If I was in charge of a hospital pharmacy it is likely that the Chief Executive Officer would be talking to me about the challenges of patient throughput and medical errors. He would be asking me to put more clinically trained pharmacists and technicians out on the wards, working with doctors, nurses and most importantly patients. He would be berating me for the time it takes to get medicines to patients, either to start treatment or to support rapid discharge.
I would have the answer. I will write a business plan and submit a case to capital budgets to support the purchase of a whacking bit of expensive kit to drive automation. Once installed I would make huge efficiency gains and I would redeploy some of my technical staff (technicians are so important these days) and my pharmacists to the wards. I would probably save money on stockholding, fulfil my targets around getting medicines to wards, supporting reconciliation and rapid discharge. I am not saying that Hospital Chief Pharmacists are heroes, but many have done this to great effect and they have my respect.
I can only assume that Ministers and Simon Stevens have been berating community pharmacy for the same sort of gains. Drive efficiency in distribution, improve safety, get better value from medicines, get pharmacists and counter staff to deal with patients to reduce pressure on General Practice and Urgent Care services.
Brilliant – but unfortunately Community Pharmacy are not hospitals. There is no separate capital budget to apply for and this sort of investment would probably need a significant loan of more than the pharmacy is actually worth. It might work with larger chains and internet or postal pharmacy services, although the largest player in the internet/postal sector is still making an eye watering loss. Automation means subcontracting and if I free up pharmacist and counter staff time then who pays for them when they go out and help people in the shop front? The pharmacy contract is mainly based on an item of service payment and if I subcontract this out then I have no money to run other services.
The community contract is just stupid and it has been for many years. It has failed to reflect the national agenda items like ‘stay well in winter’ and ‘Pharmacy first’ and it is not fit for purpose. There is no drive to change community pharmacy from procurement led to patient led right across the board. That is not to say that community pharmacy has not done a fantastic job driving down the cost of medicines to what must be one of the lowest in Europe. And that many community pharmacies provide valuable service to their communities – they do.
Having said all this – you can’t manage community pharmacy as if it is a hospital. In the words of Donald Trump – it’s stupid, stupid, stupid. Think again.