29 October 2015

A Healthy Community Pharmacy Strategy

Filed under Mark Robinson

I am doing some research for a ‘Healthy Communities’ meeting I have been invited to. Lots of clever people will be there – you know counsellors and politicians, but I doubt there will be a pharmacist.

I am walking down a high street that I have known for many years. Many of the shops I remember are closed to be replaced by a charity shop and some fast food outlets with motorbikes parked outside. There is still a ‘corner shop’ that sells newspapers and alcohol and a selection of bits and bobs. It has a heavy duty metal grill and a sign that says ‘only two schoolchildren at a time please’. Even the teashops / bakers were closed – empty tables and broken chairs still visible through the window. It all feels grubby and uncared for – just dirty. There is graffiti on the walls and I would suspect that it is not a nice place to be walking through late at night – even my research doesn’t go that far.

The GP surgery is two streets away in a pair of converted semi-detached houses. The community pharmacy, which used to be an important feature of the high street, is in the GP surgery. So I pop in and ask the question – why did you move?

The answer was simple – more than 90% of our business was in prescriptions. This move protected our business from competition and allows us to keep going.

“What proportion of your business is in prescriptions now?” was an obvious question. The answer was almost 100% – we do sell a couple of products, but we just don’t hold the stock anymore and we don’t have counter staff – well to be honest we don’t have a counter!

“And the future?” – the reply was quite disappointing – our income stays the same, but prescription numbers increase – we fuss over acquisition price, but the supply chain is not as easy as it used to be. The owners are waiting for the opportunity to sub-contract a proportion of our work to dispensing factories – they think it will save money and enable them to cut the overheads. I hope that we might be able to contract some of our staff to the practice.

I walked back to the high street and stopped someone, asking them what they thought of the high street now. You could see the pain in her face – “it was nice a while ago – but now….”and as her voice trailed off she added “well that’s called progress”.

I asked her where she bought simple medicines from or which pharmacy does she ask for advice. The answer again was quite disappointing. “Well the corner shop does sell some medicines, but it doesn’t give reliable advice – the man just reads the packet. The nearest shops are nearly half a mile away in a large shopping complex – there is a pharmacy there, but I have to get the bus”.

How sad. The community pharmacy was the anchor store in many high streets. They supported a professional image and drove footfall which ensured the viability of other shops in the high street. It was a place that residents could visit, do some shopping, get some advice, meet neighbours and even take a small amount of pride in. Now the high street is desolate, packed with the wrong kind of shops and attracting grubbiness and bad behaviour. A source of local shame and community disintegration.

It is not as if the government did not know this. They drove the community pharmacy contract so far that it only rewards the dispensing of prescriptions. The cost efficiency saving applied (this year around 3.3%) means that there is more dispensing work and less investment in front of shop care for local people. There is still no national minor ailment services or a strategy that helps to build community pharmacy as a real support to general practice which is struggling. There is no value in pointing out that a third of GP appointments could have been dealt with by the community pharmacist, if the high street pharmacies are under increasing pressure to run an effective counter. There is a view that the cost of dispensing medicines is too high so we should expect the government to continue with its plan to pressure pharmacies to close – but which ones will it be – probably the smaller high street pharmacies.

And the current regulations hamstring pharmacists from being able to manage patients properly creating expense and pressure in the system. Examples are many. In a wealthy area a family presenting with head lice purchase treatment – whereas in a less wealth area they are sent to the GP practice nurse for a prescription. The community pharmacy may test for chlamydia, but then have to refer the patient to the GUM clinic (at significant expense) to get a prescription for the treatment. The regulations are archaic and restrictive and must be changed to allow community pharmacists to care for their patients, perhaps more in line with pharmacies in Europe.

It is not as if the local authorities did not know this seeing the rents in small communities disappear and the costs for dealing with graffiti and antisocial behaviour increase. New small shopping developments are built and they ask for a community pharmacy, but the rents are usually astronomical and the regulations make things difficult. They also know that many communities have the greatest health risk and they watch community pharmacy move out of the high streets. They now have ‘nurse in a van’ programs where they could have given the nurse a nice professional setting right on the high street and supported by a local pharmacy team who knew most of the local residents.

And who supports NHS England as they remove the support for ‘essential small pharmacies’?

Please don’t get me wrong there as a lot of community pharmacies hanging on – providing a great service to their local community. Knowing some of these people, it is more a sense of belonging, professional pride and community responsibility rather than a commercial view – unsung local heroes.

However, a healthy community is as much about local pride as the new-fangled services that might be shipped in within a converted transit van parked in a dead high street or disused parking lot.

If anyone has a wish to see health communities then there is a clear need to think about community pharmacy again.

  • How do we get community pharmacy to move back to the high street?
  • How do we define ‘community important pharmacies’ as well as ‘essential small pharmacies’ and ensure their futures
  • How do we change the financial rewards from 100% dispensing to services for local people driving, different revenue streams?
  • How do we change regulations / laws to make it easier for community pharmacists to supply on prescription or sell the medicines that people need?
  • How can we make the community pharmacy the anchor for healthy communities again?

If you have any thoughts, let me know on Twitter @TheMMP1