Community pharmacists gathered for the Pharmacy Business Conference to hear how their profession can keep up with the technological advancements driving the NHS forward. Neil Trainis reports…

 

What would Matt Hancock have made of it all? The aficionado of all things tech may have afforded himself a smile had he been at the Park Plaza Hotel in Westminster to hear how some inspiring community pharmacists have improved the care they provide their communities through the use of digital innovation.

The Pharmacy Business conference, ‘Embracing Digital Healthcare,’ demonstrated how pharmacies use technology to roll out health services with efficiency, quality and speed. All to the benefit of local communities who rely on their local pharmacy teams to keep them healthy.

The message was simple. The NHS is rapidly going digital. Community pharmacy dare not get left behind. Community pharmacists, healthcare leaders and pharmaceutical executives gathered to get a glimpse into a tantalising future.

Bernadette Brown, an award-winning pharmacist who runs Cadham Pharmacy in Fife, revealed she has three dispensing robots and plans to have a fourth by Christmas. Something made possible with financial assistance from the Scottish government in the form of grants. Not much chance of that happening south of the border.

She has also invested in diagnostic equipment to improve her patient services and installed a 24-hour automated prescription collection machine. She is not so much blasé about her progress with technology, more extremely comfortable with technological innovation.

“There is lots of different technology out there…cost doesn’t come into it…we need to free ourselves up for face-to-face patient care,” she said.

Conference chair Michael Holden tried to unravel the health ecosystem and insisted the days of pharmacists “chasing green forms” was over before asking “where’s the pharmacy profit going to come from?” That was a not-so-subtle reference to community pharmacy needing to focus more on face-to-face patient services and less on dispensing income.

That, he intimated, would help pharmacies, already rocked by government funding cuts, thrive and could be achieved through the use of digital technology such as the electronic prescription service (EPS) and robotic dispensing to free up pharmacists’ time to spend with patients.

However, insisting “social media is important,” he candidly remarked that when it came to promoting themselves and their services, pharmacists were “rubbish.”

The conference would go on to hear how pharmacists can highlight their services on platforms such as Twitter and Facebook and use Linkedin to generate contacts in their local area such as GPs, other health professionals and members of health structures such as clinical commissioning groups, health and wellbeing boards and sustainability and transformation partnerships.

Michael also said pharmacists needed to be aware of how people are taking more control of their own healthcare through the use of wearable technologies. Self-care is all the rage these days after all.

Another award-winning pharmacist, Ryszard Cygan, said: “To ignore technology and IT would be foolish. It gives us confidence to roll out more services and become more efficient.”

Ryszard, who runs West Elloe Pharmacy in Lincolnshire, invested in the UK’s first ATM-style 24-hour prescription collection point and revealed it allowed him to take 2,000 new prescriptions into the pharmacy.

“Collection points are so easy for patients – touch the screen, enter the pin number, pay and collect the prescription,” he said.

Saam Ali, the founder of Pharmacy Mentor, an online platform that tries to get pharmacies tech-savvy, said pharmacies needed to be better at digital marketing.

“It is not new. It’s been around for years but independent pharmacy has never really grabbed digital marketing,” he said. “Digital marketing can generate new income streams from lost dispensing income. You need a website – it’s your digital shop window. It talks to your patients 24 hours.”

Saam also urged pharmacists to “create good quality content in form of a blog to allow you to showcase pharmacy services.”

Carol Alexandre, vice-president, information offerings, at IQVIA UK, said the number of digital health apps “has increased five-fold” while Steven Dodsworth, CEO, D Health Europe, said access to patient services and self-care can be achieved in various ways, such as through a pharmacy’s premises, website including online services, education and support, third-party virtual signposting and apps.

Chris Ellett, transformation director at Well, went against the grain. “What is digital?” he pondered. “It’s not about building a website. It’s not about (adding) an app. Please before you think about what you’re going to do in your digital space, don’t go and spend some money on some technology. And it’s certainly not about AI-powered wearables.

“Don’t build a digital strategy. Build a strategy but don’t build a digital strategy. We’re not here to make things digital. We’re here to make things better.”

He revealed 40% of prescriptions were still not being delivered via EPS despite the system being introduced 10 years ago. It was “criminal,” he bluntly insisted, that Well was spending “a seven-digit figure ferrying bits of paper backwards and forwards to GP surgeries.”

Yet despite the conference’s heavy accent on online and digital, Chris insisted there was a “massive future for bricks and mortar pharmacies.”

“Apps can’t do flu jabs and Doris still wants to come in for a chat,” he said.

Despite the allure of digital technology, nobody could argue with that.


Why bother with technology? It frees you up for face-to-face patient care

I went to a talk about 10 years ago in Scotland and they were talking about robots and I thought ‘oh my days, robots in a pharmacy, are you kidding me?’

I’ve got three now and I think I’ll have my fourth one by Christmas. Why put the expense out there for technology? Only to get time. That was my key driver. My pharmacist and me, we deserve time.

(It is about) time to see people. Time to have face-to-face consultations. Costing came into it but you’ve got to do your analysis and make sure it’s going to work in the longer term. I really needed that time or my model would never have worked.

Diagnostic equipment, the workstations, the guidelines, the comfort, how clean the place is are very important factors to me. I’ve invested a fair bit in diagnostic equipment to help people gain confidence to know the numbers, (for example) if someone is diabetic.

I have the HbA1c Cobas Roche 101 machine (which tests for risk identification, diagnosis and monitoring of people with diabetes). My patient couldn’t get it done at the doctors and wanted instant results.

When he got his result back, he purchased the Freestyle Libre (which measures and stores glucose readings) from me and within two months he was metformin-free. He is loving that he understands more foods that impact on his daily life.

The workstations are there for things like asthma, COPD, smoking cessation. I have the FeNo (fractional exhaled nitric oxide) machine to treat asthma but we want to get that as a funded model and we have put in a huge proposal and hope to get funding in the new year.

I have a BD Rowa machine which the Scottish government gave me funding for. It’s just a big, massive robot that stores stuff. Online bookings – we have found this instrumental (to our success.)

It’s important we get technology right in terms of ease of repeat prescriptions. I want automation to support me so we can get people picking up their medicines. You can order online, maybe with an app, it gets dispensed in your pharmacy and you send them a code for the (Pharmaself24) 24-hour (dispensing) machine.

The confidence to let go of that final check in the first instance was what I found really hard. How did I get round that? Automation gives me that feeling of safety.

I have the PharmaSelf 24-hour collection point. Do you compete with Pharmacy2U by getting more delivery vans and drivers? No, get one of these gadgets. Unless your patients are disabled and infirm, keep your drivers for that.

We get (patients’) mobile phone numbers and put them into our system. I have 280 people who picked up (their prescriptions) from my 24-hour machine in the space of six months. And it’s going up every week. Over Christmas and New Year’s when everyone panics, it’s great they’ve got that ease of convenience.

Bernadette Brown, owner, Cadham Pharmacy Health Centre.

Bernadette’s tips
• Don’t be afraid to invest in technology – look at the bigger picture (ie, frees up your time for more face-to-face care).
• Remember to do your cost analysis before investing in technology.
• Invest in diagnostic equipment.
• Approach stakeholders (yes, even the government) for funding in technological services.
• Give your patients convenience – install a 24-hour prescription collection point.


A prescription 24-hour collection point – that was my eureka moment
Statistics show that any pharmacy investing in automation will generally grow 10-15% within the first year. Data shows that technology is absolutely crucial if we’re going to move forward.

I bought my first robot in 2004. Three years later I was the first pharmacy to have two robots within one pharmacy doing the same work. The town had expanded and I had seen a lot of growth and I wanted to maintain the efficiency and safety of the automation.

For me, at this point, it was damage limitation – how can I use technology to minimise the damage that 100-hour pharmacies could do? About the same time I was approached to help develop the UK’s first automated 24-hour prescription collection point and the penny dropped. That was the eureka moment.

It was my opportunity to get my head around the technology and become a 24/7 pharmacy. It was being used in a number of countries, particularly Holland. By 2011 I was good to go. A month before the 100-hour pharmacy opened, I installed my first PharmaSelf 24.

I spent a huge amount of time getting the marketing right. I spent about £10,000 on marketing. A month after the 100-hour pharmacy opened, rather than my prescriptions going down, I was almost 2,000 items up. About two months after that, a 100-hour pharmacy closed down. And that was job done.

We currently have about 1,800 collections each month from our two collection points. We’re looking to getting that to about two and a half thousand by the new year. We’ve just installed our second collection point. Imagine – if I had 1,800 extra people walk into my pharmacy each month, where would I store those prescriptions? Where would I get the staff from?

Technology is not all about automation and robotics. The most important tool a pharmacist has in their pharmacy is their PMR system. It’s the best piece of technology you can invest in. Yet I still pharmacists buying the most cost-effective, the cheapest, because it’s a cost-saving exercise. But it should be seen as an investment for growth, for doing services.

In the quality payments scheme, one of the gateway criteria is the PMR system is running the latest version of software but I’ve just learned that, potentially, there is one supplier out there who has failed to grade for the majority of their customers the latest version. And unwittingly those pharmacists have declared they are running the latest version.
You must make sure the most important piece of technology you’re using is up to the job.

Ryszard Cygan, director & superintendent pharmacist, West Elloe Pharmacy.

Ryszard’s tips
• Don’t focus on making money out of generics – think differently.
• Ignore IT at your peril.
• Measure whether the technology you have used has been successful.
• Invest in a good PMR system, not a cheap one.
• Focus on effective marketing/promotion of your technology.


Digital means we can talk to customers beyond our four brick walls
In terms of community pharmacy, communicating with your customer or patient digitally offers plenty of benefits. It means we can talk to them actively in real time or we can talk to them passively 24 hours a day just by having content online such as a website.

We can talk to 10,000 people all at the same time all around the pharmacy at the click of a button. You’ll save money on paper and traditional marketing methods and talking to people digitally can allow you to compete with other organisations offering similar services.

Community pharmacy has never really grasped digital marketing. There remains a big pandemic of a lack of online presence but it’s easy to understand why. For years we simply didn’t need to market ourselves that much because we were doing fine organically by dispensing items.

Good customer service, in-store marketing and a good relationship with GPs was doing the job, so why change? However, with the evolution of digital health and mobile technology in recent years, our health demands have changed. We want to communicate with a healthcare professional right away. We want our medicine delivered to our door the very next day.

We must incorporate digital health into our business model and a significant arm of that is digital marketing. You need a website – think of it as the central hub of your digital marketing activity and digital shop window.

It can allow the user to nominate the pharmacy for EPS (electronic prescription service) from the website without the need to fill in a paper form. Users can also sign up and re-order their prescription on the go.

They can book an appointment for the travel and flu clinic without calling the pharmacy and the integration of these PGDs (patient group directions) makes this business an all-round holistic healthcare centre.

An online doctor functionality allows many prescription items to be sold digitally. Google Analytics can tell us what’s working and how that customer is behaving online.

Creating good, quality content in the form of a blog which is usually incorporated into the website will help people find services more effectively. Wrong opening times and contact information (on Google) is a really popular one I’ve seen.

You can only own and manage that information if you own and verify it. You can add photos of your pharmacy and add secondary categories to your profile (eg, primary category is ‘pharmacy’, secondary category could be ‘travel clinic’).

You could create an ad (on Facebook) that would only be pushed out to a person who reaches a certain proximity to your pharmacy and Facebook would track, through geo-location technology, if that person went into your pharmacy because of the ad.

Saam Ali, founder, Pharmacy Mentor.  

Saam’s tips

• Talk to your patients 24 hours by having a “mobile-responsive” website.
• Immerse yourself in digital marketing.
• Utilise Google Analytics to see how customers are behaving online.
• Create good quality content in the form of a blog.
• Use Facebook ads and LinkedIn for building relationships.


We’re not here to make things digital. We’re here to make things better
We (at Well) spend a seven-digit figure ferrying bits of paper backwards and forwards to GP surgeries. I’m sure (other pharmacies) do the same. That is criminal. In the modern age where you have a piece of technology that can do that for us, we’re not using it.

This is the fastest growing area… there are over 300 distance-selling contracts in England. They are getting nominations by the handful week in week out because customers want a different way of transacting and engaging with their pharmacy.

What is digital? It’s not about building a website. It’s not about (adding) an app. Please before you think about what you’re going to do in your digital space, don’t go and spend some money on some technology. And it’s certainly not about AI-powered wearables.

Don’t build a digital strategy. Build a strategy but don’t build a digital strategy. We’re not here to make things digital. We’re here to make things better.

People do want to come in. Doris wants to come in and have a chat. The services we offer requires face-to-face interaction. All of these things are going to be massively important for community pharmacy. Without doubt there is a massive future for bricks and mortar.

We have built an online pharmacy. We launched it in App Store, it’s on Apple at the minute, it’ll be on Android very shortly. We are the second fastest growing online pharmacy in England.

We’ve started to communicate and engage with our customers in a different way through text messages. In our online pharmacy we have a chat function where you can have a direct chat with your pharmacist and chat directly with GPs too.

While there are lots of apps out there and things in digital health, there is definitely not one out there that can do a flu jab yet.

Chris Ellett, transformation director, Well

Chris’ tips

• Online is great but don’t lose sight of your face-to-face services.
• Don’t stick your head and in the sand and think technology will go away.
• Focus on what’s most important to your customers and the NHS.
• Get your prescription business right.


Retail pharmacy can explain digitally-enabled services to people
Our healthcare systems grew up in a very different age. Our healthcare systems grew up looking to address bacterial infections, farming accidents, battlefields. The challenges today are very different.

Our systems have to change to do that. What we will see will be the first supermarkets in digital health. We’ll see trusted providers of digitally-enabled healthcare solutions for our citizens that are convenient, effective and affordable. And this is a massive opportunity for retail pharmacy.

You have physical premises and that’s really important. It’s unique and plays into your advantage. The trouble with digital health, whether it’s products or services, is they’re new, they’re different, they’re not familiar to the general public.

How do you get to know the retailers of the last five, 10 years? They don’t particularly fall into clean categories which is a big problem in retail. What we need to do is explain the benefit, what they are, what they do.

Out of all the organisations that could play in this digital healthcare space, we broke this down into 20 sub-segments, but retail pharmacy is almost unique for people who come into a physical space with a mindset that says ‘I’m in a healthcare environment but actually this is a retail environment. I can get help here and you have the time and the environment to explain to people walking in what you can provide to them with these new digitally-enabled products and services.’

I don’t see anyone else in the market having that ability.

Steven Dodsworth, CEO, D Health Europe.

Steven’s tips
• Think about what your vision for your pharmacy is.
• Don’t ignore online doctors.
• Don’t get caught up in technology.


Ignore digital technology at your peril, panel warns pharmacy
Panel members from the pharmacy and pharmaceutical industries were clear that if community pharmacies are to have a future, they must keep pace with digital technology.

Robbie Turner, director of pharmacy and member experience at the Royal Pharmaceutical Society, said it was clear health secretary Matt Hancock was determined to transform the NHS digitally and pharmacy would ignore that at its peril.

This year Hancock pledged some £412 million to transform technology in hospitals and allow people to receive care at home and another £75 million for trusts to ditch paper-based systems and use electronic versions which he believes will reduce medication errors by 50%.

“What we’ve seen from politicians and NHS policy-makers is that there is an expectation that healthcare will become more (digitally) controlled in the future. We’ve seen the work of Matt Hancock and (technology company) Babylon and he is no stranger to the move towards a digital future,” Turner said.

“I think we should see that as a wake-up call. Customers and patients are at the centre of what we do but it would be absolute madness for us not to focus on what the NHS, as the person who pays around 95% of your income, what they are thinking.

“And what they are thinking will be driven by the attitudes of the secretary of state for health and social care and his views are really clear – digital is here and it will accelerate and unless we get with that, we will miss out. Make sure you are as up-to-date as possible. Saying you do not do technology as a pharmacist any more and ignore the future and you will fail.”

Alliance Healthcare managing director Julian Mount said: “For me, it’s move at pace. I was at a presentation the other day where it showed that from the 1850s to 2018 in terms of the technological advancements we’ve seen in our lifetime.

“If we look back, mobile phones, word processors, computers, tablets, videos, it’s moved extremely quickly and that’s only going to accelerate. The time for talking is really done. It’s moving ahead at pace.”

Celesio UK marketing and sales director Nigel Swift said: “This is our Kodak moment. This is the time we need to change now. Someone asked about the growth in online pharmacy. I can tell you that for the last three months compared to the same three months last year, online pharmacy grew 21% compared to a standard contract pharmacy at 0.4%.

“Even if you strip the Pharmacy2U effect out, it still grew at 8.5%. There is a place for bricks and mortar to embrace digital now.”

PSNC chief executive Simon Dukes said: “The question is what should pharmacy want, what should it do? You need to focus on your customer. Many of you have one customer and that is the UK government. What does the government want? It wants to help urgent care, it wants to help the patient and it wants to help with medicines safety. Those three things and technology can help greatly.”

Turner added: “We’ve lobbied hard to ensure community pharmacies have access to patient records. We have an opportunity through access to those records to improve medicines safety, to improve outcomes for patients, to improve their access to services by flu vaccinations, MURs and new medicine service.

“We often use interoperability as barriers and it’s very simple to describe what the barrier is. With interoperability we don’t talk to practitioners, we don’t talk to GP systems. But it’s important that when we do have tools that are getting over barriers, we make sure we’re using them to the fullest.

“We at the Royal Pharmaceutical Society are working on new guidance around the use of summary care records. I know there are some misconceptions about when that can and can’t be used.”

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