The Pharmacy Business conference took pharmacists down a path to a bright future…provided they get the present right, writes Neil Trainis…
The second Pharmacy Business conference was billed as an examination of an exciting future for pharmacy but it was the here and now that resonated more than any vision.
Community pharmacists, pharmaceutical company executives and any others who made it to the Intercontinental London – the O2 heard informative talks on a range of areas that, they were told, had to be exploited to the full if pharmacies at the heart of their communities were to have a long-term future.
It had an all-too-familiar feel about it. Rob Darracott, the former chief executive of the defunct Pharmacy Voice, considered the idea of quality, more specifically the government’s idea of quality, and what pharmacy teams should be aiming to achieve.
Up next was Gavin Birchall, the founder of Dose Design and Marketing, who guided the conference through effective self-promotion and how pharmacists can identify opportunities through an understanding of their market.
Manjit Jhooty, CEO of Jhoots Pharmacy, and Rupert Newman, sales director at Celesio, debated the ways pharmacies can enhance their customers’ experience while award-winning pharmacist Ade Williams conceptualised pharmacies as wellbeing hubs helping people to avoid illness through smoking cessation and advice on alcohol intake, healthy diet and physical activity. Put simply, it was all about getting people to live healthier lives.
The theme of prevention was picked up by conference chair Michael Holden. “Apart from improving health outcomes it’s prevention,” he said.
“You probably know that Healthy Living Pharmacy runs through my blood. Prevention is what we have to do if we are going to close the door on the black hole that is NHS funding which is creating some of the pressures on us as a sector.
“If you look at the size of the problem compared to the size of the general issues that affect risk to health and risk of illness and death, then these guys are the big targets we should be aiming at; smoking, physical activity, healthy diet, healthy weight, alcohol, mental health, those are the big guys that we should be working on.”
Another award-winning pharmacist, Jonathan Campbell, spoke enthusiastically about integrated working and the importance of pharmacists developing and cultivating links with GP practices, hospitals and other health providers.
The conference heard from Sanjeev Panesar, an independent contractor who sits on Birmingham Local Pharmaceutical Committee. Smoking cessation services, he said, had “become quite stale and outdated. It hasn’t moved with the times.”
Why? Two words. Electronic cigarettes. “One of the biggest contributing factors to that was the increase in the availability of e-cigarettes over the years and that has just changed the landscape quite dramatically,” he went on.
Panesar revealed his local authority ran a small pilot where pharmacies supported people to try and quit smoking by giving them e-cigarette starter packs and plenty of advice. That was followed by another pilot scheme earlier this year involving more community pharmacies who would give patients the choice of using e-cigarettes or nicotine replacement therapy (NRT).
He went through the advantages and disadvantages of the two approaches. The disadvantages of e-cigarettes? Long-term effects are unknown, it is a relatively unregulated market and quality of products differ, they could glamorise smoking and information reported by media outlets varies.
Advantages? They appeal to younger clients, they mimic the use of smoking, are more cost-effective and produce high quit rates. Advantages of NRT? Poor quit rates and is outdated. Advantages? It is a tried and trusted method and does not harm users.
The approach of the tobacco industry, he rightly suggested, was changing. The future was electronic. “There’s been a lot of talk in the tobacco industry. The tobacco giant Philip Morris has claimed that conventional cigarettes could become a thing of the past and they themselves have got a strategic plan to move revenue away from cigarettes.
“These kind of comments from the tobacco industry really demonstrate that there’s a dramatic change in the landscape in the smoking habits of the general population. Smoking cessation services needs to take this message on board and adapt to these changes.”
Pharmacy at a national or local level was a debate that gripped the conference too. “Local is the new norm. Yes, there’s some national stuff and it’s great to have the flu vaccination service and see at least half a million delivered through community pharmacy in the first month alone,” Holden said.
“But we need other national services like EHC (emergency hormonal contraception) so that everybody who wants emergency contraception can know they can go into a pharmacy and get it. Not a postcode lottery, not have to walk through a sign that says ‘GUM clinic’ or ‘sexual health clinic’ but go into a pharmacy where they’ll get friendly, safe and efficient services. Those are things we should be pushing ahead with, big, big stuff.”
That was not where it ended. The local-national dispute occupied the minds of Sue Sharpe, Cormac Tobin and Julian Mount, representing the PSNC, Celesio and Alliance Healthcare respectively, during a panel discussion.
It was engrossing and engaging but the conference did not transport minds to a thrilling future. It did, however, remind everyone starkly of what needs to be done now.
And the sooner the better.
Look at what health approach works in your community
One of the things we were aware of was the need to understand of our local community. (In our area) there is a history of high alcohol consumption, we have a high number of people who are smokers. We also have a high cardiovascular risk profile.
One of the things the HLP model allowed us to do was to look at what our community was and start to think through as a team how we can step out and make a difference. Making a difference was not actually as challenging as I expected it to be. We are very used to having conversations with patients usually because they are initiating it.
The HLP ethos asks us to be more proactive. But actually, the proactive conversations, we already have them. We found what we were doing was shifting the conversations. Mrs Smith comes in and we would ask her about the family or what particular programme she is watching on telly.
But we’ve moved the conversation to speaking to her about her health, her wellbeing, whether she is suffering from isolation or whether there are lifestyle challenges she is facing.
Engaging health promotion, health interactions, we have learned that the key to this will be different for every community. What works in your community. Does humour work? Can you create a theatre around your idea? Can you get your patients to come in and think ‘I really love this environment. I love the way you guys interact with me. I feel comfortable talking to you.’
But the key is in HLP pharmacy, we can signpost you to a resource or an intervention or a change to revert a tragic health outcome.
Ade Williams, pharmacist, Bedminster Pharmacy.
• Understand the profile of your community.
• Identify best approach to patient engagement – humour, cartoons, fury animals, etc.
• Remember that Healthy Living Pharmacy is the model of pharmacy.
• Identify hard-to-reach groups and go where patients will be (visit pubs, etc).
• Get out into the community.
Empower staff, be proactive and engage with GPs
It’s about engaging, empowering and investing in individuals. I have two ACTs and two NVQ Level 3s. They run and co-ordinate my flu clinics, NHS health clinics and my NVQ 3s co-ordinate all my healthy living campaigns and activities we do.
Over a long period of time we built relationships with local GPs and that was essential for us to do to develop any service going forward. This was about investing in innovation and I don’t mean IT. It’s about looking at how we can create new models of care and local solutions and utilise the strengths of the community pharmacist and team to improve patient outcomes.
The next step was around healthy living campaigns. It gave our staff a sense of purpose. The GPS could see how we were working, they could see this shift in this clinical interaction with patients. The GPs said ‘let’s see what you can do for our population.’ So together we looked at the strategic joint needs assessment and found out four clinical areas that made a difference to our population.
We didn’t just run an awareness campaign, we ran a proactive screening process. We used questionnaires and patients rated as ‘high risk.’ Did we refer them to the GP? No because you’re creating more pressure on GPs without the full picture.
The GPs said ‘when you’ve highlighted those patients who are high risk, can you refer them to your spirometry, can you refer them to do blood (tests) for further investigation, then ask them to come and see me.’ So they are seeing patients at the end of the process with all the information they need. Each cohort holds about 40 patients and two or three people we picked up had undiagnosed type 2 diabetes or undiagnosed COPD. We made a difference through a screening process and a referral process. We were part of the whole team.
Jonathan Campbell, pharmacist, Old School Pharmacy.
• Ensure your healthy living campaigns have an integrated approach.
• Do not rely on national services – get involved locally.
• Do not rely on dispensing income alone.
• Empower/train your team to take on new skills and make decisions.
• Change perceptions of how GPs and patients see you.
Leaders clash over pharmacy driven at local or national level
PSNC chief executive Sue Sharpe and Celesio managing director Tobin exchanged contrasting views over whether the future of pharmacy and the services it provides should be locally or nationally driven.
The two offered their opinions during a panel discussion with Alliance Healthcare managing director Julian Mount who agreed with Sharpe that the commissioning of pharmacy services would remain for the foreseeable future at a local level.
“A national contract overwhelmingly driven towards remunerating dispensing has allowed people to become quite passive without developing their own businesses and being energetic, innovative, individual about it,” said Sharpe.
“The status quo with the NHS and the state and mindset it is in is just not geared up to people allowing themselves to just be driven by a national contract. We’ve got a big job to do to get people to wake up to the reality that it is going to be very individual efforts that are going to be the determinant between success and failure in the long-term.
“The best way is pharmacies demonstrating at local level to general practice just what they can do. I don’t think you’re going to see a national framework insisting on a transfer of care.”
Agreeing with Sharpe, Mount said: “If you’re waiting for a commission and you’re waiting for it to be given to you, the situation we have now is not going to be permissive.”
Tobin said: “I disagree wholeheartedly. The work (pharmacists do) resonates locally. They’re doing exceptional jobs there. But nationally, if the government doesn’t see pharmacy as part of the solution, they don’t. Simon Stevens’ report…doesn’t mention us at all.
“And if we do not solve that engagement and relationship problem at the top and change the way we do things phenomenally, there’s no world order. Number one, we don’t have the resources to do it because most stores are flat out.
“Secondly, there’s been a lack of investment. We haven’t invested in our infrastructures. So I disagree. It’s a combination of a nationally-driven, properly represented body who articulates what they want to do plus local initiatives that can feed right (into that). It’s both. Businesses operate that way, why shouldn’t this operate that way?”
Quality is the key in a struggling NHS
Quality is one of the things that runs through the NHS challenges right now. Local leaders think beyond organisational boundaries to find innovative solutions for local needs. Joint Strategic Needs Assessments, Pharmaceutical Needs Assessments…really important documents right now and something we can use to get into the system because they identify things that need to be done.
Yes, money is a challenge but unless you start using the building blocks that are out there and talking to other parts of the system, then we’re going to continue to have conversations with ourselves. As well as the national challenge, the real challenge is to engage at a local level.
What the local health systems in your area working on? What’s your part in that? What would quality look like if all the parties were talking to each other? What would that mean to the public and patients?
Pharmacists in GP surgeries are not just there to deliver specific services, they are there to improve the quality of prescribing and improve the quality of long-term conditions management. They are also there to improve the quality of how the system fits together.
The new focus we will hear an awful lot about over the next 12-18 months is medicines in care homes which is also about improving quality in prescribing. It’s explicitly about putting a team approach into improving the quality of care in our long-term care facilities.
Should contractors engage with the quality payments scheme? There are two reasons to do it. One, because it’s a way of getting some of the cash back. Secondly, people should do it because it’s the right thing to do.
Rob Darracott, former chief executive, Pharmacy Voice.
• Find new ways of shortening work methods.
• Find out what people want in a service.
• Use JSNAs and PNAs.
• Engage at a local level.
• Get involved with quality payment scheme.
Marketing is strategy, tactics and research. Know your population
What is marketing? It’s the science and art of exploring, creating and delivering value to satisfy the needs of a target market at a profit.
Customer experience should be carefully planned at every point in which your customers come into contact with you. How you do that is through your marketing. Your marketing covers not only your communications but everything, from how you want to be perceived to what products you offer, who you offer them to, how you offer them and then communications, telling people about those products.
The key bits to marketing are strategy, tactics, research, developing your products and planning your communications. We must understand the needs of our patients in depth before we start marketing. It’s important to think ‘what does my market actually need?’
You might spend a lot of time investing and developing a service that someone else is doing better than your doing it down the road. Or that need has already been met. Do research to understand what are the health needs of your local population. You might think ‘I’ve been doing this 20 years, I know my market.’ You probably don’t, so do your research.
You could do your own qualitative research, for example focus groups. Get some patients in, talk to them, ask them questions followed by quantitative research on a larger scale; how much did the issues raised during the qualitative research matter?
Research your competitors as well as the services you want to deliver, not just other pharmacies but healthcare providers as well.
Gavin Birchall, founder, Dose Design and Marketing.
• Plan your customers’ experience.
• Understand needs of patients before marketing a specific service.
• Use JSNAs/PNAs to research your population’s needs.
• Invest in marketing.
• Research your competitors.