It is an interesting time for community pharmacy in England. The clear message is that community pharmacy needs to change their business model. The introduction of new technology, hub and spoke dispensing and electronic transfer of prescriptions will significantly change the dispensing function. At the same time the pharmacy should pay more attention to their local community, introducing a range of new services that deliver benefits to their customers and fills some of the ever widening gaps of service provision in the NHS.
There are three big issues:
- There is no pump priming money to support the change in business model. In fact money has been lost and community pharmacy has to pay special attention to the quality payments to ensure that they don’t lose more.
- The NHS remains gripped with the mantra ‘free at the point of delivery’ and yet that delivery is falling. Waiting times are growing, consultations are in place to reduce the range of medicines the NHS provides and services are being cancelled or decommissioned. More decisions are cost based and we are slipping behind much of the world.
- We are moving into virgin territory. Community Pharmacy in England has never had to do this before. The evidence is not complete and in many situations the evidence that is available is either old or was collected for a different purpose.
We lag behind many pharmacy services in other parts of the world and we struggle to get appropriate recognition within our own country. Why is this?
However, it is often pharmacists who look on community pharmacy and say ‘you can’t do that’. Experts will criticise that the community pharmacy is not the right place – but many pharmacies have good facilities and sit right in the middle of communities. We will face the criticism that we put profits before patients and some that compare the provision of professional clinical services to selling sandwiches and shampoo. We get tied up in the continual call for increased training – don’t do that unless you have done a major training course. We will be asked to consider our professional image – and how the public view us.
Some will criticise the current evidence base, saying that our profession prides itself on its science foundation. They put evidence in front of common sense saying that evidence has to be our watchword. What they are saying is ‘don’t do it’ and you would be unprofessional to take on new services.
This is a different time. We have to start leading change from every pharmacy in England; start pushing the boundaries from an age when dispensing was enough. We have to look to our local populations and ask ‘what would you find useful’ and how should we provide that; we have to start the conversation that it will be private until the NHS is in a position to fund it. We have to ask General Practice ‘how can we reduce demand on your service’ and then work in tandem with them.
I have seen some pharmacists who have pushed the boundaries of community pharmacy practice. They do not shout about it; they do not seek awards; they get on with looking after their communities quietly with professional clinical pharmacy services that they have developed and run themselves.
We have to create our own evidence; cast of the chains and create passion for and with the people we care for.
During my pre-reg year a pharmacist who I had the highest regard for told me: “people don’t care what you know – until they know that you care”
If it is difficult – we should do it straight away. If it is impossible – we should challenge impossibility and find a way. The destiny of community pharmacy in England is in our own hands.