The Business of Pharmacy Podcast™
Sept. 5, 2022

Pharmacy Challenges in the UK | Leyla Hannbeck, MPharm, MBA, Association of Independent Multiple Pharmacies (AIMp)

Pharmacy Challenges in the UK | Leyla Hannbeck, MPharm, MBA, Association of Independent Multiple Pharmacies (AIMp)

Leyla Hannbeck, MPharm, MBA, Assoc. of Independent  Multiple Pharmacies (AIMp) discusses pharmacy challenges in the UK.

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(Speech to text)

Mike Koelzer, Host: [00:00:00] Layla, for those that haven't come across you online, introduce yourself and let our listeners know what we're talking about today.

Leyla Hannbeck MPharm: My name is Dr. Leyla Hannbeck, I'm a pharmacist by profession and I work as the chief executive of the association of independent multiple pharmacies, which is an organization representing family owned businesses here in England.


Today we are gonna be talking about the, um, state of community pharmacy in England, and I'm gonna be taking you through some of the challenges that we're currently facing in our sector and, uh, the way forward in terms of like where community pharmacy in is heading in, uh, in England.

Mike Koelzer, Host: Leila, I suck at geography, but I know looking at your past, you maybe went to Finland for pharmacy school and something else. Where did you bop around in your history? And what is your hometown where you grew up?

Leyla Hannbeck MPharm: I grew up in Finland. Um, I was part of the Swedish speaking community in Finland going to school, um, into Swedish speaking schools. Um, and so when it was time to go to university, um, I moved to Sweden, to Upal university, to complete my studies in, um, in pharmacy. I graduated as a pharmacist and started practicing as a pharmacist before, uh, moving to the UK in 2004 and, uh, progressing my career.

Mike Koelzer, Host: What brought you to the UK?

Leyla Hannbeck MPharm: Well, when I was, um, in Sweden, we used to get regularly approached by UK companies, um, who were looking for pharmacists and, um, I married to, um, a German. And so it was kind of, we were thinking at the start of our careers where we should be, um, settling and where we should be taking forward our careers.

And so when this opportunity came up, in England, then we had a discussion, okay. Is it gonna be Sweden? Is it gonna be Finland? Is it gonna be Germany? Um, and then we decided, why not? Why not go to England where we both, you know, nobody has an upper hand and, uh, we can start fresh there.

Mike Koelzer, Host: Well, I have a German background. So your husband and I have you outnumbered now two to one, so it's good. You're in neutral England at this.

Leyla Hannbeck MPharm: Good. you said that was one of the reasons neutrality

Mike Koelzer, Host: Lil define to me multiple independent. It almost sounds like an oxymoron, but it's not, it's a pharmacy business that's owned more independently, but they have more than one pharmacy. How do you define that with your terms?

Leyla Hannbeck MPharm: So when we talk about independent multiples, we mean, um, organizations that are owned independently. Um, but the owner has more than, uh, one pharmacy, but in our case, our membership allows, um, those who have more than three pharmacies, uh, because we believe that, um, when you have, uh, more than two or three pharmacies, then your business setting changes in that you will have, um, a head office function, for example, Um, you will need other pharmacy pharmacists to, and, and, um, pharmacists to work for you.

Um, and so the business model changes and hence whilst is independently owned. When you have multiple branches, you are kind of, um, in that sort of head office category.

Mike Koelzer, Host: We just have one pharmacy. My dad had a number of them, but, um, we just have one now and I just have one now. And it seems to me that with two pharmacies, you can kind of still run it as one, the pharmacist in an emergency can kind of go back and forth and you can share maybe some employees and things like that.

Three, maybe, but. Three to four, then you really start having a different business model. It seems. And you can have that different business model with two, but you certainly have to have it as you approach the handful of pharmacies

Leyla Hannbeck MPharm: Yes, that's that's right. So, um, whilst these pharmacies, pharmacy groups are kind of multiple, but they always have that sort of independent ethos in them, that sort of family business. Um, and the business model obviously changes as, as you described in that, um, you kind of develop, um, you know, that, that sort of head of its function in that people will have, for example, similar standard operating procedures, you will write it for your branches and then you need to have, um, you know, virus, um, staff members in various branches responsible for, um, different tasks.

Um, [00:05:00] and so things kind of develop in that, in that sense. But one thing that I have noticed is that that sort of independent ethos remains within these family businesses, no matter how big they get.

Mike Koelzer, Host: No matter how big they get. Is there a number that just doesn't make sense anymore? That's outside of your group or in theory, if it's still owned by a family or a person, no matter how many they have, it still has that ethos of being independent.

Leyla Hannbeck MPharm: Yes. So we have, for example, within our membership pharmacies that, uh, the owner, you know, has about over 250 pharmacies 

and that 

yes. yes. And, they are part of that independent, independent group. And you asked, um, where, where we draw the line in that, you know, there is really not, there's no line as such there, um, it's how the business identifies themselves.

And I think one thing that we, um, go by generally as sort of a, a rule of thumb is that we also have national multiples, like for example, um, Walgreen boots, and we've got, um, for example, Um, Lloyds or, um, some of the supermarkets that do have pharmacies. And so they are kind of, um, in a different category in that they're kind of the, kind of more of a corporate operation.

Um, and so, um, you know, while some of them, for example, some of the supermarkets may have lower branch numbers than some of our members, but the distinguishing factor there is that, you know, how they feel they are . So, um, our members are independence and that's how they identify themselves at

Mike Koelzer, Host: So when you say we have them, you mean in England, there are such groups and they're not a part of your group because they start to have that corporate feel to them.

Leyla Hannbeck MPharm: yes. So in England there are different categories. So we've got single independence. Um, then we've got the pharmacy groups. And then we've got the, the national, um, multiples that the corporations as such. Um, so the corporates are represented through, uh, a different organization, uh, called the company chemist association.

Mike Koelzer, Host: Do you guys have softball tournaments against them and stuff? Are you friendly with them or is that just a totally separate, 

Leyla Hannbeck MPharm: No, of course. I mean, it's in the best interest of the community, pharmacy general for all of us to work together. So we do have, um, you know, whilst there are many differences in terms of like in business model, uh, like for example, when you look at, uh, boots, for example, they've got a huge, um, health and beauty, um, part of their operation.

When you look at, for example, Asda or Tesco, the supermarkets, um, they've got obviously that, uh, food and grocery element to their, um, operations. So the business models are different. However, we do have quite a lot of commonalities as well. So we try to kind of focus on those commonalities when it comes to our approach to, um, you know, negotiating with the government, discussing with the government and, um, and, and so on.

Mike Koelzer, Host: What's the worst part of your job? What's the worst part of your week? Like an hour of your week that either gives you the most angst or you just don't look forward to it. What is that?

Leyla Hannbeck MPharm: We do have quite a lot of challenges at the moment within the world of pharmacy in England. And one of the biggest challenges that we've had for a number of years is that lack of recognition. And I think it causes quite a lot of, um, it, it, it makes you feel bad when you are not appreciated as a sector, as a profession.

and when you have that feeling, it, it kind of loads of all the bad things, you know, fall out from that in terms of like you kind of, you know, what, what we don't want to happen is that it would, it would have some sort of a knock on effect on people's confidence of, people wanting to pick a pharmacy study pharmacy and, being proud of our profession and our sector.

Um, and so that recognition is, is, is for me something that we need to really work on gaining, not because obviously of the, uh, you know, we, we we've, we've done everything we can. I mean, the sector in the eyes of the public is very high up, particularly during the pandemic. Um, what we did during the pandemic with our teams during the pandemic was absolutely brilliant.

And, and this was kind of pharmacy across the world, really stepping up and leaving the doors open and, and being right at the forefront of, um, of everything of he healthcare. But unfortunately, um, sometimes. The, uh, those decision makers in positions of power within government or, or within the civil service don't [00:10:00] necessarily see it that way.

And, um, it's fighting for their recognition, um, that that gets sometimes very frustrating. Um, and also we have been for many years suffering from a huge lack of funding, um, for those, um, who don't know much about the, the, you know, how pharmacy operates in, in, in the UK. Well, over 90% of our activities are, um, NHS focused and NHS funded.

The NHS is a national health service. And so we are very much dependent on the fees that we receive from the government, for, um, patients to be able to receive medicines free and receive services free. So that kind of, um, that funding not being there for so many years has left a lot of pharmacists struggling with cash flow with financial.

Um, issues. And particularly now, Mike, when we're seeing the cost of living rising, um, and you know, everything, you know, is going up apart from the pharmacy funding. So a lot of businesses are finding them, finding themselves in a very difficult position at the,

Mike Koelzer, Host: The article that you posted that you were quoted in and it was saying just that that costs are going up, you know, especially now they're going up. So something that was fair, even, not, not that it was, but even if it was fair three years ago, it's not fair now because everything's going up and pharmacy's going down are staying the same.

Leyla Hannbeck MPharm: yes, exactly. And when I hear you ask me about what is the worst thing in my week, um, is when I get those phone calls from people saying that Leila did, you know, I had to remortgage my house in order to keep my business AF. That is a very difficult conversation that I'm, you know, that I'm having with people.

And that kind of makes me feel very upset because I know that they've invested everything in, in those businesses, uh, in their business. And I know that, um, they've, they've done everything they can and no one should be in a position to kind of remortgage their house to stay.

Mike Koelzer, Host: Yeah.

Leyla Hannbeck MPharm: Um, because they've got just that much invested in it, their pensions and invested in that pharmacy.

Um, so it's, it's, it's difficult, um, to kind of hear, you know, having these conversations.

Mike Koelzer, Host: It seems the frustrating thing for me would be, you've got 90% funded by the, and. they're using pharmacies quite a bit. And especially during COVID pharmacies have shown their value. If you came to me and said, you know, Joe's shoe repair is going out of business and darn it, he deserves to be in business because of all the good work he does.

And it seems like he should be in business. It's like, well, I don't know, kind of supply and demand. It would be nice if Joe could still be in the shoe repair business, but that's just not how things are going these days. The problem with pharmacy. Is that there is such a need and you can see the good that's being done.

And you know that if those pharmacies weren't there, it's like who the hell would take care of this person who, who needs this? They would not be taken care of as well. And that's a frustrating part to seeking businesses, going out of business when you know the need is there, but the politicians seem to be looking the other way.

Leyla Hannbeck MPharm: Yes, that's that's right. So, um, I always say that there are various different aspects to pharmacy that sometimes people fail to see, um, one aspect of our, our, um, profession. Um, you know, obviously apart from the biggest pod, which is, you know, being healthcare professionals, right. Avail, offering accessibility and, you know, and, and, and services to patients.

We also are playing a great role within the social care element of things. So a lot of times, for those patients who are lonely and don't have anyone to speak with pharmacy teams are, you know, the people, you know, that offer a shoulder to cry on or coming and speaking. Um, with, with, with their local pharmacists.

So that social element is they're just getting out of the house for a lot of older people to just speak to somebody is, is, is that element. And a lot of businesses actually around pharmacists depend on that as well, because, um, on the, you know, in a community or in a high street, when someone gets out to, to get their community pharmacy, they're likely to pop into another store to get something else or, you know, so it kind of the economy around that, um, community or, uh, you know, that the high street kind of depends on that pharmacy as well, in a sense.

So we have a much greater role than sometimes those in, in, you know, those in position power or decision makers actually see us as, [00:15:00] um, and I think that's, that's what happens when those pharmacists in the lo in the local areas are no longer there. Then the community gets really badly affected because they have to make longer journeys because they won't have that person to speak with.

So it has a lot of, and a lot of these pharmacists are situated in areas of deprivation and in areas of, of health inequality. So, you know, the impact of these pharmacists not being there is huge on those communities.

Mike Koelzer, Host: Yeah. And it's not just traveling farther for a pharmacy once you've gone farther. That connection decreases maybe exponentially. I don't know, but let's just say it does. In other words, if a pharmacist is helping you and they know you're from a town. 25 miles away. It's different from them helping you.

If you live around the corner and maybe the kids went to school together, that kind of thing. It's not just distance, it's less and less personal care as the distance increases.

Leyla Hannbeck MPharm: Yeah, absolutely. I mean, I'm looking at myself, I mean, As a, a pharmacy service user, um, as well as being a pharmacist, but, um, I've got, uh, a toddler a two year old and sometimes I need to nip into the pharmacy and get some stuff. And sometimes I just need to kind of see things for myself and, and just, you know, read things and all of that.

So, you know, just being able to pop to my local pharmacy and, and, you know, getting something from my kid as a mom is, you know, is important. And, you know, I'm a pharmacist. I know, for example, what, um, you know, what things to get for my kid, if, if he's, he's got a fever or, you know, so on, but a lot of people are, are not within the healthcare profession.

And, you know, they pop into their pharmacy like mothers, young mothers pop into pharmacy, and they want to have that discussion with the pharmacy to see what's best for their, um, kids, uh, what products are best and what to do. And if that pharmacy is not there. So what do you do particularly now? Because, um, within, in the UK and England, it's very difficult to see a, uh, a GP because of the fact that a lot of GPS are not offering telephone services.

Um, you know, rather than popping in this, this happened since the pandemic and also GPS here are also under a lot of pressure. So getting an appointment to see a GP is very difficult. So again, pharmacy finds itself in that position where, you know, you can provide that sort of advice and support to patients who need to see your face to face.

Mike Koelzer, Host: Layla, when you are a pharmacist by training, how important is that? Let's say that you knew everything that you know, that somehow you got all the knowledge that you needed without being a pharmacist. It probably helps to say, especially when you're talking to the politicians and things like that, you're like, I'm a pharmacist.

I just don't like to throw around titles and things, but that's gotta be a pretty important title when you're then talking to a politician. So they don't try to one up you, you can say, look, I. I know I've done this.

Leyla Hannbeck MPharm: Yes. And it's happened several times in terms of being in a position. Um, you as a pharmacist, I've been there. I've done that. And, um, so when we're talking for example, about addict services, like, you know, providing, you know, op opiate substitute to, to addicts talking from my own experience, for example, how it was and how, you know, what, how that service was and how important that was, what we were providing.

Um, you know, being able to say that I used to, um, provide the service to over 60 addicts. I used to see supervised methadone, um, dispensing, oversee that to, to over, you know, 60 addicts, um, you know, regularly is something that I can, I can provide details, um, around how they felt. Um, you know, and when we talk about various different things in terms of like supply of medicines and, um, you know, the challenges that you can face that you're facing when it comes to, for example, phoning around, ringing around trying to source the medicine and, and all how much time that takes, or when you see the baskets piling up in terms of like what you need to.

Um, dispensing and you know, all of that and the services that you put when you sit in the consultation room with a patient and you're going through their medicines together with them, or you, um, discuss about their, their, their, their blood pressure or their diabetes and, you know, all of those things. And, you know, it's not just, it's not just saying that it's, it's something that I've experienced myself.

And I know that with every consultation that I have done, there's always been other things as well, in terms of providing that sort of care to the patient and, and that listening ear, basically, that they open up to you and, and, and, and all of that. So I kind of, as you said, as a [00:20:00] pharmacist, I can bring that to the table.

Um, a lot of times

Mike Koelzer, Host: Lela explains Brexit to me.

Leyla Hannbeck MPharm: oh my, we can sit here the whole night, talking about

Mike Koelzer, Host: We've got time. it to me. Like somebody who went to a high school that maybe didn't have good government or history classes. And I never really followed very well. And when the front page of the newspaper used to come home, I would just sort of ignore everything on the front page and go to, you know, entertainment or something like that.

Explain it to me. And where I want to go with this is how it affects me. Health choices and things like that. So first tell me what Brexit was,

Leyla Hannbeck MPharm: So the whole Brexit thing started with a referendum in 2016, um, where people voted, um, to come out of the European union. And so up until then, um, obviously Britain was part of the European union and then the whole process started in terms of like, um, coming out and, you know, that we were, for example, bound by some European laws, um, around various different things.

And so that kind of gradually, um, got pushed aside in that, uh, for example, they're not thinking about introducing different laws, you know, that used to be, um, European laws. So to say, um, you have to bear with me. It's kind of difficult to explain this topic, but 

Mike Koelzer, Host: Well, you think it's difficult for someone from England to explain it? Think about how hard it is from an old guy from us to understand it

Leyla Hannbeck MPharm: I don't envy it. Um, so, so, so basically for pharmacy, it meant that, um, like everyone else, like every other business, in terms of like, um, you know, we are, we were banned by some laws, for example, ified medicines directive, which, um, you know, was some sort of was a European law. But then, um, with, um, UK no longer being part of, um, uh, Europe, then our regulator medicines, health agency have to now put a different process in place for that.

And, um, there were, for example, laws that affected, um, data protection and so on. And some of those laws, um, stayed because they came before Brexit. But I mean, anything after that, well, obviously the UK will not be affected, um, by that. Um, but so essentially, um, Brexit impacted on. Pharmacy, like it impacted on a lot of people's, um, lives in that, you know, whatever happens within our political sphere, politic political, um, uh, surrounding in terms of like how the government moves forward with regards to various different policies related to Brexit, it affects us all.

Um, so, you know, so we are not kind of immune as a sector to, um, you know, what's happening with, with, with Brexit. So from our perspective, essentially what we do, um, as we've always done as a sector is that we put our head down and we make sure that we put patients at the center of everything that we do, because that definitely hasn't changed in that patients will always remain our focus.

Mike Koelzer, Host: Were there any European pharmacy laws that when Brexit came, you were no longer under those laws and now you have to write some of your own or did Brexit not have anything to do with pharmacy law? 

Leyla Hannbeck MPharm: Um, well, well, yes, there was, for example, the, the, the rules and regulations around phos five medicines directive, that was gonna be a European directive. Um, and then when the UK left that obviously kind of no longer applied to the UK, but we need to kind of have our. Way forward with that. Um, because UK cannot be the only country not having anything to do with phosphide medicines, because otherwise it can be the dumping ground

for, for phosphide medicines.

Um, we also have quite a lot of problems, for example, in Northern Ireland in, in that, you know, Brexit has caused for example, medicine, supply issues, um, there, which is kind of very complicated and, and very, um, hard at the moment for, pharmacies in the Northern, in Northern Ireland.

Mike Koelzer, Host: Cause of maybe different transporting laws and things like that. It's just 

Leyla Hannbeck MPharm: Yes, us. 

Mike Koelzer, Host: free anymore.

Leyla Hannbeck MPharm: Yes. Yes. It's it kind of back comes back to that, uh, European free market and, you know, and, and, um, and obviously the deals that they have been negotiating with, um, the EU, um, and how that affects, for [00:25:00] example, the Irish border. um, you know, between Ireland and Northern Ireland. So, um, I think, um, yeah, so that has had, you know, a lot of, uh, yeah, that has impacted on pharmacies there quite a lot, uh, the medicine supply, which is, um, which is difficult for them.

Um, but yeah, generally there was another law that was, that just came out just before Brexit, which was extremely complicated. And that was called GDPR and GDPR was very much about data protection. And what it really meant for pharmacy was that we had to be careful in terms of like whose data we sharing and what we're doing with third parties, you know, data sharing with third parties, or, you know, how we kind of put, you know, how, how data's handled generally in, in pharmacy.

So there were very rigorous laws around that. Um, and. GDPR was implemented just, just before Brexit. So we are all kind of bound by, um, those data protection laws that GDPR brought in.

Mike Koelzer, Host: You're familiar with the term HIPAA in the us,

Leyla Hannbeck MPharm: No, what's

Mike Koelzer, Host: similar thing, it's health portability, something or other same idea. It was a bigger law that, uh, the part that pharmacies see is, you know, privacy of their data and things like that, 

which I thought that. Overkill for pharmacies because you know, as well as I do, especially with independently owned pharmacies, we've been doing patient, you know, privacy, or trying to be prudent with the information we've been doing that for hundreds of years, you know, and this law came in it kind of preached to the choir.

The law came in and it may have protected some of the goofy things that big corporations were doing as far as marketing and, you know, paying doctors and all that kind of stuff. But pharmacies weren't doing that anyway. And the problem is when you have some of that enforcement. Independent pharmacies are an easy target for inspectors and that kind of stuff. You know, the bigger places they've got legal teams and it's harder to get in on some of that stuff. So that stuff bothers me when these laws come out and then we're the target and we weren't even the offender in the first place.

Leyla Hannbeck MPharm: Yeah. And, and, and as you said, independent pharmacies, you know, don't have that sort of legal team behind them and don't have that sort of resource behind them to implement some of these laws. Um, and with the GDP, obviously it puts a very hefty, hefty figure on if you broke the broke, the rules broke the law, whatever happened, then, you know, you would be, you know, paying half to some, uh, which I don't remember off the top of my head, but it it's, it, it was very rigorous and it was also very difficult to get your head around the rules.

I mean, it was kind of a lot of as, as it tends to it's on the legal, so a lot of jargon involved, so kind of deciphering some of that, um, for independence, you know, was not an easy task at all. I remember I used to go around the country, um, talking about GDPR in terms of how you need to comply with GDPR.

And it was one of the most boring 

topics I have ever spoken about in my life.

Mike Koelzer, Host: It's terrible. Then you gotta do the training every so often. I Talked to some of the leaders of the American pharmacy groups and they said that sometimes they'll meet with other groups across the countries. Do you do any of that in your role?

Are you meeting with any other people in your position or I know. One of your past positions was more just of the pharmacy association in general. Do you meet with any world people or, or is that not a thing?

Leyla Hannbeck MPharm: Uh, yeah, occasionally, um, we meet with others, other people from different countries, and it's always very interesting to exchange, um, ideas and see how things are in, in, in various other countries. And sometimes pharmacy operates in such a different way that you kind of think, oh, okay. Um, how, how does that work in some countries, for example, they haven't got.

the big corporations that we've got here. So the pharmacy model's completely different in that you've got to be a pharmacist and own a pharmacy, then you've got to, you know, you cannot have more than one pharmacy or, um, you know, if, if, if you have more than one pharmacy, then at least you have to be a pharmacist, you know?

So, and, and then there are all laws in terms of how they buy and, you know, sell medicines, um, you know, through their wholesale or manufacturing and all of that, which is, which tends to be different in some countries. And so, um, I have worked in Sweden as a pharmacist. For example, when I was [00:30:00] working as a pharmacist in Sweden, I belonged to the state.

So I think that was one of the only countries in the world where the pharmacy belonged to the state. And, um, it was in the early two thousands that they actually opened it up to the private sector. Um, but that's, that was a very different model of, of

operating. So yeah, it's, it's, it's.

You know, there are lots of various different models, um, out there, but within the UK as well, in terms of like, you know, we've got, um, as an organization, we've got various events that we hold for our members and they come together from, um, England, from Wales. And sometimes people travel from, um, Scotland or Northern Ireland to come in.

And even within the UK countries, you can see a lot of differences in terms of like operation, for example, you know, the contracts can, the pharmacy contract can vary, um, between countries, pharmacy contract in England, for example, varies to the contract in Scotland and the Scottish tend to get it better.

Mike Koelzer, Host: They do a better job with the reimbursement that contract or

Leyla Hannbeck MPharm: um, well, their contracts, um, is, is, is more pharmacy friendly compared to, for example, England,

Mike Koelzer, Host: with the NHS. 

Leyla Hannbeck MPharm: With the NHS in that they, the services that they offer, um, kind of they're entrusted to deliver services, but they're also compensated for those services adequately. Um, and so pharmacy is, is a kind of a part of a very much part of that valued part of the healthcare sector.

Um, but in England, for example, we've had a lot of challenges, um, trying to get to the, to a similar level, to, to Scotland. Um, but then again, you look at, for example, Scotland has a smaller population. England has a bigger population, but that shouldn't really be an issue in terms of like stopping the progress and recognizing our sector, 

um, going.

Mike Koelzer, Host: When you say 90% is from the NHS, what's the other 10%. Is that just the elective walk in stuff, not through physicians and things. Is that, is that what that is?

Leyla Hannbeck MPharm: So yeah. So, well over 90%, um, yeah, definitely the NHS. And then, um, obviously we've got the over the counter medicines, um, that pharmacies do, and then you've got some provide private services, um, that, um, you know, offer private services that could be bringing private income. But yeah, you know, very much overline

90% is NHS dependent.

Mike Koelzer, Host: In the US, our nemesis is the, uh, pharmacy benefit manager, because they basically charge the corporations.

A lot of money, pay us a little bit of that money and they keep this spread and nobody likes them. At least nobody likes the opaque ones because you can't see what the hell they're doing. It's all secret. It's all smoke and mirrors. in England when you've got the NHS as 90% of the revenue. And you've got the pharmacies.

Do you have such a middleman? And what is your view of them?

Leyla Hannbeck MPharm: Oh, so, yes. So basically, the way it works here is that we've got a contract that it's kind of, um, you know, the supply part of it. Um, and then we've got the service part of it. So the supply part of it sits with an organization called the department of health and social care. So the department works for the government in terms of, um, um, compensating for the costs of medicine.

And they very much work, for example, in relation to things that have to do with the supply of medicines. But then we've got, um, the NHS England, which is an organization that, um, works, you know, for the NHS looking after looking after, um, a phrase basically in England and they are mainly in charge of, um, the services and the direction of travel in terms of like setting the strategy for, um, how, for example, healthcare service and pharmacy looks like, um, going forward.

And that, for example, if, if you are offering a service it's, um, you know, for example, like a hypertension service or like a diabetes service very much, uh, likely that it's, um, commissioned via the via NHS England. So the kind of two different organizations that we are having. um, negotiations with, but also, um, the people with the money are the treasury.

So the treasury are in charge of, um, the funding and where it goes

Mike Koelzer, Host: Who [00:35:00] do pharmacists hate? We hate the opaque PBMs. Uh, some people hate the, uh, corporations that have unrealistic job requirements for the pharmacists unrealistic metrics. And so on. I'm trying to think about who else we hate. That was probably the main


Leyla Hannbeck MPharm: you're right. Okay. 

Mike Koelzer, Host: maybe the insurances who haven't, uh, aren't paying for pharmacy services and so on, but this isn't coming from you because you maybe have to be a little bit more politically correct, maybe, but.

If I come up to the average pharmacist and I say, who do you hate in England? That is above you in pharmacy. Who is that? Who are they gonna name?

Leyla Hannbeck MPharm: I think if you would, well, if, if, if you would ask pharmacists, sometimes they would say to you that they feel let down and they feel, you know, that for example, NHS, England could do a better job at promoting pharmacy and, and, um, and yeah, and, and, um, you know, having that better recognition of, of, of, of the sector.

So, um, I think, um, I don't know the, you know, to use the word hate, but I think. People are disappointed in terms of like the past years in particular, how, um, things have gone in terms of like, you know, pharmacy has had such a, a horrible situation in that, you know, the funding squeeze and, you know, and everything, you know, they have to do more for less, um, and so on.

And it's, it's not recognized. And after the pandemic, there were all these nice words like, yes, you know, pharmacy did this, pharmacy did that's perfect. But, but, but

People are not, not seeing that tangible

action. Words are lovely. I mean, hearing how lovely pharmacy teams have worked, how much they have put effort in and so on, but. if you really rec, if you really want to recognize someone, you don't just say words, 

you, you actually show it in your action.

Mike Koelzer, Host: Who hires you? Who do you answer to? And I know ultimately you can say, I answer to the pharmacist because that's where my heart is and all that stuff, but who do you actually answer to?

Leyla Hannbeck MPharm: I'm not gonna say all that fluffy stuff,

Mike, but 

Mike Koelzer, Host: fluffy stuff.

Leyla Hannbeck MPharm: um, well, well we have a board

and, uh, uh, my board, um, consists of pharmacy owners, pharmacy contacts, our members. So I respond to them, but I also respond to, um, not just those members that I, that I represent, but also many times, um, independence as, as a whole.

Independent pharmacies as a whole, but my, but, but, but, but I answer to my board, 

Mike Koelzer, Host: How many are on the board? 

Leyla Hannbeck MPharm: Um, we've got 10 at the moment on the board, 10, um, pharmacy owners.

Mike Koelzer, Host: It's nice to know that the board members that are hiring you are in the battle and they know what's going on. They don't have, uh, unrealistic expectations. I would say. Would you say that?

Leyla Hannbeck MPharm: Um, I'll actually quite, um, lucky to be working with a board that is very knowledgeable and they actually help me quite a lot in terms of bringing things to me, um, that they are facing. So everything that we do is not really. From the ivory tower. So to say things, that's saying, oh, this is what we want, blah, blah.

It's all based on reality and what can be achieved and what needs doing so, um, and everything that we do in terms of like the messaging that we put out there, um, the work that we do with the media and we are kind of very active in the sphere of national media as an organization, because we want to bring what pharmacists doing to the public and making politicians see for themselves what is going on.

Um, so you know, everything that we do is not really sitting in an Ivo tower, you know, saying, oh, well, this is how I should be. We actually are doing it. We know what the realities are and what we're capable of and what the challenges are and how we need to tackle those challenges. We offer solutions. It's not that we just, you know, as a sector, we just say, you know, we complain and complain and 

morning nag.

Mike Koelzer, Host: You're not just their psychologist.

Leyla Hannbeck MPharm: exactly. No, we offer quite a lot of, you know, many times we offer solutions in terms of what we can do backed up by evidence. Um, but it's just getting through 


Mike Koelzer, Host: now. 

Leyla Hannbeck MPharm: bit. That is very, very difficult. Um, and then I, I get, I get to hear well, everybody's on the same board, all businesses are suffering.

Well, [00:40:00] I completely sympathize with all businesses and I sympathize with everyone from a pharmacy perspective. We've seen during the pandemic that this sector is needed. If needed, pharmacists are not like any commodity. They are medicines that patients cannot.

Mike Koelzer, Host: and 

the squeaky wheel gets the grease. You know, there might be other companies involved too, but you gotta speak up. Then everybody's got a voice.

Leyla Hannbeck MPharm: exactly. And, and, and Pharmac again, we bring a lot of other businesses together, as I said, you know, when you go to see your pharmacist, you're likely to pop into somewhere else. And in short it is frustrating. Mike,

Mike Koelzer, Host: Layla. explain the average board member to me. Are they guys, are they ladies? What would be the average person on that 10 person board and how many pharmacies would they say they own on average?

Leyla Hannbeck MPharm: Oh, uh, I haven't counted how many pharmacists actually on I think it's, it's near 500 or maybe more 600 pharmacies between them. between the 10 of them. Yes. And the, well, there are men, 

you tend to see that here in the UK, the vast, vast majority of pharmacy owners are 

Mike Koelzer, Host: Hmm. 

Leyla Hannbeck MPharm: And, um, so that kind of transpires onto the boards.

In most organizations, you'll find that the, the main constituent of the board is, is 




Mike Koelzer, Host: What's the average age, would you say?

Leyla Hannbeck MPharm: The age is different. So we've got, you know, some that are, you know, young and they're very early forties or, or late thirties. Um, and then you've got some that, um, are from the sixties. kind of is, is a, is a balance when it comes to the age.

Mike Koelzer, Host: Do you notice a difference between a younger, I'm just gonna say guy, because that's who you're dealing with. Mainly, do you notice a difference between the younger guys and the older guys? Are the older guys either more jaded or are they more patient or whatever? Do you see a difference in personalities between a 40 year old and a 60 year old when it comes to pharmacy and their communication with you and so on?

Leyla Hannbeck MPharm: I think it tends to be that, um, everyone, again, the good thing with my board is that everyone brings something to the table. So, um, the young guys, for example, they can bring things that, you know, they've, you know, from technology, for example, perspective, there are this, you know, generation that they can, you know, they're very good at, um, online and, and things like that.

And then you've got the, the older ones that have been in the business for a longer time and they kind of have seen it all 


Mike Koelzer, Host: Which ones are grumpy, are the younger ones grumpy or the older ones

Leyla Hannbeck MPharm: I think age has nothing to 

do at all. 

Mike Koelzer, Host: on. They don't call, they don't call people grumpy old men for nothing, but you're saying age

Leyla Hannbeck MPharm: uh, I don't think so. It it's to do with personality. So it's to do with, you know, what you're passionate about and what you, you know, you care about, and so on. I don't think you, we can categorize, at least not my board in terms of like, you know, if you're older, you're more grumpy or, or, or not. I think it's more to do with what is more important to them.

Um, sometimes at a particular topic could be of importance to someone that they get passionate about 

Mike Koelzer, Host: Yeah 

Leyla Hannbeck MPharm: not as important for somebody else.

Mike Koelzer, Host: It's hard to tell passion, I suppose, because when you look at somebody, you don't know if their passion's growing or if they were passionate and now they've kind of given up or maybe they haven't given up, but they've accepted some things.

It's hard to tell where somebody is and I guess everybody's on their own

Leyla Hannbeck MPharm: Yeah, I think, um, it's been very difficult. The past few years have been very difficult. Obviously I think people's energy's been sucked out, um, because of the pandemic and, and what we have done. And also the workforce challenges that we are currently facing and underfunding and all of that.

So I think, um, but people keep, you know, people are passionate about, you know, what they do about their business, about what they build up over the years. And, and they just, just don't want it to go under and, and they, they continue being passionate about that. But I think there is a feeling of sadness.


Leyla Hannbeck MPharm: People feel, people feel that, you know, over these past few years we've done everything we possibly can. Um, as a sector, everything we've asked, we've done it,

Mike Koelzer, Host: When we started off, you mentioned that that respect wasn't there. Would you say that their respect has gone down or maybe [00:45:00] it stayed the same, but it hasn't responded to pharmacies' response to COVID.

Leyla Hannbeck MPharm: We definitely have very huge respect for the public. Um, very, um, and we do have respect with the politicians and we do have respect with, um, those higher up, um, you know, in the decision making process. Um, but it's just, you know, and, and they know that farmers can do it and they want to, um, you know, for pharmacies to do more, but it's.

it's one thing saying that in terms of like that we want pharmacies to do this and that. And another thing to actually, to actually allow pharmacies to do that, by, for example, remunerating it properly by, for example, you know, being honest about the fact that there are these challenges that they need to be supported with.

Um, so that's why we say it becomes about words rather than really tangible actions, um, for this sector. 

Mike Koelzer, Host: Layla, a lot of times when things don't go the way we want them to go, we like to think of an enemy. You know, somebody who is not letting us get there. And a lot of times the enemy is the person that's making the most money from something. They just look like greedy enemies.

When people think of the NHS not responding well to pharmacy, is there someone. Getting rich off of this or would they say, well, nobody's getting, Rich's just that, the taxes aren't there to fund this.

Leyla Hannbeck MPharm: Our funding is very much sitting. The vast majority of it is sitting with the treasury. So it's the treasury that releases the money to the NHS. Is the treasury that releases the money to the department. Um, and so it's very much dependent on the way the treasury is going.

Mike Koelzer, Host: Is the treasury the same as the government, or do 

Leyla Hannbeck MPharm: yes,


Mike Koelzer, Host: Is that being different?

Leyla Hannbeck MPharm: none. It's the same as the government. So the, the, the government, um, uh, you know, holds, holds the treasury. So they essentially control, um, in terms of where the money, where the funding is, is going. And, uh, what we hear a lot of times is that, well, everybody wants a piece of the funding. So, um, you know, dentists say, we want it, doctors say, we want it, pharmacists say we want it.

And, um, you know, you know, not to mention all the other businesses that kind of say that they're suffering and they want to, you know, for, for example, the hospitality sector may say, you know, we want some money and you know, other sectors may say they want it. and they keep saying that there's simply not enough money in the part to be able to give to everybody.

So what we then need to do, what we are trying to do, um, is to offer them the sort of solutions. Look, if you give the pharmacy the money, this will happen. And this, you know, if you, which, which a lot of times makes sense because, um, but they make sense really. not just a lot of times they do make sense in that if the government are, are having targets, for example, for patients not to end up in accident and emergency, or end up in hospitals with which, which would cost the NHS more money, or would, would, would go to a doctor, uh, to get a service, which you could get cheaper in a, in a, in a pharmacy in terms of like, you know, um, you know, leaving the doctors, get on with other things.

Well, obviously that is a no brainer in terms of like, you know, the value that we offer the NHS. Yeah. So if you allow us to do it, if you fund it properly, you will see how much benefits you are gonna get out of this. I mean, we've, we've, we've demonstrated that, um, that for example, delivering COVID vaccination of flu vaccination to coming pharmacy can be such a, such a good thing, or, you know, and, and getting your, for example, participating in the prevention agenda before people, um, to get to that stage where they need hospital appointments or seeing, you know, going to accident emergency.

So the evidence is there. and so it's just kind of, for them to make that decision, to actually support this for the, be to the best benefit of the NHS and also the patients.

Mike Koelzer, Host: It seems like that's a huge benefit and it doesn't seem, cause I know in the US there's all kinds of studies like that too. You prevented someone from going to the ER and that kind of thing. It seems like the numbers are there, but it doesn't seem like people are responding to those. And I don't know, maybe it's shortsighted.

Maybe if they see a saving somewhere, they don't want to look at the potential. What could have been worse? Maybe they're just jumping on something quickly. I don't know. I don't know why they don't respond to those kinds of numbers.

Leyla Hannbeck MPharm: [00:50:00] Yeah. Well, this is something that, uh, we don't understand either in terms of like, you know, when you got this in front of you, this resource in front of you in the form of community pharmacy, where there is so much that they can do and have shown that they can do, um, You kind of, and it's the accessibility as well, you know, just being able to walk through your community pharmacy and, and get, you know, done.

It's very valuable. Um, but unfortunately I think it's, it's one of those things that, you know, no matter how hard you are working at it, um, I think, um, yeah, I mean, we are in the same boat. I mean, if you speak to a doctor, they would say the same thing they would say, oh, we are starved of funding.

If you speak to a dentist, they will say to you, oh, um, you know, most dentists are now providing private services because they don't wanna deal with the NHS anymore, you know, because they're not getting funded. Um, and people cannot always pay for the private dentist appointments. so everyone will say that, but, but in the case of pharmacy, we obviously have that evidence to back it up as well.

Mike Koelzer, Host: One of the biggest problems in the US is the smoke and mirrors, how there's a lot of different definitions of cost and then there's rebates. And then there's, uh, you know, wholesale and acquisition and all this stuff. And it's all thrown into this mix and the manufacturers, especially the pharmacy benefit managers do a good job of throwing these terms around to confuse even the politicians.

And then they get confused and then they don't even know exactly what they're voting on because whom do they trust and things like that. When some of these rules get put in place, as far as pharmacy reimbursement and so on.

I don't hold my breath in thinking that the change is gonna come soon, but at least some of that makes things a little bit more transparent so that the politicians can understand it more in England. Do you have all that confusion? All those levels, it seems like maybe it's not quite as confusing because you don't have as many players in it.

Leyla Hannbeck MPharm: So we've got the politicians and then we've got the civil servants. So, you know, we mainly negotiate with the civil servants who then, you know, then discuss with the, with the, with the politicians. So our main, now, the main conversations that we have are with the civil servants.

Mike Koelzer, Host: Is there someone in there trying to confuse things at all? Is there a weasel in there that's trying to confuse stuff or is it pretty straightforward?

Leyla Hannbeck MPharm: uh, well, we actually, you know, everything is kind of new now, so we've got a set of new several servants now 

Mike Koelzer, Host: Yeah 

Leyla Hannbeck MPharm: So for 

our chief pharmaceutical office is a new person now.

Mike Koelzer, Host: of Brexit.

Leyla Hannbeck MPharm: Um, no, it just, just, it just just happened really, you know, the former, the other one retired and we have now a new chief pharmaceutical officer.

And then, um, you know, the people that we are, we are talking with at the department of health are, are new. And you can see, they do have, um, you know, many of them do have a positive, um, kind of way of looking at, at 

community pharmacy. 

Mike Koelzer, Host: kind of placating you. They don't come up with anything.

Leyla Hannbeck MPharm: Um, well, they, they, they hear from us what, you know, what the case is in terms of like the data that we have to offer. And, um, and then they take it to the decision makers in terms of like within, within, within the government. And so, um, and so it's, it's kind of complicated. It's very complicated in that, you know, we've got, you know, so many various different layers, um, that we need to go to go through, but we do obviously talk directly to the politicians as well to, you know, we do go to the parliament and hold events at the parliament and talk to the politicians.

We talk to the ministers and the secretary of states and, um, in terms of trying to push a case forward. Um, but there are these barriers there in terms of like at the highest levels of perhaps civil service, um, that we still haven't been able to. get through perhaps and, and, you know, and convince and try, well, it's we are, we, we know what we are about

and the evidence speaks for itself.

Um, it's just the culture of leadership that needs changing. Um, I think within, within those, um, um, 

Mike Koelzer, Host: and I think that with any change it, you gotta keep pushing. You don't know who's gonna break through, you don't know what's gonna break through, but you, you can't choose that ahead of time. You have to hit it on all levels and then all changes that way someone gets a hold of [00:55:00] something

Leyla Hannbeck MPharm: exactly. And that's what keeps me going, Mike, in terms of like, you know, sometimes when you hit a brick wall and you think to yourself, oh gosh, now we hear you again. Um, you can't, you know, I, I, I say it to myself. I keep pushing, keep pushing, keep 

pushing, keep pushing, and be patient, keep pushing, keep pushing, 

and, um, find a new way of doing it.

Find a new way of doing it. And, um, you. One day it'll get through

Mike Koelzer, Host: Leyla, if I had to pick one person to blame, I don't know England that well, but if I had to pick one person to blame in all this, I'm gonna say Prince Harry.

Leyla Hannbeck MPharm: excuse me. He's he's he's your, you know, he's an American now, so you should be, you should be his 


Mike Koelzer, Host: All right. My favorite, uh, news that I read I'm on it for way too long. Every day, even though they got too many damn ads online. Now that's England right? The daily mail, but it's called mail online. 

Leyla Hannbeck MPharm: My 

Mike Koelzer, Host: Right. So that's my favorite news And not because I'm like, Hoy toy, like I like, you know, British news and stuff.

It's just, it's good. It's like a combination of like, you don't know these, but like people magazines slash USA today. It's news, but it adds human interest stories and so on. But Once in a while, when something happens with, uh, prince Harry, is it still okay to call him prince or did he get that removed?

Leyla Hannbeck MPharm: No he's called Prince Harry

Mike Koelzer, Host: Once in a while they have prince Harry they'll have prince Harry. And, uh, what's her name? Meghan Is Megan?

Leyla Hannbeck MPharm: Meghan 

Markle Markle 

Mike Koelzer, Host: Meghan Markle 

and they'll have like 20 stories of them in a row and 

I like it too much. 

Leyla Hannbeck MPharm: You can

see that they don't like them. Mm.

Mike Koelzer, Host: The general public, you how's prince Harry. is he a trader?

Is he okay? What's the word on the street in, uh, in England?

Leyla Hannbeck MPharm: oh, um, you're asking my opinion or generally what the word is on the street.

Mike Koelzer, Host: What's your opinion?

Leyla Hannbeck MPharm: Um, to be honest, I don't follow 

follow that. I do read daily mail. I do. Um, I do, um, I think it's, it's the most red paper or online, um, in the, in the UK actually. So it's got a huge readership. Um, I do read, um, you know, obviously I want to keep in the loop in terms of like what's happening and, and you know what people write because you can see the commentaries 

of, um, what people write is is

important, but, but, when it comes to those stories, um, to be honest, I just skip through them.

I don't read them.

Mike Koelzer, Host: The comments on mail online. And I've actually, I don't do this too often, but I actually have a handle. I'm not gonna tell you what it is, but I've got a and I'll go on there and comment once in a while.

Leyla Hannbeck MPharm: you 


Mike Koelzer, Host: I'm not gonna tell you who I

Leyla Hannbeck MPharm: Oh my God. So we know all these nasty ones coming from you,

Mike Koelzer, Host: Ah, well, yes, yes

 You got this queen over there, long time she's been, I think 70 years now,

Leyla Hannbeck MPharm: yeah, well, no, uh, yeah. Yeah, I think so. Yeah. 70 years. Yeah. 70th anniversary.

Mike Koelzer, Host: They don't do anything. Right. They just look fancy. They just represent England. 

Leyla Hannbeck MPharm: Well, their role is kind of not be involved in any politics really, and

just kind of represent as such. Um, but I'm not the best person to ask about this because I'm not re I don't follow stories about Royals and all of that. Um, cuz I, I, you know, having grown up in Finland, it's just, we haven't been much into royalty.

When I look at my kids, for example, in school, um, well they're taught about it right from a young age, in terms of like, about the queen and about, um, you know, how to write to the queen and you know, stuff like that. Um, so it kind of is embedded in them as they grow up.

Um, but this wasn't the case with me in terms of when I, when I was growing up, this wasn't really something that I had followed. And so, um, so as such, I don't really that much attention

Mike Koelzer, Host: the Kardashians

Leyla Hannbeck MPharm: Um, I think everyone in the world knows,

uh, about the Kardashians. 

Mike Koelzer, Host: the 

Royals is kind of like following the Kardashians. Right. It's kind of like a gossip gossipy thing.

Leyla Hannbeck MPharm: definitely. Um, you know, it's, it's one thing that, you know, the media have something to write about as well. You know, occasionally when they're out of stories, they can put some papers, um, you know, write something about, about, um, you know, the Royal family or, or, or so on.

But as I said, when I go to daily mail, I mean, right now in the UK so much is happening. In terms of like, you know, with, uh, the cost of living, energy prices, war and Ukraine, um, then you've got, know, everything else that is going on, that you just there's [01:00:00] too. There's loads of stories to read. Um, so I kind of flip through the other

Mike Koelzer, Host: You know, what else is too much besides the, uh, the queen is, um, soccer. We just don't care about foot, you know, English football. We just don't care about that over

Leyla Hannbeck MPharm: Oh, no, it's lovely football is, is in, in the, in the DNA

of, uh, 

Mike Koelzer, Host: don't care about that over here. that. 

Leyla Hannbeck MPharm: I don't understand. I mean, again from I'm I'm, you know, in the UK people like rugby, um, I don't understand that game, but it's a 

big deal 

in America. Isn't it?

Rugby or 

American football. 

Mike Koelzer, Host: not that huge. I think it's maybe, um, Australia is that rugby. Do they do a lot of 

Leyla Hannbeck MPharm: they 

Mike Koelzer, Host: something 

Leyla Hannbeck MPharm: New Zealand does. Yeah. Yeah. You do baseball. Don't you


are huge. 

Mike Koelzer, Host: baseball. That's the pastime of baseball and apple pie. When you think about the American way, it's baseball,

Leyla Hannbeck MPharm: Is it more popular than basketball? Which one would you

say is a basket? 

Mike Koelzer, Host: uh, it's about the same probably, basketball, baseball and football are about the same. And then there's, you know, other stuff, people are gonna argue with me, but there's NASCAR and hockey and all that, but the big three are probably baseball, football and basketball.

Leyla Hannbeck MPharm: yeah, 

Mike Koelzer, Host: We share more in common with you guys as independent pharmacy owners than we differ much more in common.

What words would you give to pharmacists? And I know this is a time of frustration and a time of sadness. What would you leave with at this point?

Leyla Hannbeck MPharm: I think, um, as pharmacists, we should really be proud, um, of our sector and our profession. I think, um, one thing that we have, we have seen over the past few years is how important overall our profession has within the society. We are part of the fabric, um, of people's lives and society. And so we should really be proud of that.

And when we don't get the recognition, which is very hard sometimes because obviously we work really, really hard and we are right at the forefront of healthcare. Um, we shouldn't let it get us down. Um, and we should come back up and be proud. And, and a lot of times, you know, it's those patients and, and, you know, that value us that we should think about in terms of like what they say to us should really matter a lot.

And so, and we know that they do value 

  1. We know that the work that we do for them is very important. Um, I just need to hammer that home to those in position of power and, and the decision makers to make sure that they see things the way the constituents and the public see it. Um, so that's the challenge that I have, for example, with, with my role.

Mike Koelzer, Host: Boy Lela, it's a pleasure reaching out to you across the pond, as they say. And as we talk, we don't know when the voice of the pharmacy, I mean, has broken through, but it continues to break through and we don't know where that is.

So I appreciate you coming on and talking about this and doing what you're doing.

Leyla Hannbeck MPharm: It's been a pleasure, Mike, thank you for inviting me to this. it's been lovely chatting to you 


pharmacy in the UK.


Leyla Hannbeck MPharm: thanks Mike.