than I am at home–and they don’t fancy all that paperwork we face these days. Certainly, you have to put in a lot of time to make a living and that’s after a 6-year training. But there’s another side to it: as a neighbourhood pharmacist you play an important part in peoples’ lives as a source of advice and comfort that no website can rival. It’s the human side of the job that makes it rewarding. I’m not thinking of early retirement.”


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