OPINION: Time for pharmacy to reset and recover

Michael Holden says independent community pharmacy contractors have no time to waste but focus on developing their own post-pandemic recovery plans…

As community pharmacy reflects on and learns from its excellent response to the Covid-19 pandemic, the time is now right to move forward and plan for reset and recover to create a sustainable future for the sector.

Negotiations on Covid-19 related costs and what will happen to the £370 million advance payments (on average that’s £32,000 per pharmacy) are ongoing and discussions on the next steps for implementation of the five-year contractual framework have started but there are no visible outcomes at this stage.

Following the publication of the Wright Review, consultations on pharmacy representation and support are happening with a recognition that change must happen. The report identified many recommendations and highlighted the need for a clear and united national vision and strategy for community pharmacy in England.

It also calls for a national communication strategy to enhance external perceptions of pharmacy. While not explicit, this is presumably targeted at the public, but also those who commission what we do (NHS, DHSC and Government) and other providers of local healthcare services that we should be working with.

Some multiple pharmacy groups are already announcing significant restructuring and remodelling plans in response to the financial, operational and landscape challenges, but where does that leave independent pharmacy?

What are the learns

So what have we learnt from our response to the pandemic (if we didn’t know it already)?

• Pharmacy cares
• Pharmacy is dynamic and can respond quickly to changes in demand when forced to do so
• Collaborative and integrated working helps overcome some challenges and improves relationships with other pharmacies, other healthcare providers and patients
• Embracing digital communication and technology improves efficiency and effectiveness
• Efficient processes increase productivity and safety
• Agility needs to be embedded in everything we do
• Change must happen at every level from contractor upwards

What is the reality

The outcomes of research undertaken by Pharmacy Complete through conversations with owners and managers of independent pharmacies and local pharmaceutical committees has shown that pharmacy contractors and their teams are understandably facing a number of critical problems:

• Financial impact: Falling revenue, costs exceeding income, cashflow challenges monthon-month, overdraft increasing, being asked to do additional work without a fee
• Personal strain: Working longer hours, feeling undervalued, worried about health and business viability, isolated and alone, unable to say ‘no’ and losing confidence
• Feeling out of control: Unable to see a future, not knowing where to start and overwhelmed with information
• Team performance: Disengaged and demotivated, wrong skill-mix, staff turnover and absence, concerns about being at risk
• Capacity: Not enough time, not enough staff with the right skills to release pharmacist time, low-margin dispensing and supply chain management dominating activity, operating efficiencies and productivity sub-optimal
• Competition: Losing patients to online providers, reduced footfall into the pharmacy and falling service revenue and OTC purchases. Independent community pharmacy owners can no longer wait for others to change and there is an urgent need to reset to a service-led offer and develop their own recovery plan.

Independent community pharmacy owners can no longer wait for others to change and there is an urgent need to reset to a service-led offer and develop their own recovery plan.

What is in your control

The Sphere of Control (see Fig. 1) illustrates three key circles into which activity may fall. It is easy to fall into the trap of focusing our time and energy on things that impact or concern us but are out of our control; an example would be the national funding negotiations or the limitations that are the outcome of the pandemic. This not only saps our energy, but also can demoralise us into thinking there is nothing we can do.

There are things that we can and should attempt to influence but only when there is a beneficial outcome; for example, the current review of representation and support or our local relationships with other pharmacies, GP practices and the Primary Care Network.

Our main focus should be on those things that are in our control such as the people we employ, our own behaviours as leaders and managers, the way we operate our pharmacy, the way we examine our local market and the quality of the experience we give to our patients.

What could you do now

The Austrian psychiatrist, Viktor Frankl, said: “When we are no longer able to change a situation, we are challenged to change ourselves.” Developing a plan has to be underpinned by the self-recognition of a need to change what and how you operate to get a better outcome. The plan should be based on three key questions:

1. Where are you now?a. Understand the key indicators of your current performance

   b. Your prime opportunities and threats

   c. Your team strengths and weaknesses d. What your patients think of your pharmacy

2. What can you control right now?a. Focus on things within your control b. Regain control by setting a clear vision c. Establish key priorities and measurable goals with timelines d. Build your personal and business resilience e. Manage your time more effectively f. Improve efficiencies and productivity g. Reduce waste (time and money)
3. How can you be agile to change right now?a. Engage and involve your team

   b. Delegate and empower effectively

   c. Get your environment right

   d. Optimise NHS services, e.g. NMS, flu vaccination

   e. Grow self-care revenue

   f. Build private services

   g. Engage with key local stakeholders

   h. Be assertive (not passive or aggressive)

   i. Effectively promote what you do No one is saying this is easy but doing nothing is not an option and no one else will do it for you.

Michael Holden is chair of Pharmacy Business Conference and Associate Director at Pharmacy Complete.