Community pharmacies are facing tough times; around 165 have shut up shop since October 2016 with a steep increase in closures recently, according to the Pharmaceutical Services Negotiating Committee (PSNC). Slashed government funding hasn’t helped or the NHS crackdown on prescriptions for cheap over-the-counter medicines.
Like many high street traders, pharmacies face a barrage of competition from supermarkets and online providers. Their economic viability is in question at a time when health secretary Matt Hancock wants pharmacists to help ease the pressure on the NHS.
“It’s vital that we maintain a network of fully funded community pharmacies, but it needs a new business model with sustainable funding,” says Simon Dukes, chief executive of the PSNC. “We want an extension of existing services so community pharmacies can offer more support for patients and local communities.”
There’s no magic wand, yet pockets of excellence and best practice exist. Some pharmacists are being more creative with innovative services. The idea is to meet the growing demands of patients, while at the same time supplement income lost due to cuts.
“The future is about delivering services that patients really want. We have highly trained health professionals in the community. Let’s use them in the best way possible,” says Paul Mayberry, who owns a small chain of pharmacies in South Wales.
01 ADDING VALUE
It’s time that pharmacists were more visible. “A lot of opportunities for guidance, prevention advice and patient care are lost when pharmacists are tied to the dispensing bench and rely on counter staff to perform this role,” says Claire Anderson, professor of social pharmacy at the University of Nottingham. Reconfiguring the work of the business so the highly skilled pharmacist is not doing the boring or mundane tasks, but more of the value-added services with patients front of house, makes sense. “We don’t want them to just be dispensing medicines, but offering an invaluable service to people who come in,” says Mr Mayberry.
02 NEW SERVICES
From travel health to flu vaccines, advice on a sore throat to reviews of medication, or healthy living pharmacies (HLPs), there is a lot more to community pharmacies than dispensing. There are now 9,400 accredited HLPs in England. “These offer public health advice, self-care support and clinical services. Evaluations show they help avoid GP visits and are valued by patients,” says Mr Dukes. The good thing with new services is they support community pharmacies in boosting income, diversify their revenue streams, therefore make them more resilient and in the long term ensure they’re more valuable to the communities they serve.
03 PHARMACIES FIRST
Let’s face it, doctors are overworked. The first thing that Mr Hancock did when he became health secretary in July was pledge investment in community pharmacies in a bid to relieve pressure on hospitals. Pharmacies are in a good position to be a first port of call for patients. However, the operating model needs to evolve. “Community pharmacies cannot really progress unless they change from a fee per item dispensed, or medicines use review completed, to a more patient-centred approach where they’re paid to provide care to the community. Contracts should be more aligned to those of GPs,” says Professor Anderson. Pharmacies First, rolled out in Devon, has saved thousands of GP appointments and hundreds of A&E visits. The campaign, funded by the NHS, allows patients to receive care for minor ailments direct from pharmacies.
04 AUTOMATION AND TECH
Automating the laborious tasks, such as dispensing and labelling medicines, with robots, even offering some forms of advice via screens, can help free up pharmacists’ time so it can be used for high-value tasks, especially in dealing with complex patient issues. There’s also space for web-based pharmacies and virtual consultations. There are now apps that help patients comply with taking medicines. If patients offer to share their adherence data, pharmacists can then monitor and track what medicines people take. Wasted medicine is a growing problem in the NHS. It is estimated that as much as £300 million is wasted every year in this way as 50 per cent of people regularly miss doses. “This is just the tip of the iceberg. I believe billions of pounds is lost in this way. There are many indirect costs as well, not to mention the long-term effects of say diabetes patients and others with long-term illnesses not taking their medication. Pharmacists can help with this,” says Mr Mayberry.
05 REALISING SOCIAL CAPITAL
Pharmacists, unlike GPs, have more time to talk. They provide a lot of unrealised social capital in local communities. Not only are they a good centre for health promotion, they are supportive when it comes to disease prevention and promoting self-care. They can also refer people to social support. “Healthy people and patients visit the pharmacist more than any other health professional. There is strong evidence that pharmacists can help to reduce risk of cardiovascular diseases, support smoking cessation, screen for diabetes and provide sexual health services, including emergency contraception,” says Professor Anderson.
06 GOVERNMENT SUPPORT
The NHS is under pressure, even though chancellor Philip Hammond gave a £20.5-billion, five-year boost for NHS England in this year’s Budget. However, community pharmacies are still awaiting publication of the NHS Ten-Year Plan. With better funding, they could become wellbeing hubs on the local high street. “Achieving that requires a bold future vision from the UK government and the provision of a multi-year funding settlement which will enable community pharmacies to transition towards providing services that do more to relieve pressure on the NHS,” says Mr Dukes. In Wales, money has been ringfenced by the Welsh Assembly for pharmacies to offer new services. These funds make good use of pharmacists’ skills, relieve doctors’ surgeries and improve access to smoking cessation and other services.
Bringing pharmacists into the wider primary-care network is crucial. There have been pilot schemes, for instance, supporting long-term illness in West Yorkshire. Patients received personalised support to set goals, and manage their health and medicines, resulting in improvements over 12 months in key metrics. “The challenge is not identifying good ideas, but finding ways to spread them at scale and pace. Ideally, national commissioning would give all patients access to the best services and ensure full integration of services regardless of their location. However, the government’s drive is for local commissioning,” says Mr Dukes.
08 CUSTOMER EXPERIENCE
“People are so used to pharmacies being there that they do not appreciate them as a social-infrastructure commodity. Like parks, train tracks and youth centres, they’re only truly missed when they’re gone,” says Mike Bereza, managing director of Voyager Medical. The fact is pharmacies need to do more in terms of promoting themselves. Customer expectations are at an all-time high in an Amazon-driven era of instant gratification. The good thing is that community pharmacists are in a great position to bolster patient experience. “Much of healthcare is actually surrounded by compassion, human contact and care. When I, as a pharmacist, serve your grandmother’s stroke medicine, I am not just giving her an object and sending her off. I am talking to her, asking her about how she is and what she is up to,” says Mr Bereza.