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Tariq
June 2020
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Rebuilding the Foundation of Pharmacy

Pharmacy businesses are coming to terms with a new way of life. Although the lockdown may have eased along with the mass panic dispensing we saw in March/ April, unfortunately, the challenges and pressures facing the pharmacy sector very much remain in the danger zone.

The government offered some temporary funding relief at the height of the lockdown, but the more skeptical amongst us will fear, probably with some justification, that any funding we have received will be clawed back at some point in the future anyway. This leaves businesses in the same position of needing to find ways to remain viable in the face of ongoing threats. The fact that we now have to do all this whilst staying 2m away from each other and our patients, is just the icing on the cake of problems we already had.

No doubt many pharmacists are looking to new services as a way of bringing in customers or growing prescription volume. I would not blame you if you did. But before you launch into new growth opportunities, let’s take a moment to reflect on where we are and where we are going.

Not designed for today

The problem with pharmacy is that we are trying to build our business on structures that were not designed to withstand today’s pressures. The foundation of pharmacy is weak, and we are trying to add more complexity without addressing the inefficiencies of our existing and outdated business model.

When I qualified as a pharmacist, an average pharmacy dispensed 4,000 items per month. Back then, you’d get a paper FP10, print the labels on the PMR, pick your stock and a pharmacist would do a final check by waving the box around in the air. Piles of baskets with half-completed prescriptions would be strewn across the benches. The dispensary would be plastered with sticky notes guiding the staff through their day. Despite being torn between dealing with patients, answering calls, and checking items, the pharmacist would seemingly be in control amid this apparent chaos.

If you picture that scene and wind on 25 years later, what’s changed? Well, nothing in terms of the scene. Except an average pharmacy is now dispensing 8,000 items. The pharmacist also has to provide clinical services as well as the burden of evidencing their compliance with regulatory requirements. It’s harder to get hold of stock. Oh, and the profit now made on each item is half of what it was before.

Essentially, a quarter of a century on, pharmacies are doing double the work for half the money using the exact same worn-out tools and process. Sure, a few pharmacies have robots and there are a few software applications that make recording stuff easier, but fundamentally the model of dispensing has not changed.

The thought of adding more volume, more services, and more workload into an environment that can barely cope with what it already has, is like adding more floors to a building whose foundation was only meant to be one story.

Reimagine and Re-engineer

In most pharmacy businesses, dispensing activity accounts for 95% of its income and unless we plan on giving up our dispensing role, we need to re-engineer the very nature of how we operate. If the heart of pharmacy is dispensing, then the heart of dispensing is the PMR and we need this to shift some gears. 

  • Barcode Validation – barcoding is used in every industry for ensuring accuracy in their processes. No other industry relies on “Look Alike Sound Alike” posters to remind them what they need to take care of. We should not have to lobby manufacturers to change their packaging to make the strength stand out. Barcode validation within the PMR at the point of dispensing should be mandatory to ensure safety.
  • Intelligent Checking – Pharmacists need to be smart about what they spend their time checking. The volume of prescriptions we now do makes it impossible to spot every risk scenario. Some prescriptions present more risk of harm than others. We need PMRs that can identify risk in an intelligent way and fish these out for review.
  • Re-distribute workload –Today’s remuneration model simply does not afford the pharmacist to be involved in every dispensing transaction. We need to re-engineer our processes so junior staff who follow a simple procedure can dispense without compromising patient safety.
  • Production Line – We need to think of dispensing as production line work. Stuff comes in and stuff goes out. Clinical risk needs to be handled separately, as mentioned above, but supply needs to be treated as supply. If we want to prevent Amazon one day from taking our business, we need to think like Amazon now and the PMR needs to support a production-like workflow.
  • Paperless – Even with the advent of EPS tokens, pharmacies print them out so they can continue with the old process. We need to become a paperless business and what comes in as electronic needs to stay electronic. PMRs need to support a digital workflow rather than relying on paper to support the process.
  • Integrations – No single system exists which can do everything you want it to do. However, you should at least have the ability to connect your system with something else that does. We need greater interoperability within our PMRs so join up the various software applications we use and reduce the time we waste between them.

 

The UK is slowly waking up to the enormity of the healthcare challenge it faces post-Coronavirus. Chronic illnesses, such as diabetes, heart disease, and cancer were put on snooze whilst our healthcare system dealt with the pandemic. Very soon, these are going to hit us with great impact and pharmacy needs to be ready to support the system. 

 

If we proudly want to see pharmacy standing tall in the future as one of the skyscrapers in healthcare, then we best go back to basics and fix our foundation first!

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