On the 17th December 2015 the DoH dropped its bombshell provoking a new unity in Pharmacy to oppose the cuts. At this point there are 42,604 signatures opposing the imposition of these cuts and the petition maps show that this response comes evenly from across the country.
These cuts are short sighted and will fail to deliver the DoH plans. As usual there is little holistic view of the health sector and pharmacies role within it and also a failure to grasp obvious benefits of a clinically focused network close to where we all live across the UK. As a Pharmacist with 38 years service told me recently
“as our patients faculties recede we are here every day to help them to remember to do the right things for their health”.
Messing with this without a clinically driven service plan is likely to cost the NHS far more than the £170m saving.
After saying this the stated aims of the DoH are worth further consideration, in their petition response they say –
We need a clinically focussed community pharmacy service that is better integrated with primary care and public health in line with the Five Year Forward View. This will help relieve the pressure on GPs and A&Es, ensure better use of medicines and better patient outcomes, and contribute to delivering 7 day health and care services. So the Department is consulting on how best to introduce a Pharmacy Integration Fund to help transform how pharmacists and community pharmacy will operate in the NHS, bringing clear benefits to patients and the public.
A clinically focussed community pharmacy service sounds attractive. We are relatively new to pharmacy (almost 6 years now) but after conducting discussions with hundreds of pharmacies across the UK what was surprising is the one number every pharmacy knew without fail was the branch item count. When we tried to understand the number of customers a pharmacy was supporting they were surprisingly more vague.
The NHS contract has constantly tied income to dispensing volumes and pharmacy has transformed itself to chase this. Your item count identifies your remuneration and therefore achieving larger and larger volumes has been the battle ground seperating neighbouring community pharmacies from each other and other primary care services. Pharmacy has continued to invest in services which protect its volume of items and this is for the benefit of its customers as these are valued services mostly delivered for free.
Pharmacy responds well to changes in its contract to focus its priorities. If the DoH is serious about this clinically focussed service then changing the contract (in stages over years) to reduce the emphasis on dispensing incomes and increase the emphasis on promoting health through clinically focussed services would be the right thing to do.
The DoH petition response also stated a desire to improve efficiency
We want to transform the system to deliver efficiency savings and ensure the model of community pharmacy reflects patient and public expectations and developments in technology. This is the time to embrace developments in technology to provide the best possible service.
We will also consult on amending legislation to allow independent pharmacies to benefit from remote dispensing processes (known as ‘hub and spoke’) which facilitates more use of automation and increases efficient dispensing processes.
Is it embracing technology in improving processes and reducing work hours?
Many pharmacies we visit will proudly show their workflow process and explain how items are safely but quickly processed and delivered to customers. They may be processing 60% items on a 4 week cycle at the back of the branch with a combination of community and residential care with numerous MDS compliance aid types. Is it really efficient?
As a manual process with a small volume and the added complexity of differing types then its probably efficient but if you think of combining all branch workload in a Hub and applying automation then the standalone manual pharmacy operation is not efficient.
When we look at repeat prescriptions then this is a planned workload upon which we can consider different ways of processing. If we look at just the compliance aid production then this will be a sizeable portion of the work hours to do all repeats. Moving this workload to a hub and applying automation has a number of key benefits.
- Done properly this will reduce the work hours of this activity significantly, we often see an 80% reduction in hours. To gain this benefit you have to centralise and then you have to automate those activities. Having a hub with no supporting automation technology is like having a car with no wheels, you will not get anywhere.
- Done properly it’s going to improve the quality of the compliance aid product you are producing making it safer for the customer. If we have to have compliance aids then I for one would prefer it to be created by an automated process using a machine rather than handled manually.
- This is your defence against the cuts as it delivers savings while maintaining your workload and improving your service. In addition you will be positioned to take advantage of other pharmacies that don’t improve their efficiencies.
If we look across the Channel at our continental neighbours then we see a wide divide in implementation of compliance aid automation. Here in the UK we have at best estimate 25 – 30 installations of this technology across all manufacturers and this includes community pharmacy, prison and hospitals. We produce over 100m trays a year with the vast majority (more than 99%) filled manually.
In France there are at least 650 installations, about 250 across the hubs in Germany, and 150 in the Netherlands and “bankrupt” Spain has almost 60. Is community pharmacy in the UK embracing productivity improvements, well on this evidence no.
We are unclear why community pharmacy in the UK has been slow to adopt technologies which have a proven record of delivering benefits. We think it could be that the few installations that exist are not widespread enough to become the “norm” encouraging others.
We think with DoH focus, impending cuts and the ever increasing workload facing pharmacy that this attitude will shift and automation will become very common.