Mike Holden looks at how pharmacists can take control of their future by embracing the right technologies and marketing strategy
The Challenges
There cannot be anyone working in or with community pharmacy that either feels or sees the pain that emanates from the current operating climate. Pharmacy closures; increased workload and operating costs; increased patient and commissioner expectations; and, more fundamentally, an inadequate, undervalued and poorly structured remuneration and reimbursement contractual framework.
As important as they are, we will not focus on these points here as they are not in the control of pharmacy owners and managers. They are the responsibility of those organisations that represent them at a national and local level who must deliver a better outcome as difficult as that may be.
However, there are matters which are in the control of pharmacy owners and managers. These include their premises, their team, their systems and processes, their relationships with other healthcare providers and the broader community, their NHS and private service offer, and how they promote and deliver them to give the best patient experience.
In order to create the head space to develop and implement a business plan, pharmacy owners and managers must make time to work on their business as well as in it. Then it requires the capacity and capability within their team to deliver the services and that excellent patient experience.
The Enablers
So how to create that head space and capacity to develop, implement and deliver that plan?
There is no silver bullet and it’s a continuous process. It begins with a shared vision and plan that is owned by the whole team. The capacity and the capability comes from having the right team ethos and skill-mix, systems and processes in place to deliver an effective and efficient operation. It requires effective delegation and empowerment, and the adoption of the right technologies plus a marketing strategy. Together, this can create the required operational efficiencies and enhance the experience for all.
In this article we are going to focus on technologies within an overview of options; however this must be an integral part of the bigger plan.
- Patient Medication Record system – having the right PMR system is critical for an efficient and safe dispensary operation. In fact, PMR is a misnomer; what is required is at least a patient management system that can complete all dispensary functions efficiently and safely, and manage patient relationships. This means utilising QR codes and scanners to create a safe and auditable trail across all steps of the prescription journey; being paperless as far as possible; being integrated with as many other digital support elements as possible; and communicating with patients.
For too long we have operated with PMR systems that are little more than labelling and ordering machines which at best capture basic outputs of some NHS Advanced Services. However, providers such as Titan have led the way in developing more efficient and integrated dispensary management systems releasing valuable pharmacist time for services. Their latest planned launch, Titanverse, will be a platform for services and an operations command centre. PharmacyX also delivers more efficient dispensary management, and the soon to be released Apotec system will apparently provide a more integrated operating system.
- Clinical Management Systems – even the more advanced PMR systems are not yet a full CMS so some pharmacies have adopted an additional system alongside their PMR. Examples include Semble, Pabau and Jelly. These systems allow the booking of appointments for NHS and private services; consultation notes using templates for each service which capture patient histories, test results, diagnosis, treatment recommendations and can create private prescriptions for IPs; and communication with patients and referrals to other healthcare professionals as appropriate.
Having a system like this facilitates a fully auditable record of clinical consultations, including NHS services like Pharmacy First, which can be accessed by other authorised individuals in the pharmacy thus providing continuity of care and underpinned by good clinical governance.
- Apps – there are a plethora of Apps out there including the constantly evolving NHS App. The more common ones being adopted by pharmacies include Charac, Accurx, Healthera, PharmAppy and Pharmdel. To a greater or lesser extent, these enable patients to order and track the status of prescriptions, book appointments for services, manage deliveries, and enable two-way communication between the patient and their chosen pharmacy. Some of these are or can be integrated into some PMR systems.
Imaan Healthcare have recently adopted a white-labelled version of the Charac app to improve the relationship between patients and their pharmacy. Saghir Ahmed, their Superintendent Pharmacist, recently said that the decision to use Charac was driven by rising patient expectations which was accelerated by the pandemic. They also want to reach a position where, by embracing technology and improving skill mix, their pharmacists will only spend 10% of their time involved in dispensing and the rest with patients delivering services.
Sunil Kochhar at Regent Pharmacy in Kent has embraced many aspects of digital technology to support the management and delivery of both NHS and private services. They use Jotform to create pre-consultation questionnaires which patients coming into the pharmacy for services such a Pharmacy First clinical pathways, EHC and Travel Health access through a QR code displayed in the pharmacy. This pings up on an iPad for the pharmacist to notify them that a patient is waiting for a consultation so that they can prioritise their work. It also provides professional and management information. This process helps manage patient expectations, gives them confidence that they will be cared for, saves repeating too much information in the consultation, and provides confidentiality and anonymity for sensitive matters like EHC and contraception.
- Other applications – there are a number of web-based applications which are adopted by pharmacies to support regulatory compliance and record keeping. These include CDRx, PharmSmart and PharmCD; some are partially or fully integrated within some PMR systems. Then there are the data capture and management systems which are widely used by pharmacies in England for NHS services – PharmOutcomes, Outcomes4Health and Sonar Informatics.
- Automation – dispensing robots, whether they be for original packs, monitored dosage trays or sachet dispensing, and medicine pick-up points. These all require careful assessment as they are a significant investment but can provide benefits. They will be right for some, but not all pharmacies, and should be a decision taken after putting everything else in place to ensure the pharmacy operation is as efficient as possible.
There are also workflow management solutions that can work in tandem with automation whether in a standalone pharmacy or a group running a hub and spoke system (N.B. this has to be a single business entity under current legislation). An example of this are the options provided by Centred Solutions.
- Digital marketing – one of the many challenges that community pharmacy faces is a lack of understanding of their market, i.e., the health needs of the community they serve. There are tools to help with this including Shape Atlas and Fingertips which provide health profiles for an area.
The public do not generally understand what pharmacy does beyond dispensing prescriptions and selling medicines. There is the NHS Service Finder based on the Directory of Services, and many pharmacies have their own website. Some use social media including Google Ads, Facebook and Instagram to promote their services. This can be self-managed or by using professional agencies such as Pharmacy Mentor and Pharmafocus.
Increasingly, pharmacies are utilising digital screens in their windows and within the pharmacy to promote products, services and health campaign messages. Some manage their own content; others use agencies such as HealthPoint or 9-Ways Digital.
Conclusions
Healthcare is no longer what it was a decade ago. Technological advances, coupled with the impact of the COVID-19 pandemic and the economic climate, have and continue to drive change through innovation. The need for efficient systems, contactless care, personalised treatments, high quality patient experience and outcomes, digitised health records, and AI-driven processes has become more pronounced than ever.
Pharmacy is not exempt from having to respond to this and the shifts in patient and commissioner (NHS) expectations. Legislation, regulation, professional standards and guidance must reflect these shifts so as to enable, not hinder, progress, but without negatively impacting on patient safety.
Pharmacies must consider what technology is adopted, how it is adopted and what the risks and benefits are of using technology are. The benefits include improved efficiency, streamlined workflow, improved patient safety and patient-centred care, efficient inventory management and regulatory compliance.
While technology has the potential to transform healthcare for the better, it also carries a number of risks which pharmacies need to be aware of and mitigate. These include privacy and security risks, inaccurate data and information, a potential dependency, inequity of access and higher operating costs if other changes in operating practice are not leveraged to improve efficiencies and increase revenue.
We must get to a point where pharmacies are able to use a single system or at least a fully integrated set of systems with single entry of and access to patient data. We must acknowledge that technology, in all its guises, is now an intrinsic and important part of the pharmacy team. At the moment it seems that pharmacy is not driving technology, technology is driving pharmacy?
Michael Holden FRPharmS FRSPH is associate director of Pharmacy Complete.
