On my first night in Germany, I went for a walk, partially to acclimatise to my new surroundings, but also to avoid staring at the wall of boxes I’d spent most of the day lugging up to my fourth floor apartment. Seeing everything with fresh eyes, one image still sticks in my mind: the bright red gothic A symbol of the local Apotheke. I’m not really sure why this image stood out so prominently, but perhaps it was less to do with the symbol, and more because it was my first encounter with my greatest nemesis, German pronunciation. “Apotheke” I said out loud, anglicising the o, e, and th sounds to match the word “apothecary”. I would continue to pronounce it this way, slightly proud of my ability to understand some meagre level of German, until a few weeks later my then girlfriend pointed out I was saying it incorrectly.

Despite my inability to correctly say the word Apotheke, I was struck by how often I saw the sign in places I visited. No matter which village, town, or city I travelled to, I would see the same big red A. I came to realise that this was the standard across the country, barring those especially quaint establishments that retained older, more decorative variations. Even then, the A would feature somewhere within the premises, either on the name badge of an employee, or affixed to a wall. The sign was somewhat remarkable as it told me something about the differences between the UK and Germany. In the UK, there is standardised signage for the local pharmacy, but only because they are part of a national chain such as Boots or Lloyds. As I would learn much later, German law prevents private companies from setting up their own chains, and even prevents pharmacists from having more than three branches, which must be located within a defined distance. In this way, the German state ensures third-party-ownership, such as major corporations, can’t profit from the industry at the expense of consumers, while making sure that pharmacies still retain access to fully trained and onsite pharmacists.

All of this sounds fairly positive, and for the most part it is, but then nothing is ever perfect. Though customers are somewhat protected from corporate gouging, access to medications are still heavily restricted. This doesn’t simply mean prescription medications, it means all medication, from cancer drugs to paracetamol. Over the counter medication does exist, only the counter in question is the one in the local Apotheke. Unlike in the UK, and most other European countries, the German consumer can’t peruse a supermarket aisle to find Ibuprofen or low level cold and flu remedies, they must visit their local pharmacy and talk to a pharmacist before being given access to something as mundane as a tube of Bonjela. This does create quite the conundrum, especially for British people who may have some easily remedied, but slightly embarrassing affliction. In the UK it is perfectly possible to pick up some ointment or other and slip it in with the weekly shop, in the hopes that the checkout assistant doesn’t notice. Of course, having worked in supermarkets myself, shop assistants always notice these things, but they usually have enough sense not to say anything. Here in Germany, that scenario would be a ten minute conversation, with a range of options being presented, often in full earshot of the rest of the shop.

Some clearly like this type of service, and in fairness to Germany, most people are far less prudish than the British person trying to hide their haemorrhoid cream in with the frozen peas. Nevertheless, it is a culture shock when it happens and no matter how nice and friendly the Apotheke employee might be, it never really takes the pain out of these interactions. Even if you happen to be picking up something for a significant other or a partner, you still run the risk of other customers assuming whatever you happen to be buying is actually for your own personal use. This happened to me recently, and while in the midst of a very detailed explanation on the side effects of a certain product, part of me wanted to turn to the other people in the queue behind and loudly state that I was doing this for someone else, a selfless act of self-immolation, rather than discussing my own dodgy ailment.

Thankfully there has been some modernisation to the sector, with the introduction of websites like DocMorris which now allow people to buy certain low level medications without the need to travel to a pharmacy. While the perpetually embarrassed Britons living in Germany may rejoice at this development, it is rather more focused on those rural areas that have no pharmacy nearby. The stipulation that branch pharmacies must be located within a short distance of a central pharmacy, combined with a failure to update the compensation packages for medication since 2013, means that rural pharmacies have begun to disappear, leaving isolated communities with little option but to travel to the nearest large town or city. The issue of costs has been such an issue, pharmacists went on strike last year demanding the price of compensation go up from from €8.35 to €12. Clearly the industry needs more reform, which is why German Health Minister Karl Lauterbach (SPD) recently presented a draft of possible reforms to alleviate the problem.

Among the proposed changes are steps to make hiring of new pharmacy staff much easier, including the acceptance of foreign qualifications to make hiring skilled workers from other countries much simpler. Given Germany’s reticence to accept foreign qualifications in many industries, this is a giant leap forward in itself. Furthermore, plans also include increasing the distance between branch pharmacies, meaning a central Apotheke could administer to branches much further afield than is currently possible, directly addressing the issues found in rural areas. These branches would not require an onsite pharmacist at all times, but instead would allow pharmacy staff to administer medication provided by a central parent pharmacy. Should a pharmacist be required, they will be available via some form of conferencing software.

It might be thought this would be music to the ears of pharmacists across the country, yet the proposals have been met with backlash nationwide, with some Apotheken even hanging protest banners in their windows to show their discontent with Lauterbach’s plan. There has been tentative support for some of the draft law, such as allowing vaccinations to be carried out on premises of Apotheken, but mainly the reaction has been broadly negative. Concerns focus on two points, the plan to have pharmacies without a permanent onsite pharmacist and scant information on potential funding improvements. While criticism should be expected for any plans involving healthcare and patient safety, there is something of the typical German reluctance to see any change in a positive light, even if it earnestly seeks to solve a problem.

Much of the opprobrium meted out boiled down to complaints about funding which taps into a larger issue, one that time and again restrains the ability of the German government to deal with its problems. The point blank refusal to lift restrictions on debt accumulation, known as the Schuldenbremse (debt brake), means that the EU’s largest economy must work within highly restrictive budget constraints. What is perhaps as maddening as the cult of debt reduction, is the fact that no one seems to mention this obvious point in any of the reporting. Whether you like the current government or not, its ability to manoeuvre is presented as a lack of willingness, rather than a structural issue with the way Germany has run its economy over the last fourteen years. So ingrained is the concept of saving for a rainy day, even when the downpour comes, and the roof begins to leak, Germany prefers not to act, possibly assuming the clouds will part of their own accord. Fixing the roof never comes into the equation.

How Lauterbach’s changes will impact the country’s Apotheken is still unclear, with the proposed vote on the draft law being postponed until after the summer recess. I fully expect this to focus on tearing down the plan, and very little debate or presentation of serious alternatives, other than more funding which clearly is unlikely to materialise. In the end, it is those on the ground, the people living far from a pharmacy, who will ultimately suffer without some form of change to the status quo.

Proofreader: @ScandiTina

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