Community pharmacists face around 1.2m health related visits every day, making them one of the most visited healthcare providers.
Far from the traditional transaction based model of dispensing medication prescribed by GPs, community pharmacists are now playing an ever growing role in preventative healthcare.
In fact, pharmacists feature heavily in the NHS Long Term plan, which sets out a vision of pharmacy professionals becoming more relied upon by patients and “clinical pharmacist prescribers” playing a central role in primary care networks.
This refocus on pharmacists as clinicians and independent prescribers for some medications that have previously required GP intervention presents plenty of opportunity for pharmacists, but also challenges when it comes to adoption and promotion.
Gurminder Singh, a second generation pharmacist who has worked to transform his family business into a model for what pharmacists can be in the new healthcare landscape, told us about his experience as part of our new Game Changer video series, and we’ll be using lessons from him to highlight the challenges in this blog.
Before you get into the blog, watch episode one of our new docuseries "The Game Changers of Community Pharmacy" by clicking the image below
Community pharmacists already deliver an increasingly varied range of preventative health services, and there are more than 9,500 “Healthy Living Pharmacies” in England, which regularly use interactions with patients to promote healthy living.
Health monitoring and advice around issues like cardiovascular disease, smoking cessation, sexual health and vaccinations are all new services pharmacists are able to offer, widening their role in preventative health care and allowing patients to access services quicker than if they tried to go through a GP.
Initiatives like Pharmacy First are also giving pharmacists a greater role in community healthcare, allowing patients to be referred to a local pharmacy to get prescriptions and medication for some common conditions like earache and sore throat.
Increasing interactions with patients allows more opportunity for pharmacists to promote additional preventative services.
And patients already have positive perceptions of receiving services through a pharmacy rather than through their GP, with 90% of patients who sought help from a community pharmacist in the last year reporting they received good advice.
Introducing new health services into community pharmacies is one of the steps Gurminder decided to take as he took a bigger role in the family business, he said helping patients take control of their own health is becoming a more important part of his family’s pharmacy offering:
“If patients want to take their health into their own hands then we need to make it accessible for them. From there they can gauge on their own body’s level of what they need, whether it's to change their diet, health or lifestyle.
“It’s also about doing those preventative measures that the NHS are trying to do; services like blood pressure checks and smoking cessation and making those accessible for people, as well as having more advanced treatments so that people can change their health.”
This element of helping patients change their health is a key feature of future, clinically led pharmacies, as well as stepping in for some longer term condition management.
While not preventative, pharmacists are also gaining opportunities to play more of a role in helping patients manage some chronic diseases such as asthma, diabetes and raised blood pressure.
Looking at a report by the Royal Pharmaceutical Society, it’s clear to see where community pharmacists can add value.
One key area is medication advice, with RPS’s report highlighting that 30-50% of medicines prescribed for long-term conditions aren’t taken properly.
Dedicating more time to patient consultations, rather than just dispensing medications enables pharmacists to help patients understand their medications and how to take them so they’re able to get the benefits from treatment.
Another key area where community pharmacists can support the wider healthcare community in chronic condition management is freeing up resources within GP surgeries and NHS facilities.
RPS’s report found that long-term conditions account for about 50% of GP appointments, 68% of outpatient and A&E appointments and 77% of inpatient beds days.
With the NHS under pressure, waiting times rising and one in 20 patients waiting at least four weeks for a GP appointment, giving community pharmacies a bigger role in chronic condition management can be just what’s needed to improve access to care for patients - and provide pharmacies with opportunities to provide additional services.
While the primary benefits of additional services within community pharmacies should be improving patient care and opening up access to treatments and consultations, it does also provide opportunities for pharmacists to diversify revenue streams and become more profitable.
With price fluctuations and funding pressures meaning many pharmacies are selling medicines at cost - and in some cases at a loss - adding additional revenue is critical to the survival of these vital community health hubs.
Something that isn’t lost on Gurminder, as he explained in our Game Changer series:
“We thought we could support the pharmacy and our overheads, like staff wages, our own wages and general overheads with the [additional, clinical] services we provide, because how it was working out more recently is that the amount we were getting for medications was the amount we were spending on medications, and there wasn’t any leeway to pay to run the business.
“They want you to prevail by doing more services, doing more clinical exercises in the pharmacy and changing the role, so if you’re left behind in the old pharmacy, you won’t survive.”
For all the opportunities available with additional services, pharmacists must still create the environment in which they have the time to deliver them.
Technology will play a huge role in freeing pharmacists from repetitive manual tasks involved in dispensing medication and managing stock, whether it’s robotic dispensing taking over the counting, packaging and dispensing of medication, or pharmacy management software taking over tasks like payment claims for clinical services.
The balance between technology and providing a personal service is something Gurminder knows all too well as something which, he says, should free pharmacists up to take on the more challenging, but rewarding aspects of being a critical part of community care.
He said being able to gauge a patient when they’re unhealthy, having those human to human interactions was a bigger part of pharmacy services now, with solutions like robotic dispensing taking over the more laborious and “easy”, in his words, part of patient care.
Gurminder added: “The counter is the hardest thing to learn in a pharmacy, because you’re thinking on your feet, almost semi diagnosing a patient as they’re talking in order to ask the questions we need to ask, that’s the hardest bit of pharmacy.
“The dispensing side, people can pick it up in minutes, so I would say it’s now about building the confidence and almost putting yourself back into being a new counter assistant in the pharmacy.”
As Gurminder says, pharmacists stuck in the old model aren’t likely to survive in a future where pharmacies will be seen as serving a more consultative and clinical role in community healthcare, and particularly when it comes to preventative services.
It’s going to take vision and changing mindsets in order to thrive in the new environment, something Gurminder is doing with great success.