The first Pharmacy Business conference highlighted the uniqueness of pharmacists and their teams. Pharmacy Business editor Neil Trainis was there to see it unfold…
Those who gathered for the first ever Pharmacy Business conference might have had a very uneasy feeling at what was about to come out of Westminster’s corridors of power funding-wise but they should have left the Intercontinental London 02 hotel feeling empowered.
Passion for Healthcare was the theme of the conference, staged one week before the government’s announcement that it would slash pharmacy’s budget. It was staged by the Asian Media and Marketing Group, publishers of Pharmacy Business, and undiluted passion was what we got.
Whether it was Claire Ward, chair of Pharmacy Voice, exalting community pharmacy and bluntly criticising the government from a stage she expertly used to powerfully project her views or drug company executives and pharmacy politicians debating the pros and cons of Brexit, there was passion.
But most importantly there was passion from five very talented, very hard-working community pharmacists each of whom revealed how they have improved the health and well-being of their local populations.
And as each of them articulated their experiences, enthusiasm and passion crept through every word. Bina Patel from Kalsons Pharmacy in Westcliff-on-Sea spoke about how she and her team have helped patients get the most out of their medicines.
Jignesh Patel from Rohpharm Pharmacy in east London navigated the conference through the process of effective engagement with commissioners, something many community pharmacists have not managed to achieve with great success.
Up next was James Tibbs, a confident, young pharmacist who has built a fantastic Healthy Living Pharmacy at AR Pharmacy in Southampton. He had some insightful advice for pharmacists on how a good, effective HLP should look and feel, words that were particularly valuable given the NHS’s focus on preventing illness before it strikes.
Another young pharmacist full of self-belief, Amish Patel from Hodgson Pharmacy in Kent, took to the stage to talk about his successes with technology, advancements that are vitally important to community pharmacy if the sector is to move forward and play a pivotal role in a modern NHS. His message: Don’t be afraid to embrace technology.
Sunil Kochhar, who runs Regent Pharmacy in Kent, delivered a stimulating talk on self-care pharmacy and how community pharmacy can and should be putting the patient at the heart of their own healthcare.
Their stories highlighted the value they bring to healthcare in the UK – a value that was best quantified not by reports on the social value of pharmacy or dossiers estimating how much pharmacy saves the NHS annually.
Pharmacy’s value here was measured by stories of real life flesh and blood patients whose lives have been improved, prolonged and in some cases saved thanks to the dedication of their community pharmacy teams.
For her part, Ward relished the opportunity to talk about Pharmacy Voice’s Forward View, launched before the announcement of the cuts to pharmacy funding and driving three key agendas; pharmacy’s role as the facilitator of personalised care for people with long-term conditions; pharmacies as the first port of call for episodic healthcare advice and treatment; pharmacies as neighbourhood health and well-being hubs.
“Those three core domains we focused on in the Community Pharmacy Forward View are already being done in many places up and down the country,” she said.
“The challenge for us is to make sure we are consistently delivering those things but that we are also getting support from the NHS and government to do it.
“But we know how challenging it is out there right now. We know in many cases community pharmacy is gated out of CCGs. We know you’re struggling to make inroads in Health and Wellbeing Boards.
“We need to think about how we campaign and work together collaboratively to promote community pharmacy. Wouldn’t it be fantastic to have some sort of cross-sector campaign to promote pharmacy.
“I went to see Lincolnshire LPC and they’re looking at a marketing campaign to promote the pharmacy heroes in the run-up to the winter and flu campaign, driving people through the door of Lincolnshire pharmacies.
“What a great idea. But why should it stop at the borders of Lincolnshire. Why not take that and do it across the country nationally? We have to show that community pharmacy can and should be at the centre of primary care delivery for patients.”
For community pharmacists, it is all about telling their stories. This conference gave pharmacists the chance to talk about what they do so well and, of course, spread their wisdom to others in their profession.
Through the pages of Pharmacy Business, it might yet even enlighten those in the dark about the nitty-gritty of pharmacy practice, namely government ministers and leaders of general practice. Even if the damage has already been done.
After all, a well worn suggestion has been that the government has not been aware of what community pharmacy exactly does because community pharmacy has been poor at telling those stories.
In what turned out to be an uncomfortably prophetic criticism of the government, Ward said: “The most deprived communities, those with the greatest health needs, rely on their local pharmacy. And while successive governments have called for community pharmacy to provide more health services in the community and relieve the pressure on GPs and A&E, they’ve not provided the resources or the vision to actually achieve this.
“It is clear yet again that the government is not offering neither the resources or the vision to achieve that potential that community pharmacy can deliver.”
Time, she warned, waits for no pharmacist. “We now know there is a time for change coming for community pharmacy. In that context, we need to think about why we are where we are because the health and care system is facing major challenges and significant change.
“People are living longer. We are seeing the advancement of science and technology. We know people’s demands and expectations are much greater and when they’re living longer, they’re going to need more support and more help.
“And all of this costs money. And this is at a time when the government and NHS England are trying to control what can only be described as an insatiable NHS appetite.
“So everybody in every single stream of healthcare are having to look at the role they play not simply in the context of cash but in the context of better patient outcomes. How do we work together? How we put patients at the heart of everything we do and we we provide that cost-effective care.”
Ward insisted everyone in pharmacy has “to talk the language of the NHS and Five-Year Forward View because that is what is running through everything that is changing in the NHS and in everything that is determining what the government does.”
But she added: “We also need to realise the ambition of the sector and the profession, something we’ve all talked about for many, many years. But it has escaped us in terms of consistency and advancement across that sector.
“We know whatever we do, it has to meed the needs of patients and the public and also the government. That is about realising community pharmacy’s potential.”
Shailesh Solanki, the executive editor of Pharmacy Business, was keen to illustrate how critical community pharmacists and their teams up and down the country are to patient care. He also stressed the conference should teach other pharmacists to up their game in various areas of pharmacy practice.
“This conference is all about learning from the very best pharmacists. Pharmacists are at the coalface delivering exceptional services to communities up and down the country,” he said.
Michael Holden, the former chief executive of the National Pharmacy Association and founder of the pharmacy network Pharmacy Complete, attempted to infuse a sense of belief and urgency into the pharmacists in the room.
“Nothing is impossible if you have the will and skill to deal with it. The pace of change is accelerating,” he said. “Keeping up with that change is a very significant challenge particularly for the independent sector.
“We will get a feel of people who have made change happen in their business at a grassroots level by having ambition, vision, innovation. And that’s the purpose of this conference, to impart how they’ve done it, why they’ve done it and what they’ve achieved from it.”
And from that point, five highly talented, devoted, determined, passionate community pharmacists took over.
Empower your staff in medicines optimisation – Bina Patel
You have to take a holistic approach. Our professionalism should be patient-centered and you should be working in partnership with other clinicians.
We wanted to help our patients take ownership about their health, about their medication. We had a situation where the surgery near us closed down, two of the doctors passed away and the situation was very dire because we had nothing near us contributing to prescriptions that should be coming into us.
We had to rethink how we take this forward. How can I rescue my business? Firstly I looked at my knowledge. Thankfully, because I had a secondary role as a lecturer at university, I always had to be clued up. And I had a hospital background.
I thought ‘I’m knowledgeable. How do I make my pharmacist knowledgeable? How do I make him confident so he can support me in this agenda?’ The way I did it was I targeted meetings where the staff had to train each other.
Each person was given a topic and they had to present amongst themselves. My pharmacist had to take the lead in directing the conversation. It started equipping them with the confidence to talk to people and actually give advice on how things can be done and how self-care can be improved.
It’s not just about prescriptions. We looked at when people came in for advice, do we give them the self-supporting advice they need and is it evidence-based? Because if it’s not evidence-based, it’s not safe advice.
We targeted a company that does health screening tools and we have a screen in the pharmacy. I said to the staff ‘if the pharmacy is busy and someone asks for advice, why don’t you take them to the screen, go through the screen’s information with them, provide the patient with information.’
We usually ask the question ‘have you already had this before? Are you aware this is what you should be doing?’ And ‘these are the things you should do to manage your condition better.’
As a result, all my staff understand they cannot hand out medication by themselves. They have to involve the dispensary team and the pharmacist.
– Hold meetings where staff train each other – gives them confidence to talk to patients.
– Make sure your advice to patients is evidence-based.
– Collaborate with other clinicians
-Join a buying group to support you.
Identify issues commissioners have and meet that need – Jignesh Patel
Commissioning is a complex process. You need to understand what issues these organisations have and where we can have a role in engagement to address these issues.
What are the perceived barriers to commissioning? There is a lack of confidence in NHS managers. Stakeholders have concerns about commissioners. Commissioners may not have the personal qualities required to manage finances of a particular agenda.
Conflict of interest may prevent commissioners working alongside other healthcare professionals. NHS managers and other healthcare professionals may not trust the financial capacity of commissioners in delivering plans.
Commissioners may not have knowledge and time to appropriately manage finance. There are concerns about probity issues leading to GPs being commissioners and providers. There are concerns about transparency when GP commissioning services through other healthcare providers.
Encourage dialogue and debate with a whole range of people. Develop creative solutions to transform services and care. Articulate the need for change and its impact on people and services. Demonstrate awareness of the political, social, technical, economic, organisational and professional environment.
Communicate your aspirations. In terms of knowledge and evidence, use appropriate measures to gather data and information. Carry out analysis against an evidence-based criteria and use information to challenge existing processes.
Don’t feel that every time you approach your CCG or GP practice, they’re going to say no. You’ve just got to listen and on day you might find there is a problem you can deal with. I’ve been lucky because I’ve had very supportive GPs and CCGs.
There are lots of research funds out there. If you use research funding, you’re more likely to get funding from the organisations doing the research.
If you’re travelling the data collections through primary care, then it’s much more difficult to do. GPs or even commissioners, unless they see the benefits, they’re not going to pay you extra money for that data.
-Understand how your values differ from other groups/individuals.
– Identify your own emotions/prejudices.
– Take in feedback from a variety of different sources.
– Ensure your plans are flexible and consider needs of others.
– Use research funds to gather data on value of your services.
Take HLP concept into your local community – James Tibbs
What is a Healthy Living Pharmacy? The best thing about Healthy Living Pharmacy is that it’s pretty much what we do anyway. There’s not much difference between being a Healthy Living Pharmacy and a normal pharmacy.
The thing that surprised me was that it was quite easy to do. The key thing is to get your staff engaged from day one. They’re the ones who are going to be championing it. They’re the ones on the front line.
The Healthy Living Champion training isn’t that difficult. We had these things called world cafe events where lots of pharmacies in the area got together and we had a brainstorm about how we’re going to apply that, how we’re going to do the training.
Having other pharmacies who are Healthy Living Pharmacies in your network and staying in touch with them is fantastic. Technology has helped us massively.
Being a Healthy Living Pharmacy doesn’t just mean having that stamp-mark on the door or the windows. It’s about actually using it and going out into the communities. We do a lot of work with our local college as well. Every month I go to the college and engage with the students and offer health advice. The college asked me to do this because they recognise Healthy Living Pharmacy is a quality service.
We have lots of health campaigns in-store and we developed one for mental health. I don’t feel we do enough for mental health. We have a permanent stand in the store related to mental health which we keep updated and fresh and interesting.
We are working with the GP surgeries to develop a hypertension clinic in the pharmacy. We do a lot of work with Gypsy and travellers, going out to see people in their natural environment. We got commissioned to do NHS Health Checks through Gypsy and traveller communities through vaccinations.
– Get your staff engaged in HLP.
– Create Healthy Living Pharmacy networks with other pharmacies.
– Look at Joint Strategic Needs Assessments (JSNAs).
– Get out into the local community.
– Get GPs/CCGs involved.
Drive self care by building up your P medicines – Sunil Kochhar
Pharmacy is the new lifestyle. The public go to pharmacy as part of their lifestyle just like they go to a hair salon, they come to a pharmacy.
We mustn’t forget our reputation as a profession and build up our P lines. When we do these consultations can we sell these products? We need to make sure they’re credible and we look after our profession.
I believe we do this through services and clinics. Clinics can be external practitioners. We have a chiropodist who comes in, acupuncture, physio and we now have a skin specialist. What we’ve done in our pharmacy is create an ecosystem.
What that ecosystem is is that the service will link to a clinic and retail setting and that’s how we build up our retail. We mustn’t forget the power of consultations. In 10 minutes you can recommend products for treatment and prevention and enroll the patient on to a service. That’s the power of consultations.
You can use consultations to record patient information and create private records from retail sales, so when I click on a patient I always ask them to come back, get them to do a review.
We mustn’t forget our staff. We need to make sure our staff understand what pharmacy is. How do you do that? Through training. We have a system where every staff member gets one hour training per week.
Know your community. The only way you get to know your community is by going out into the community. We use different mediums to collect data. Social media is a good way if you want to do data collection, you can do questionnaires online.
When people visit we do patient satisfaction review surveys. Our staff collect data and we’ve developed our EPOS to collect data. Regarding consultations, you can these apps where you can write patient notes and create personalised plans for them.
Collect that data and build by consultations, understanding what the community wants, you create new services. We have a consent form. We use the same kind of platforms, for example MUR forms where we have to get consent. We’ve adapted those to our private services. We use things we already know and adapt them.
– Build up your P lines.
– Don’t forget the power of consultations.
– Train your staff.
– Get to know your local community.
– Collect patient data using different mediums.
Consumers are using technology so we must be tech-savvy – Amish Patel
Our consumers are changing. They are using technology more and more. They are finding more ways to get more information about their health. They are more tech-savvy. They search for apps, they search forums.
One in 20 searches on Google are healthcare-related or 2,000 health queries every second. The kind of things people are searching for is headaches, skincare, anything healthcare-related. These are interactions that we are not capitalising on. It’s not people walking into a pharmacy any more.
There are devices we can acquire. There’s a thermometer which links to your smartphone, an otoscope where you can look into the ear, take pictures, email back to your GP or consultant.
There is a baby onesie which monitors the motion of the baby, the temperature of the room, the audio in the room. There’s a scanning device which lets you monitor your blood pressure, temperature, heart rate, pulse. And if you still need to contact your GP, there’s a video recorder. There’s a company called Babylon in the UK for example whereby it sends you the video recording from your GP any time you want. It’s essentially putting your GP in your pocket.
Our consumers are using YouTube. There are 360,000 videos on how to treat a cold alone. How about using a tablet inside the pharmacy? We’ve done away with leaflets. Now we use an app linked into NHS Choices which people can search for content.
EPOS – most EPOS systems collect patients’ names, telephone numbers and email addresses. You could easily use that to mailshot (people).
A robot is slightly more pricey than other technology but the return on investment, in my case, three to five years. I can do fast dispensing and give you the best service at the same time. And it’s become a talking point – people have come from other pharmacies just to see the robot.
Websites are crucial. They’re not too expensive, £300 you can have an all-singing, all-dancing website. We have a health passport which we use locally. It allows patients to record at home test readings such as glucose, cholesterol, blood pressure. Other website features include repeat ordering.
– Use health tech such as thermometers, otoscope, baby onesies & scanning devices.
– Embrace social media such as YouTube, Facebook, Twitter.
– Ensure your pharmacy has a website.
– Use tablets inside the pharmacy – allows patients to look for health info.
– Use EPOS to mailshot patients.
– Consider robotic dispensing – great return on investment.
Brexit a disaster? Yes it is says Alliance Healthcare MD…no it isn’t says Numark MD
John D’Arcy and Jeremy Main, the managing directors of Numark and Alliance Healthcare respectively, clashed over their views on Brexit’s impact on pharmacy.
Describing Brexit as a “an utter disaster” during a panel discussion, Main said: “Frankly I can’t think of one positive thing to come out of it for us or for the industry. The impact immediately for us on PIs…the exchange rate…is an absolute disaster. That will create a lack of profit for all of us. We’ve got a high percentage of Eastern Europeans working in our warehouses, particularly in the Midlands. That creates uncertainty. It’s going to mess up licensing. It’s going to mess up medicines regulation. The European Medicines Agency is going to move out of London and go somewhere exciting like Milan. It’s an absolute wasteland.”
In contrast D’Arcy said: “I don’t think it’s a disaster at all. At the moment supply, there’s still issues but it’s reasonably good. And it’s reasonably good because there’s plenty of stock and it’s driving prices around pharmacy. The price of APIs is going to go up.
“But if you look at the world, the pharmaceutical industry is a global business. And yet health goes increasingly local. If you have a localised market, coming out of Europe means we’ve got the ability to manage our health system in our way.
“If we’re not paying one hundred billion into Europe, you can use that in some way. Norway is out of Europe. We’re out of Europe. I do believe there’s life outside of Europe. Europe is losing 17% of its budget. If lost 17% of my members and Jeremy lost 17% of his customers, I don’t think it would be more gloomy.
“Do I think it’s a calamity for us? No I don’t. I think we’ll get through it.”