The government recently announced it will invest an extra £645m into community pharmacy over the next two years as part of its Pharmacy First programme. The news was positively received by the sector and many hailed this a glowing endorsement of pharmacy and the government’s commitment to the profession. Patients will be able to visit their pharmacy for common ailments and pharmacists will get paid. So what is there not to like? All that campaigning has paid off. Job done, right?
Well, yes and no. We cannot deny that new money, outside the global sum, coming into the sector is a good thing. Recognition of the role that pharmacists can play in primary care is indeed a vote of confidence and we should give credit where credit is due. However, we may need to think this through before we insert that metaphorical flag into the mountain we’ve been trying to climb for the last two decades. Putting aside the fact that the services are limited in their scope to just seven ailment areas, the main challenge is how on earth will pharmacists resource the delivery of these new services.
In recent years, the government has been ratcheting up the services available from community pharmacies. The Pharmacy First package joins a growing list of other services that pharmacists already provide but the problem is that pharmacists have been struggling to deliver even those.
In February this year, out of the 11,048 NHS pharmacies in England, only 25% met more than half their eligible NMS allowance. Only 21% of pharmacies did 10 or more blood pressure checks. Only 27% of pharmacies claimed 10 or more CPCS consultations. Meanwhile, dispensing volumes had increased by 4% compared to February 2022, and the number of pharmacies was 100 less than before.
Whichever way you look at the stats, the fact is that pharmacy businesses are too busy dispensing and simply not able to maximise their potential to take up even existing services let alone new ones.
Why can't pharmacies just employ another pharmacist? Well, as any pharmacy owner will tell you, that is easier said than done. Most of the time they can’t find one, and if they do, locum rates are so high that it would quickly negate the income from any services, so what’s the point!
Unless we find a way out of this conundrum, it doesn’t matter how many services get launched and they may as well not be there. If the government wishes to ease NHS pressure and create Pharmacy First, we need to solve the challenge of our workforce first.
Big strides but not enough
The inefficiencies in a typical pharmacy are an obvious major barrier to progress. The good news is that we now have solutions that can release valuable pharmacists time from the dispensing process. Over the last 4 years Titan has demonstrated that by digitising the dispensing workflow and using barcode scanning, we can delegate dispensing to junior staff without any compromise to patient safety. This paperless process has helped remove the need for pharmacists to be involved in final checks. The introduction of Titan’s AI has also reduced pharmacists' involvement in clinical checks even further so mundane checks and dosage changes can be automated using machine learning.
Whilst all these measures are a big step forward, and help pharmacists save around 80% of their time, they still have to be involved. If we are to really take advantage of the opportunities, we need a solution where the pharmacist has 100% control, but 0% involvement. So how do we do that?
We often hear there are no pharmacists. I disagree. There are plenty of pharmacists. The issue is that they are just not at the right place, at the right time or at the right price. What if, instead of pharmacists travelling to your pharmacy to do work, we were able to take our work to the pharmacist, wherever they may be?
We have already established that a process whereby the pharmacist essentially does one job - clinical checking, ensures a safe dispensing workflow. We have also established that clinical checking is digital, i.e. something done on a computer and has no physical touch point. In fact, many pharmacists using Titan, do their clinical checks whilst in the consulting room or in the evening when they get home.
This begs the question, why not just hire pharmacists to sit at home and they can do the work for you. The answer is, we can. We now have many Titan sites that are already distributing their workload amongst other pharmacies in their group or to pharmacists working from home. In this way the on site pharmacist is essentially freed up 100% from the dispensary.
In fact, the success of technology in helping reimagine the dispensing process, makes us question what else can be either automated or redistributed. If we can get pharmacists to sit at home to do clinical checks, why can’t they do some other activities which also don’t need physical presence. Take NMS as an example. This requires pharmacists to follow a set process whereby they engage the patient, carry out an intervention and then a follow up. Most of the time, this is done by the pharmacist over the phone. As long as the pharmacist has access to all the information, where that pharmacist is calling from doesn’t really matter.
And before anyone cries “this is remote supervision”, it’s not, because the RP is still on site and there is no need to change the law.
Pharmacy is being given a golden opportunity, not only to earn more income, but also to demonstrate its worth. If we don’t take up these services, we risk losing them. Let’s not forget many of the services we are being given are because GPs have been unable to cope with the increase in primary care demand. On the face of it, pharmacies don’t have any more slack than GPs. Therefore, our ability to succeed where others have failed is simply down to how well we adapt, change and innovatively solve the workforce challenge.
Recent advances in technology now give us the ability to think differently about how we run our operations. We can be more creative about how we deliver our services. We are no longer limited by technology, but rather just our imagination and our willingness to break convention.