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The long read: is technology a threat or an opportunity for pharmacy?

08 Dec 2017

Technology forms part of our daily lives. Should pharmacy harness its potential or steer clear, asks Léa Legraien

Over the past few years, a wave of technological improvements has hit the NHS.

From the implementation of robotic dispensing in hospitals to machines taking blood pressure in GP practices, NHS England has increasingly been embracing automation.

In community pharmacies, technology enables the storage of patient records, the delivery of prescriptions via Electronic Prescription Service (EPS) and – in some cases – the robotic dispensing of medicines.

In 2015, Keith Ridge, chief pharmaceutical officer for England, said that ‘the pharmacy world has been calling for change for years. The stars are lining up, and firmly pointing towards a clinical and digital future’.

But is there a more sinister side to the rise of technology in the sector? Is it possible that, with constant improvements, technology could outlast pharmacists?

The Pharmacist’s reporter Léa Legraien looks at how technology is shaping pharmacy and whether the sector should embrace change or fight against a digital future.

Robots among pharmacists

The past 10 years have seen an increasing number of pharmacists turning to robotics.

If the word ‘robot’ conjures up images of machines resembling human beings, the reality is somewhat different. Robots in pharmacy currently take the form of dispensing machines, usually made of mechanic arms.

Paul Mayberry, owner of the seven-strong Welsh pharmacy chain Mayberry Pharmacy, realised that if he wanted to make efficiencies in his business and make the most of his highly trained pharmacists,
he had to implement leaner processes. So eight years ago, he bought two robots.

‘In most pharmacies, pharmacists are involved in every aspect of the dispensing process, from ordering stock to labelling,’ he says. ‘But they only add value in two places; the clinical check of prescriptions and spending time with the patients to talk about their medicines. Every thing else can be delegated to somebody else, such as the technician.’

Freeing up pharmacists from the dispensing process means they have more time to allocate to patients, and reduce dispensing error rates.

Mike Holden, principal associate at consultancy company Pharmacy Complete, argues that robot dispensers ‘only add value to medium or large pharmacies’, working on a hub and spoke model.

To date, around 20% of pharmacies dispense more than 10,000 prescription items per month. But, as Mr Holden explains, many pharmacies may not be equipped to process that many prescriptions.

‘We’ve seen a 50% increase in prescriptions in the past 10 years going through pharmacies with very little increase in resource or other technology to support that efficiency other than robotics and minor changes and improvements to PMR systems,’ he says. ‘When we’re only getting £1.29 activity fee, to be able to give some of that to a hub and let the pharmacy be the spoke is challenging’

Dispensing medicines vs patient care

Dispensing prescription items doesn’t exclude providing patient-centred services. As in many areas, technology works best when it supplements human interaction, making sure patients receive appropriate advice and make safe use of their medicines.

But the funding cuts imposed on English community pharmacy by the Government in 2016 have made it ‘increasingly challenging, both from cashflow and financial points of view, to just dispense’, says Mr Holden.

‘It’s questionable whether a hub can make it work with the logistical costs, posting or delivering.

‘But are we just delivering a packet of pills or are we adding some value to that? Otherwise we’re no different than a pharmacy that is in a large warehouse,’ he adds.

‘Amazonisation’ of the sector?

Seemingly not content with dominating retail across the globe, Amazon sparked fear after announcing its plan to enter the US pharmacy industry.

The online retail giant recently acquired pharmacy wholesale licenses in 12 states, which means it can cover the distribution
of medical-surgical equipment devices as well as other healthcare-related equipment.

In Japan, customers are able to buy some drugs on Amazon’s website, after the company expanded its Prime Now delivery service in April 2017.

To purchase these medicines, patients just have to fill up an online form where they indicate their symptoms and medical history. Once a pharmacist gives their approval, items can be shipped the same day.

And with a UK pharmacy market worth £12bn per year, it’s possible that Amazon could be eyeing up our sector, too.

Not everyone is hostile towards the idea. Mike Hewitson, superintendent pharmacist at Beaminster Pharmacy in Dorset, thinks that ‘if Amazon wanted to provide a wholesale operation to pharmacies, most independents would welcome this with open arms as it’s a way of preserving footfall in pharmacies’.

‘It isn’t necessarily in direct competition with them because few have meaningful online businesses,’ he says.

‘I’ve heard various commentators saying that we should as a sector be trying to out Amazon.

‘Amazon has $22bn in cash. We won’t win a knife fight with a guy with a machine gun. To deal with it, we need the right combination of contractual reform, added-value services and investment in improved customer experience.’

Whether Amazon could enter the UK market is still an unanswered question. And even if it did, the real question is what community pharmacy could do to halt its roll-out.

Drug vending machines

Back in 2010, the now dissolved Canadian company PharmaTrust brought two drug dispensing machines to the UK, which were trialled in two Sainsbury’s stores in West Sussex.

If only a few people have heard about the machines, it’s due to their lack of success and withdrawal from the market.

Mr Holden believes that the machines ‘were ahead of their time and the technology wasn’t meeting the requirements to make them work properly’.

Around the same time, Pharmaself24, considered Europe’s leading automated prescription collection point, entered the UK and Irish market.

Just as an ATM delivers cash, the machine gives 24-hour access to medicines to patients in a ‘safe way’. It also features a video screen, allowing patients to have a conversation with a pharmacist.

Mr Holden says: ‘It’s not meant to replace pharmacy local care but improve access 24/7. It’s about meeting the needs of the community you serve.’

Threat or opportunity?

Technology is both a threat and an opportunity for pharmacy depending on people’s perspective and the way it is used. Many argue that if it improves efficiency and safety, while freeing up time and giving better patient experience, then it’s positive.

Mr Hewitson argues that those who see it as a threat are more likely to think pharmacies act as a supply chain and not a clinical service.

He says: ‘Those people see a cost rather than a value, some of which could be automated. But this could actually increase waste and disempower patients and professionals’.

Embracing the future

Whether technology is used for social media, website, pro-active communications to patient and partnering with other healthcare providers, many pharmacists are ready to embrace it.

Dr Leon Megginson, from Louisiana State University, wrote: ‘It’s not the most intellectual of the species that survives; it’s not the strongest that survives; but the species that survives is the one that is able best to adapt and adjust to the changing environment in which it finds itself.’

At a time when pharmacies are struggling to cope with financial pressures, technology might well be part of the solution and not a means to an end or, indeed, the end itself.

As Mr Hewitson says: ‘Our problem isn’t that technology will replace pharmacists, but that our existing infrastructure isn’t delivering the sort of development that pharmacists and their teams need to engage either with other healthcare professionals, or patients.’

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