Watching the pharmacy minister and others show a lack of understanding of community pharmacy, while pharmacy organisations respond to the imposition of pharmacy cuts, leaves me in a very positive mood. That is not to say that the cuts will not be hard felt and might actually lead to the failure of some pharmacies, but the challenges become clear and the opportunities obvious. It is not a time to criticise pharmacies for selling certain products, their lack of a seat at the table or the need for robust evidence, but to look at ways to work together and thrive again.
Pharmacists and pharmacy owners must accept that they work in a professional clinical retail healthcare environment. It may not feel like it now, but this is the endpoint. It is time to smarten up and think critically about what is on offer. Then they need to think like a business in satisfying their customers’ healthcare needs. Every pharmacy sits within its own catchment population and manages passing customers and people working in businesses close by. Pharmacies need to think more clearly about who their customers are, what their healthcare needs are how the pharmacy can engage and offer each one a specific parcel of care. This is proactive clinical community pharmacy practice. Let us stop thinking about community pharmacy and look at what a ‘pharmacy community partnership’ might look like.
It is also time for pharmacies to cooperate. I do agree that Pharmacy seldom has a seat at the table or are invited to the ball. This is a real problem in England and less so in other devolved nations. But you do not get a seat at the table if you do not deliver – you are never heard if you are not a provider. There is a major issue around variation in performance. I commissioned services within community pharmacy many years ago and the issues were inclusion and performance. I simply did not get enough community pharmacies to engage and deliver across a locality.
You have to praise the work of some community pharmacy groups (West Yorkshire comes to mind), recognise and support the introduction of federated models and appreciate that some pharmacy leaders, such as Pharmacy Voice strongly support the concept of cooperation and that variation is our greatest performance issue. Until commissioners can look at community pharmacy and feel convinced that the majority of pharmacies in their area will deliver – then we will always struggle. So the message here is stop complaining, use your business expertise, implement ‘proactive clinical community pharmacy practice’, provide and deliver and you will then see your invitation come through the post.
The fact that NHS England chief executive Simon Stevens doesn’t know what we do is not unusual – we see this every day. When we ask patients – they mainly remember the prescription that was sorted out, the collection and delivery service, the monitored dose system that was used and the time taken by the pharmacist to explain about the medicines. It is sad that all of these are usually unfunded value added services. Too many people bypass the pharmacy and go to A&E and general practice. Of course, posters and national pharmacy first campaigns help, but people need to believe that they get an equal service in the pharmacy.
I would go so far as to say that community pharmacy has to enhance their service to the point where people believe it looks and feels every bit as good as general practice and are willing to tell their friends and neighbours. GPs must also recognise that the GP Forward View may be no more than a sticking plaster and it is in their own interest that community pharmacy absorbs more of the workload.
We also need to look at training. I am tired of seeing programs that include a consultant talking about what they do. I want to see community pharmacists talking about what they do. Some would say that we are ‘experts in medicines’, but it is time for us to use that knowledge to become ‘experts in care’. Community pharmacy must be the career of choice for pharmacists, stretching their clinical knowledge and fulfilling their ambition to care for people. With the focus on dispensing falling, there is an ideal opportunity to change pharmacy for the better. There is undoubtedly a lot to do, but for many businesses that are 90% NHS, the cuts have generated the leverage for change. It really is now or never.
Mark Robinson is director of the Medicines Management Partnership and pharmacy advisor for NHS Alliance.