Katey Logan
Search for other papers by Katey Logan in
Current site
manchesterhive
Google Scholar
PubMed
Close
Customers who don’t buy anything! The introduction of free dispensing at Boots the Chemists
in Posters, protests, and prescriptions

In 1948 Boots the Chemists was placed at the intersection of high-street commercialism and public healthcare as its pharmacists took on the role of delivering dispensing services for the new nationalised health service. This chapter investigates how the NHS, as a cultural phenomenon, profoundly impacted the high-street retailer and its cohorts of professional pharmacists after 1948. It follows the changes in the physicality of dispensing in the shop setting, the advertising of NHS services in shop windows, and the enhancement of pharmacists’ professional reputation through their role in public health. While for the pharmacy profession as a whole, state-compensated dispensing was economically risky, Boots incentivised its pharmacists to compete for NHS prescriptions, leading to a massive uptake in service usage and customer footfall. Analysis of prescription service data highlights the importance of a new population of customer-patients who ‘didn’t buy anything’ yet drove Boots’ ‘NHS business’ by taking advantage of free dispensing services. The chapter locates the NHS’s cultural reach in a novel physical and material domain on the high street, in the relationships between pharmacists and patients, and in the expression of professional identity. It concludes that the symbiotic relationship between Boots and the NHS propelled both to become ‘bigger’ cultural players.

This chapter looks at the emergence of the National Health Service (NHS) on the British high street in 1948. It explores people’s access to prescription medicines delivered in shops, as opposed to the health treatments and consultations available from surgeries, hospitals, or other familiar ‘institutions’ of the NHS. Specifically, the chapter asks: what cultural shift – evidenced by the millions of patients trailing from general practitioners’ (GPs’) surgeries to chemists’ shops for their free medicines – did NHS dispensing evoke and impart on community chemists and their customers? ‘Cultural’ aspects of the NHS and its manifestation in the high street draw from Ludmilla Jordanova’s wide-ranging work on visual and material culture and Roger Cooter’s analysis of cultural history as a successor of the social history of medicine.1

The subject of the case study is Boots the Chemists, a retail pharmacy chain that grew from a family herbalist business in Nottingham in 1849 to become the UK’s eponymous high-street chemist with around 2,500 stores.2 As the founding date shows, Boots was operating in the private sector for almost a hundred years before the inception of the NHS, and in the seventy years since then it has been contracted to provide dispensing and other services for NHS patients. It is this marriage of consumerism and nationalised healthcare, and its cultural impact on service users and providers, that is the focus of the chapter.

The state-sponsored NHS began on 5 July 1948. Literally overnight, GPs were contracted to provide free and universal community healthcare for men, women, and children. Although private healthcare was still an option for those who wished to have it and could afford to pay, the principle was established in law that healthcare provision was no longer reliant on local practice, wealth, circumstance, gender, or charitable support. As part of this new nationalised system, private-sector pharmacists were contracted to provide free dispensing services. In removing dispensing from doctors’ professional domain, the NHS brought a new demographic of clients to the high-street chemist’s shop, specifically women and children, whose healthcare needs were met, largely, for the first time.

The Boots Archive has a rich collection of extant documentation covering the retailer’s twentieth-century operations.3 The research described in this chapter used public domain annual reports and chairmen’s statements as well as private company records. In particular, the company’s retail staff magazine, The Bee, represents a rich source of visual and material culture and comprises articles and photographs of Boots products, shops, staff, and sports and social events, as well as humorous illustrations, correspondence, and reportage, produced for and by the retail staff. Its format was based on contemporary pharmacy journals which focused on pharmacy education and professional issues, as well as reader correspondence, cartoons, and political discourse. The Bee magazines were issued (under one editor4) at least four times annually from the 1920s to the 1960s and give a rich impression of shop life and the issues facing and tackled by the company’s chemist-managers and their staff. The other significant archive source for this study was the company’s annual statistical reports, which provide very detailed, store-level information on income and expenditure – including breakdowns of private and NHS dispensing – payroll, store numbers, profitability, and employee census including roles, full-time or part-time working, and gender breakdown.

Records show that from the mid-twentieth century, the geographic reach of Boots’ thousand-plus stores in the UK extended from the Orkney to the Channel Islands, from inner city to rural county town,5 with the company pushing an ambitious advertising strapline, ‘chemists to the nation’.6 The pharmacists operated in a cross-section of UK communities and were representative of community pharmacy practice nationwide. From this period Boots dominated retail pharmacy through its acquisition of competitor chains and provided the commercial prototype for ‘follower’ corporate chemists within the UK such as Lloyds Pharmacy, Superdrug, and latterly the supermarket chains Tesco and ASDA.

In 1948 Boots pharmacies were positioned at the intersection of consumerism and public healthcare, and this chapter looks at how they shaped and interpreted cultural visions of the NHS through four key domains: firstly, the visibility of NHS prescription dispensing services, both in terms of the physicality of dispensing in the shop setting and in shop window advertising which communicated the forthcoming healthcare changes; secondly, in the development of customer relations, where the high-street chemist was obliged to welcome NHS patients – including those customers who ‘don’t buy anything’ – the antithesis of model consumers; thirdly, the company’s specific response to NHS ‘business’ in terms of incentivising shop managers to embrace and develop it, and corporate investment in the physical environment of the shops to accommodate NHS demand; and fourthly, the impact on high-street pharmacy professionalism that the NHS made by providing pharmacists with a prominent, legitimising, and essential role in the new national healthcare system.

This chapter also contributes to the debate around the extent to which 1948 marked a stark cultural or political turning point in terms of histories of healthcare. While some insightful work has depicted 1948 as less temporally significant and representing more of a continuation of pre-war trends,7 particularly with reference to the hospital system, this analysis adds nuance to our chronologies by emphasising 1948 as a temporal puncture: Boots advertised the newness of the NHS system in shop window displays, and presented July 1948 as a significant marker for change in the relationship between pharmacist and patient.

The case study of a single institution therefore provides a rich and diverse source of cultural data. It lends itself to a multi-layered definition of culture as material and environmental, as an expression of the everyday relationships between healthcare providers and the public, of economic change, and of professional identity. This diversity highlights the ‘bigness’ of the NHS as an institution whose cultural reach extends beyond traditional hospital and local surgery settings. Like Alex Mold’s chapter in this volume on health messaging in the public domain, this case study places the NHS in the community, addressing the editorial question of how the NHS is lived and felt in public life and culture.

Finally, the case study acts as a reminder that the high-street chemist’s shop is a far more familiar place to most NHS patients than the hospital, Mathew Thomson’s ‘symbolic space of the NHS’. It is the place where, from 1948, millions of NHS prescription medicines were presented and dispensed, mediating patient entry, exit, and interaction with the institution that is the NHS.

Physicality of the pharmacy

The physical presence of pharmacies in the high street makes them a central cultural mediator of public beliefs about the NHS. Within the shops, the pharmacists’ professional healthcare role is a very public one. Their workplace makes, and has long made, them accessible, allowing them to give appointment-free consultations, receive direct customer feedback, and feel ‘valorised by patients’ in a public setting.8 They are visible, unlike doctors and dentists or hospital clinicians whose consultations are conducted with privacy, intimacy, and purposeful confidentiality behind closed doors. There is little real privacy in the chemist’s shop, with the exception of the quasi-private ‘spaces’ introduced in the 1990s to accommodate methadone users or smoking cessation patients.9 Ordinarily, both the pharmacists and their patient-customers are in plain sight at the dispensary counter, perhaps talking in hushed tones, but nevertheless on show as either the professional providers or the sick recipients of medicine or medical advice and intervention. Management academics describe the workplace practices of pharmacists as performative; that is, they ‘perform their work’,10 ‘being’ professionals, providing theatre for other shoppers and staff alike. It is this public performance of healthcare in practice that differentiates the high-street chemist’s shop from the GP’s surgery and boosts the cultural significance of the dispensary.

For pharmacists working in 1948, the dispensing workload pushed them away from the public gaze at the centre of commercial shop life to a more full-time position behind the dispensary counter. The dispensary environment was enhanced or expanded in many Boots stores, as the chairman explained in his annual general meeting (AGM) speech to shareholders in 1949: ‘our Shopfitting Department has been working to capacity altering and enlarging dispensaries […] to give […] the best conditions for both patient and our own staff alike’.11 In some shops the dispensary was relocated away from the busy sales floor to allow the pharmacists to better concentrate on their work, and in large stores they were moved off the ground floor and into first-floor accommodation. This was part of a change in physical infrastructure in the Boots stores, where investment in new and larger dispensing counters was seen as vital to delivering the enhanced NHS service.

Therefore both the pharmacists’ position in the shop and the shop setting itself set up a new cultural exchange with NHS patients. And as Boots’ portfolio of stores expanded, with the acquisition of thirty new shops in the immediate post-war period and a steady year-on-year increase for the decades afterwards, so did the public’s experience of NHS dispensing on the high street.12

NHS advertising in Boots shops

The physicality of Boots’ retail space, in towns and cities nationwide, was also ‘requisitioned’ for NHS advertising, again making Boots an everyday cultural representative of the new service. In advance of the introduction of the NHS, Boots ran an advertising campaign in its shop windows outlining the dispensing services available from 5 July 1948. Figure 6.1 is a photograph of a shop window displaying the relevant show cards, published in the Boots internal magazine, The Bee, as a demonstration model for other stores to copy. The NHS ‘narrative’ was given a full window display where possible, essentially advertising the prescription service alongside medicinal ‘products’. In effect, with over 1,200 stores at the time, Boots provided a prominent high-street advertising channel for the government’s national health service.

The visual and narrative discourse speaks directly to the passing public, whether Boots customers or not. As Figure 6.1 shows, the main directive – ‘Let us dispense your National Health Service prescriptions’ (top left) – asks (potential) customers to choose Boots pharmacists to dispense their prescriptions. The reference to customer choice underlines the availability of NHS prescriptions and all chemists’ obligation to dispense them. A further message, ‘Bring your prescriptions to Boots’ (top right), reinforces this, and the accompanying photographic image of the white-coated professional chemist, working diligently to prepare medicines, invites trust in the chemists’ professional expertise and practice. A third notice, in bold and capitalised type and entitled ‘The New National Health Service’ (bottom right), again advertises the availability of the service and exhorts passers-by to bring their prescriptions to Boots. The NHS ‘message’ is culturally rich in its universality and didacticism: ‘From that day every man, woman, and child is entitled to medical attention, medicines, and surgical appliances, free of charge.’

The products themselves, dispersed across the window display, represent both commerce and pharmacy professionalism. They have cultural resonance and graphically illustrate Boots shops as a site of both traditional and modern specialist skills. The professional tools – specie jars, weights and measures, scales, pill roller, measuring jars, medicine bottles (containing tonics), medicine boxes (containing powders), pestle and mortar – are materials of medical knowledge, and implied status. Commercial products were therefore imbued with life-enhancing medical professionalism.

The NHS is framed as ‘the greatest single occurrence in our history’, despite this proclamation being made in the aftermath of the Second World War with all of its social and economic consequences. This underlines its cultural significance, as does its presence in shop window advertising; the blending of socialised healthcare services and commercial practice cements the shop setting as a cultural mediator for the NHS. This expression of commercial culture in the high street does complicate visions of the NHS institution as the ‘universal’ service of post-war democratic settlement. Indeed, looking at the role of retail pharmacies reveals that commercial interests have long played a part in shaping and mediating NHS healthcare, decades before campaigners – discussed in Crane’s chapter in this collection – began to raise concerns about private-sector interference in nationalised healthcare, in the 1980s and 1990s.

Commercial insecurity and NHS implementation

A second way in which high-street pharmacies acted as a cultural mediator for the NHS was through the everyday relationships established in stores between health workers – the pharmacists – and their patient-customers. The patient-customer was an early iteration of Alex Mold’s emerging ‘patient-consumers’ of the 1960s, 1970s, and 1980s, who increasingly challenged the power of the medical profession through organised action.13 The patient-customer had a similar dual identity as both a medical patient and a consumer of medical service, though in this case they were buying or receiving a product in a shop setting, and the interaction was likely to involve direct financial transaction. The patient-customer, then, derived agency from personal spending power, not collective protest or action.

The financial viability of participation in the NHS dispensing service was a contentious issue for many high-street pharmacists, and letters to newspapers and professional journals in the late 1940s and early 1950s communicated a frustration with the delay in government remuneration for services. Independent pharmacists, in particular, appeared angry at the high NHS workload and delayed financial payback,14 as well at as their new beholden-ness to state health regulation.15 Newspapers reported private chemists threatening to strike and leave the new health scheme because of a reduction in fees in 1950,16 while letters to the editor in the Pharmaceutical Journal championed a challenging approach to government, suggesting that ‘a much stricter line must be taken in our negotiations and a more realistic attitude to our day-to-day problems adopted’.17 These pharmacists campaigned against the NHS, risking a cultural backlash from patients eager to use the new service. The incongruity of pharmacists in commercial shop settings threatening strike action against the state signals an interesting cultural dissonance.

In contrast, Boots pharmacists working ‘front-of-house’ with NHS patients were not part of a ‘generic’ pharmacy profession frustrated by NHS bureaucracy, because they benefited from the economic protection of the Boots organisation. It was the company’s shareholders that were predominantly exposed to the vicissitudes of NHS market economics. Similarly, corporate chemists needed only to manage stock orders from head office, and not stock purchases from independent wholesalers, so despite any concerns about the administrative burden of working for a large and complex business organisation, they remained relatively cushioned professionals whose high-street livelihood did not have to depend on tight financial management or personal entrepreneurial risk. This economic support was important on two levels: firstly, in reducing the pharmacists’ financial anxiety, it softened their response to the NHS, creating a supportive culture; and secondly, it influenced relations with patients, for example, in shop conversations and opinions about NHS healthcare. Conversely, it suggests that those private chemists without financial backup lacked this common purpose and partnership culture.

That Boots pharmacists were ‘for the service’, not ‘against it’, suggests political, economic, and cultural alignment at odds with other professionals in the sector, implying a complex cultural response to NHS implementation in the pharmacy sector. This disparity resonates with Gareth Millward’s findings in his study of GPs’ responses to patients’ requests for sick notes after 1948, described in his chapter in this collection.

‘Customer service’ for non-paying customers

Another area of cultural interplay between Boots pharmacists and the NHS was their interaction with ‘non-paying’ customers. Despite the economic buffer protecting Boots pharmacists, they did shoulder a significant increase in workload produced by the throughput of new scripts. The volume of NHS dispensing required a renegotiation of relationship between customers, now NHS patients, and shop staff, now NHS service providers. The Boots staff magazine, The Bee, featured articles, correspondence, and occasional cartoons contributed by retail employees which communicate what pharmacists were thinking and how they were responding to the situation.

One cartoon in particular (see Figure 6.2) portrays the changing relationship between Boots pharmacists and their customers. The cartoon, created by an employee named as ‘SHS’ from Stourbridge (store number 237), was published in The Bee in February 1951. This cartoon’s two protagonists – pharmacist and customer – stand in front of the store dispensary. A directional notice, ‘Please hand in your prescriptions here’, shows the controlled access to the dispensary, where prescriptions are processed. This represents a new efficiency in prescription management in Boots stores, following a programme of structural extension of dispensing counters after 1948.

Both protagonists look young, healthy and happy: the pharmacist in a ‘white coat’ and holding his coat lapels in a gesture of confidence and authority, the customer the antithesis of sick patient. She wears smart clothing, jewellery, and accessories and looks directly at the pharmacist – an appearance and confidence associated with Boots’ middle-class clientele. The cartoon one-liner is the pharmacist’s statement, ‘We’ve missed you these last few days, Mrs. Jones. Have you been feeling well?’ The pharmacist humorously draws attention to the customer’s overuse, perhaps abuse, of the new NHS prescription service.

The cheerful and engaging demeanour of both parties suggests that excessive use of the NHS service may be of benefit to both: the customer receives free medicines, and the pharmacist receives government recompense for medicines and dispensing costs. The pharmacist is seen to be teasing the patient for her repeat visits to Boots. She is not given a voice: instead the pharmacist states that she has been ‘missed’ over the previous few days and asks, ‘Have you been feeling well?’ The reference to being missed suggests that her usage is being monitored; the pharmacist is acting as gatekeeper for the NHS, but he is not angry or punitive, and on the contrary the word-play suggests he is missing her as a customer. So, while she may be exploiting the new healthcare system, he can benefit commercially from her actions. In this depiction, the NHS is not associated with a poor and needy clientele, or indeed with the sick. Indeed, it is a free public service rather than a social service associated with working-class patients using the pre-war National Insurance scheme, and this communication intends to remove any stigma from public healthcare provision. The cartoon, published in the company’s staff magazine, sends a message to Boots pharmacists that NHS prescriptions are to be welcomed and are not in conflict with either their professionalism or commercialism. Furthermore, the analysis shows that even ‘dry’ economic change is advocated, negotiated, and communicated through culture, in this case the ‘theatre’ of cartoon characters.

It is important to appreciate that this cartoon was for private circulation only, and this visual analysis is a singular interpretation: there is no way of measuring its impact at the time.18 It was created without NHS ‘approval’, certainly below the radar of state regulators or service commissioners, and yet its publication in the retail magazine implies editorial endorsement, and its humour, though perhaps ambiguous, communicates both resistance and challenge to the new healthcare order. It also shows the ubiquitous and pervasive nature of the NHS’s cultural reach, beyond national broadcast and newspaper outlets. The impact of the NHS, even in its first decade, was being negotiated through visual imagery in niche and popular media alike.

NHS workload and profitability

To put Boots’ NHS business in context, it is important to review the disruptive nature of wartime economics and the role it played in setting up the post-war business culture at Boots. Between 1939 and 1945 the economics of shop life were turned upside down as products became unavailable or rationed, shopkeepers could not sell, and customers could not buy – conditions that continued into the post-war period. The Boots pharmacist and head of staff training, W. C. Jarvis, described this in the first post-war edition of the retail magazine: ‘Many of our practices were so changed as to be reversed. Instead of salespeople persuading customers to buy they were often compelled to limit the customers’ buying […].’19 War dislocation was not reversed overnight and, indeed, the return of many pharmacists to Boots from the armed services and other civil service roles was not complete until 1948. Therefore while this case shows that the inception of the NHS in 1948 was a decisive turning point for Boots staff and customers alike, because of the war context it was also part of a decade of dynamic and inexorable social and economic change.

Cultural change was highlighted in the chairman’s AGM speech to shareholders in August 1949:

The outstanding event for your Company […] was, of course, the inauguration last July of the National Health Service. This has led to a vast increase in dispensing and in the demand for drugs […] we have done our utmost to help in making the pharmaceutical service [...] a success from the public’s point of view […] I should like to pay a special tribute to all our staffs for the fine job of work they have done in dealing with this immense volume of new business […] and in particular for the high standard maintained in the dispensing.20

The market impact of the NHS included a significant increase in demand for dispensing, which, taken alongside the introduction of self-service and the expansion of Boots stores in terms of numbers and size in the 1950s, resulted in greatly expanded workloads and changing work practices. Statistics generated from annual reporting of profitability, store network development, staff census, and dispensing services at Boots show an exceptional increase in dispensing within the context of an expanding network of stores and a growth in pharmacists’ employment across a thirty-year period.21

Figures 6.3 and 6.4 show the impact of the inauguration of the NHS on Boots’ dispensing business in terms of volume and value. The size of the increase in business is staggering when set against a relatively modest increase in qualified pharmacists and apprentices.22 In 1948 National Health Insurance (NHI) workers’ insurance scripts ceased and were replaced by the free NHS scripts, but for purposes of clarity in relation to private scripts, the graphs in Figures 6.3 and 6.4 depict them as a continuum. The number of NHI/NHS prescriptions spiked upwards in 1948 (approximately 500 per cent) and maintained a high level throughout the 1950s, while the value of prescriptions over the same period shows a continuous increase, again spiking upwards from 1948. The footfall that these increased transactions represent reflects a jump in customer numbers (measured in sales transactions) from 230,209,607 in 1948 to 240,937,400 within a decade.23 This step-change in customer footfall and economic return underlines the impact and significance of NHS transactions on high-street culture.

Incentivising NHS work

As the previous section shows, the volume and value of the NHS dispensing service impacted the pharmacists’ workload and the company’s profitability respectively. Further investigation of remuneration policy at Boots shows how the company incentivised its professional staff to undertake increasing amounts of NHS work. In the inter-war period Boots operated a sales commission scheme which rewarded shop managers (always pharmacists) and senior sales staff with commission on ‘own goods’ sales. In the 1930s the scheme was regarded by some pharmacists as somewhat toxic, since relentless ‘salesmanship’ undermined the pharmacists’ professionalism,24 though it survived unchanged until the 1940s. As a result of the wartime dislocation described above, Boots dropped the scheme, and with commission gone ‘the sleek-haired, blue-eyed boys’ (the pharmacists) were consigned to the back room and out of the busy shop.25 This discourse in the staff magazines suggested that retail staff were pleased that the pharmacists were no longer ‘competing’ with them for sales, and that by dropping the incentive scheme the company had changed pharmacists’ behaviour in respect of customer interaction.

The statistical records offer data relating to changes in remuneration practice. They include figures on the annual expenditure on retail salaries, with breakdown for branches, regional managers, and relief managers (today’s locums). The recording of bonus and bonus schemes changed over the years, making comparisons difficult, but headline figures show that managers’ bonuses stopped in 1941, presumably as sales and profits were thrown into turmoil by the war, and re-started in the financial year 1953–54. Instead, a payment in lieu of the suspended bonus was paid out between 1942 and 1948. In addition, a new managers’ bonus scheme for dispensing started in financial year 1948–49. This is evidence of a very direct relationship between dispensing volumes and pay, essentially incentivising Boots store managers to increase the NHS work and patient throughput of their stores.

This change in financial benefits provides another explanation for the fact that Boots pharmacists accepted the NHS workload while, as mentioned previously, the private chemists and hospital chemists were threatening strike action and unionising respectively.26 The situation in which pharmacists were paid bonuses for pro rata dispensing, in an era when NHS dispensing figures rose exponentially from zero, certainly fitted with the Boots company chemists’ identity portrayed in the discourse in The Bee: their sense of financial security, their readiness to compete for scripts and to give a warm welcome to the ‘Mrs. Jones’ customers. Ultimately the sheer volume of new customers, and their consequent trade, provided an undeniable economic boost, as the case of Boots shows, and when linked to bonus schemes it propelled the high-street chemists to better-paid and higher-status roles within their communities.

The commission problem identified in the 1930s was therefore resolved by aligning the pharmacists’ commission not with commercial sales but with dispensing volume, a significant shift in incentives which for the first time linked take-home pay with core pharmacy work. The change in bonus policy, whether driven by the organisation or the pharmacists, made a profound change to pharmacy professionalism, and one that separated Boots pharmacists further from private chemists, whose income and livelihood were more directly funded by shop sales.

Another feature of the direct commercialising of the new NHS dispensing service was the competitive ‘sales’ drive set up to help deliver it. A company-wide competition (Figure 6.5) positions NHS dispensing as a ‘great opportunity’, with cash prizes ‘awarded for the biggest PERCENTAGE increase in the number of prescriptions dispensed’, and one that necessitates branch effort on a scale never seen before in order to fulfil Boots’ potential as ‘Chemists to the Nation’. The NHS ‘business’ is fundamentally linked to competitive sales, with the throughput of NHS scripts measured on an annual like-for-like basis, rewarding the best-performing stores in each region.

The Bee’s internal coverage of the NHS window display demonstrated a commercial imperative to increase market share by attracting patients into Boots at the expense of rival independent or corporate chemists. Here the NHS was used as commercial bait to incentivise store staff and ultimately to increase share of NHS ‘business’. Therefore, NHS dispensing, Boots’ ‘NHS business’, was directly driven by employee incentive schemes which determined the behaviours of the retail staff in their day-to-day professional and retail practice. In this way, participation in NHS dispensing made a significant economic and cultural impact on the chemist chain, its pharmacists, and their patient-customers.

Professional identity and public duty

The fourth and final way in which Boots pharmacists were culturally impacted by the NHS lay in the developing dynamic of professional identity and public duty. Professional identity was affected by the imposition of the NHS in that it helped establish a different relationship between UK pharmacists and the public. Similarly, the pharmacists’ regulatory relationship with the state changed from one where they had some administrative duties, such as creating and maintaining registers of poisons in response to the 1933 Poisons and Pharmacy Act, to a wider level of regulatory duty which brought governmental scrutiny of both their pharmacy practices and their expertise.

There is evidence of a problematic relationship with NHS ‘authority’ in the discourse in The Bee as well as in the pharmaceutical press and indeed the mainstream media. Boots pharmacists discussed establishing professional associations, independent of the company, which would work at regional level to talk over problems ‘in particular in connection with the NHS’ as well as the more political endeavour ‘to get Boots pharmacists on the local NHS Committee’.27 The first regional association – Boots Surrey and South West Pharmacists’ Association – was formed in June 1948, anticipating the issues to come after the introduction of the NHS in July. Within six months the protagonists shared in The Bee their collective aspiration to become more influential in professional matters, stating:

We are an entirely non-political Association of employee pharmacists, existing solely in a constructive and co-operative capacity, knowing that if the Firm [Boots] goes ahead, we shall go ahead too […] It is one of our aims, and also of our neighbouring Association – Boots Pharmacists’ Association, Metropolitan – with whom we work harmoniously in very close co-operation, to get some Boots men on the council of the Pharmaceutical Society. We shall continue to keep a careful eye on all future developments affecting the welfare of our pharmacists and feel that as long as we continue to strive for the highest ideals, our efforts will not have been in vain.28

This statement sends a strong message about the Boots, predominantly male, ‘collective’ who wanted to represent ‘our pharmacists’ on both the Pharmaceutical Society Council and (as previously mentioned in the article) the local NHS committee. Both these initiatives, publicised in The Bee in March 1949, show the pharmacists working independently of the Boots organisation but self-identifying as ‘employee pharmacists’. That is, it was not the members of the Boots executive who were blazing a trail to the Pharmaceutical Society Council, but branch chemists who, through their own identity work, strove to represent the working collective of Boots retail pharmacists. This is a tangible manifestation of employee chemists engaging with the wider profession.

Hence Boots pharmacists were energised by public service work imposed on them by statutory change, and were encouraged to look outside the company and indeed to aspire to sit on the Pharmaceutical Society Council, the institutional embodiment of their profession. However, there is no indication that this broadening of professional identity displaced their corporate identity or loyalty; and the impression given to all other pharmacists within the readership of The Bee was that this outreach work is in the interests of the company as much as in the interests of its pharmacists. This development coincided with hospital pharmacists joining trade unions, or being subject to trade union marketing efforts, and seeking to collectively negotiate salary and remuneration after 1948.29

Boots, as a corporation, intended to support the NHS and ensure its success. Within a few years, the agency of this early discourse was confirmed in a line of the chairman’s AGM statement emphasising that ‘the Firm of Boots The Chemists is regarded more perhaps as a public service than as a purely commercial enterprise [...]’.30 There is also evidence of a more routine and collaborative working relationship with state institutions, such as hospitals, or the local medical authorities. After debilitating floods in Whitstable, Kent, in 1953, Boots pharmacists responded to the Medical Officer of Health’s request to ‘undertake the distribution of a gift of whisky, five ounces at a time, on prescription, to distressed folk […] [maintaining] Boots reputation for service’.31 On the following page of The Bee there is another description of Boots pharmacists supporting public health. Here a ‘hospital trolley of products’ is provided for distribution at the Royal National Orthopaedic Hospital in London.32 In both these examples Boots pharmacists sought to demonstrate that they were working for the benefit of the communities in which they served, at the request of government and on their own initiative. Another example appeared in a statement showing empathy for mothers whom Boots pharmacists actively and demonstratively cared for in their shops, knowing that they had left their sick children unattended at home while collecting their prescription medicine. The Bee of March 1949 stated: ‘We try our best to make the atmosphere in the branch warm and friendly, so that the worried housewives feel cheered.’33

These behaviours and attitudes were a response to the many children’s prescriptions that were dispensed as a consequence of the NHS. They also indicate that ‘the doctor has called’ at people’s homes, a community service that before the NHS was available only privately and was now a cause of increased prescribing and dispensing.34 This emphasises, once again, the ‘bigness’ of the NHS in reaching beyond the culturally iconic hospital and surgery settings and into high-street communities and indeed family homes.

In the pre-NHS period there was evidence of a constructive dialogue between medical professionals and Boots chemists, and chemists were positively encouraged to make contact with and support GPs, not least because the latter group could refer patients into Boots stores for their scripts. This relationship continued to develop within the new NHS framework, where both GPs and pharmacists learned to deliver, at speed, the new public services. In the early years of NHS implementation there were positive comments in The Bee about ‘our doctor friends’35 and sympathy for their heavy workload. In 1949 a hope was expressed by a contributor that the ‘rush of the new Health Service’ would not over-burden GPs by placing ‘a heavy strain upon them’.36 The remark reflected contemporary anxieties that the anticipated popularity of the NHS could adversely affect the healthcare professionals who delivered it, showing specific professional solidarity with GPs. It also acknowledged the leap in GPs’ patient numbers in the first six months of the NHS, when an extra 21.5 million patients registered, increasing the national patient list to around 40 million people.37

Discourse published in The Bee also expressed advocacy for the pharmacist’s role as ‘co-worker’ with the doctor,38 a description that helps build a picture of the changing professional status and identity of Boots pharmacists in relation to doctors and public service. Thus NHS work was creating a changing dialogue between the professional groups delivering it. This supports the earlier observation that 1948 was a turning point in the cultural life of those healthcare staff bound by contract to deliver the public services of the new universal institution.

The public duty conceptualised as intrinsic to NHS dispensing therefore had an effect on the professional identity of Boots pharmacists. It broadened their interests, encouraging them to participate in professional institutions. It altered their relationship with state medical officers and regulators, and it fostered a closer and mutually beneficial relationships with GPs, their one-time professional rivals.39

One final element of a changed professional identity has been alluded to in the discussion above of the pharmacy’s physical environment. The separation of the pharmacy counter and pharmacist from the sales floor and ‘commerce’, as a result of the stores’ re-configuration, created a boundary between these aspects of the roles, and this was apparent in the language used by an apprentice pharmacist who anticipated a ‘greater distinction’ between professional work and day-to-day shop work.40 Perhaps this fed a professional need, and indeed a public expectation, to see pharmacists as more ‘elevated’ or embodying higher status than shopkeepers of old, evoking the ‘merely traders’ description in the pre-NHS period.41

All these factors – proactive activity in professional organisations, new emphasis on public duty, more collaborative relationships with doctors, and re-positioning within the shop setting – legitimised the public health role and enhanced the professional reputation of Boots pharmacists. By association they also changed the public profile of both the retail chain and the pharmacy profession in general.

Conclusion

The dispensing of medicines brought the NHS to the heart of the British high street. In the post-war era the focus on selling was a commercial imperative to pull neo-nationalised industries and corporations back into profitability, and Boots was no exception. In addition, the establishment of the NHS had a critical impact on pharmacists in that it contracted them into public service dispensing, free of charge, to a new population of patients. For all Boots retail staff this was a big departure from typical shop life, as customers were now to be welcomed into stores to pick up prescribed medicines without necessarily purchasing goods.

Delivering the NHS dispensing service became a vital part of private chemists’ work and helped retail pharmacy to expunge a historical reputation for profiteering and occasional quackery. The chemist’s shop itself was now a site of public healthcare provision, becoming a ‘marketplace’ for procurement and distribution of medicines and a cultural beacon of the people’s NHS in practice. Indeed, this combination of commercial site and nationalised dispensing service perhaps helped establish, facilitate, and consolidate the habit of prescription medicine as an enduring panacea for ‘Western’ ill-health. It not only enhanced the reputation of pharmacy professionals as medicines’ experts, but legitimised the high-street store as a site of material healthcare provision. From the perspective of private corporation partnership with the NHS, Boots the Chemists formed a mutually beneficial relationship with nationalised healthcare. The dispensing service was delivered effectively, and the NHS work gave Boots shops a legitimacy that helped build Boots’ reputation as 'one of the high street’s most trusted brands’.42

In terms of the cultural history of the NHS, this chapter helps broaden the debate by locating the NHS’s cultural reach in new physical and material spaces, in the relationships between shop customers and pharmacists, in economic and financial framework, and in the expression of professional identity. It also demonstrates that Boots was a key mediator of cultural representations, beliefs, and meanings in relation to the NHS. As a result of their symbiotic relationship, both institutions become ‘bigger’ cultural players.

Notes

Photographic images in this chapter are reproduced by kind permission of Boots Archive (BA).
1 Ludmilla Jordanova, Look of the Past (Cambridge: Cambridge University Press, 2012); Roger Cooter, ‘“Framing” the End of the Social History of Medicine’, in F. Huisman and J. H. Warner (eds), Locating Medical History (Baltimore: Johns Hopkins University Press, 2004), pp. 309–37.
2 Today Boots is part of the global healthcare retailer and wholesaler Walgreens Boots Alliance, employing around 415,000 employees in over twenty-five countries. See www.boots-uk.com/about-boots-uk/company-information/walgreens-boots-alliance/ (accessed October 2019).
3 BA has some material available online at http://archives.walgreensbootsalliance.com, but the archival record is accessible at Walgreens Boots Alliance’s UK head office in Nottingham via the company archives team, telephone (+44) 0115 9594228.
4 The editor of The Bee was H. J. Davis.
6 BA, WBA/BT/16/8/43/26.
8 C. Curchod and G. Reyes, ‘Producing One’s Own Medicine: Identity Tensions and the Daily Identity Work of Pharmacists’, Academy of Management Proceedings, 2017, no. 1, p. 10.
9 The Boots publication Pharmacy First (Spring 2009) refers to a pioneering service in Glasgow which saw pharmacists supervising the self-administration of methadone among drug users. The scheme arose in 1993, and the Glasgow Drug Public Service was established in 1994. When the publication appeared in 2009, twelve Boots stores offered the service. BA, WBA/BT/34/39/2/2/13.
10 M. Pratt, K. W. Rockmann, and J. B. Kaufmann, ‘Constructing Professional Identity: The Role of Work and Identity Learning Cycles in the Customization of Identity among Medical Residents’, Academy of Management Journal, vol. 49, no. 2 (2015), pp. 235–62.
11 BA, John Boot in The Bee, October 1949, p. 7.
12 BA, WBA/BT/16/8/43/6–35, statistical reports.
14 ‘Chemists may Rebel’, Daily Mail, 17 May 1950, p. 1.
15 The Daily Mail published an article in 1950 about doctors refusing to ‘snoop’ on chemists by sending them bogus scripts on behalf of the Ministry of Health in order to test their dispensing ability. It was a level of scrutiny perceived by pharmacists as intrusive, lacking in trust, and threatening professional independence, as a letter to the Pharmaceutical Journal indicated: ‘It is unnecessary to reiterate here the pharmacist’s objection to the continued policing of his professional work.’ Pharmaceutical Journal, 21 January 1956, p. 39.
16 Articles in the Daily Mail cite anger at reductions in fees and delays in remuneration and report threats of strikes and resignation from the health scheme. The headlines include ‘Chemists’ Fees Cut’, ‘Chemists may Rebel’, ‘No Drugs Threat by City’s Chemists’, and ‘Chemists say “We Quit”’. Daily Mail, 22 April 1950, p. 1; 17 May 1950, p. 1; 23 June 1950, p. 1; 31 August 1950, p. 3.
17 Pharmaceutical Journal, 21 January 1956, p. 51.
18 While historians acknowledge that reception of visual sources is difficult to measure, I liken the cultural power of the cartoon to a consumer product advertisement, which Hand describes as an ‘idiosyncratic cultural product […] [emitting] overt and covert messages.’ Jane Hand, ‘Marketing Health Education: Advertising Margarine and Visualizing Health in Britain from 1964–c.2000’, Contemporary British History, vol. 31, no. 4 (2017), pp. 477–500.
19 BA, W. C. Jarvis in The Bee, Summer 1948, p. 42.
20 BA, The Bee, October 1949, p. 6.
21 BA, WBA/BT/16/8/43/26, statistical reports.
22 Pharmacist numbers varied between 1,900 and 2,000 in the late 1940s and early 1950s, though apprentice numbers showed a more dramatic increase with around 300 recruited between 1948 and 1950. BA, WBA/BT/3/8/7/6–35, statistical reports.
23 Ibid.
24 In a letter to the editor as early as 1930, a correspondent suggested that the ‘commissioning problem’ was problematic: ‘The Manager is up against difficulties in breaking the system.’ BA, The Bee, May 1930, p. 213. It alludes to the profits vs. ethics tension inherent in selling medical remedies on commission.
25 BA, ‘With Whom We Served’, The Bee, Summer 1948, p. 26.
26 Boots pharmacists cheerfully boasted of scripts with as many as eight items and challenged each other to report higher numbers. BA, The Bee, Summer 1948, p. 29.
27 BA, The Bee, March 1949, p. 11.
28 Ibid. The juxtaposition of an association with political tactics but a ‘non-political’ manifesto reflects Mathew Thomson’s work on the commandeering by electioneering political parties of a welfare state that is ‘above politics’. See https://peopleshistorynhs.org/encyclopaedia/party-political-manifestos/ (accessed 8 October 2021).
29 Modern Records Centre, Coventry, Trades Union Records, MSS 292/54.07/1, ‘TUC, Organisation of Special Industries, Chemical Workers and Chemists, 1927–1942’; MSS 292/54.07/2, ‘TUC, Organisation of Special Industries, Pharmaceutical Employees, 1946’; MSS 126/TG/RES/GW/37/X/4, ‘Transport and General Workers Union, Pharmaceutical, Optical and Medical Councils: Circulars and Minutes, 1951–1969’.
30 BA, Boots Pure Drug Company Ltd, Annual Report, 1953.
31 BA, The Bee, June 1953, p. 22.
32 Ibid., p. 23.
33 BA, The Bee, March 1949, p. 26.
34 Ibid., p. 28.
35 BA, The Bee, July 1949, p. 42.
36 Ibid.
37 Modern Records Centre, Coventry, MSS 292/847/1/60, ‘TUC, NHS Joint Committee 3/2 1937–38 A.R.M 2a 1938, Supplement to the British Medical Journal London Saturday April 30 1938 A General Medical Service for the Nation’, 1938; MSS 292/847/5/38, ‘Public Health in 1948: Remarkable Statistics. The First Months of the National Health Service’, 31 March 1950.
38 BA, The Bee, Summer 1948, p. 25.
39 The sociologist Andrew Abbott argues in his book The System of Professions that professional jurisdictions form part of a system in which different professionals and para-professionals jostle for power. The changing relationship between GPs and private pharmacists, forged in the post-1948 period, exemplifies this ‘inter-dependent’ system. See Abbott, The System of Professions (London: University of Chicago Press, 1988), p. 2.
40 BA, Miss P. Smith, ‘The Future of Pharmacy’, The Bee, Summer 1948, pp. 25–6.
41 BA, The Bee, June 1937, p. 153.
  • Collapse
  • Expand
  • Top

Posters, protests, and prescriptions

Cultural histories of the National Health Service in Britain

Editors: and

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 34 34 19
PDF Downloads 23 23 14