the future.

[Pharmanaut]

lots of talk, lots of proposals, but no money.
johnep

Probably better to invent them ourselves.
One or two ideas going around in my head for when the GP owned 100 hour pharmacy opens up in their new surgery.

[howe928]

Patients have had a rough deal from governmental contract changes to the health professions. What a great success the new GP contract has proven to be; now the majority of patients are unable to contact their GPs over a weekend. However, patients can at least keep themselves busy by extracting their own teeth with a pair of pliers while sitting in casualty in the hope of seeing a doctor to solve their dental problems.
The result of these changes is the worse accessibility to GPs and dentists that I have seen in my 30-year career. The most polite way of describing the situation is as a shambles. Now the latest brainwave of “responsible pharmacist” will reduce patient access to their pharmacists in their pharmacies, while weakening your long-term future and income.

Already a large number of independents do not fulfil their MUR quota because they realise that it is impossible to safely run the dispensary whilst hurriedly performing a MUR. I feel sorry for those pharmacists being bullied by area managers to fulfil their MUR quotas in dispensary environments that are often understaffed. A recent pole in the C&D also quotes than nine out of ten pharmacists will not use the responsible pharmacist absence option. Without doubt, you need a second pharmacist to abandon the dispensary in these ways.

Remote dispensing and checking would appear to solve this problem. Scripts remotely dispensed and delivered to the pharmacy ready checked could be handed out to the patient with counselling points fed to the technician via a VDU. Remote supervision will cater for any questions not answered by the dispensing staff. It will release the pharmacist from the physical process of maintaining the safety of the in house dispensed item. In such circumstances it would be easier and safer to perform MURs and vacate the dispensary to perform the myriad of tasks we are told can be performed.

agreed with the above

let's do some math
1 dispensing fee = 90p per item
1 MUR Medicines Use Review = £25 = 28 items
1 AUR Appliance Use Review = £27 = 30 items

MUR/AUR = time, paperwork, rushing to check off waiters = increase dispensing error risk, absent from dispensary, interrupted, backlog prescriptions to be checked, queries to be handled, invisible pressure, customer satisfaction (waiting time), trays to be checked

worth it (whose neck is on the line?)? or wait till the centre dispensing is in place or when there is a second pharmacist around

[bobbin]

lots of talk, lots of proposals, but no money.
johnep

No new money, anyway. We will have to do more services to get back the money which has been removed from purchase profits ie. we do more work for (at best) the same money.

[vanquish s]

Exactly all these careers are possbile the areas where i can apply my knowledge are limitless. At school i loved resistance materials. I awalys help my dad and family out when they work around the house. There is jsut somthing satisfying about designing and building an object from scrap. Will also helped build the local go cart for a cubs/scouts charity race.

[El-loco]

I find myself in broad agreement with the above two posts of gmorris291.

What I would ask him, though, is what he suggests we do about it.

I believe that the first action should be to reclaim a professional body that has our interests at heart and is not content to sell us down the river in the service of the CCA.

The next elections for the national boards are going to be VERY important for all of us.

[El-loco]

I find myself in broad agreement with the above two posts of gmorris291.

What I would ask him, though, is what he suggests we do about it.

I believe that the first action should be to reclaim a professional body that has our interests at heart and is not content to sell us down the river in the service of the CCA.

The next elections for the national boards are going to be VERY important for all of us.

[gmorris291]

In reply to El-loco, I wish I knew the answer to our long term future. It’s certainly not bright, neither is it Orange!

As a matter of interest, the two posts I have written in this blog are essentially extracts from a Broad Spectrum Article I wrote in the PJ on 24th November 2007. I was amazed at the time that not one letter agreeing or disagreeing with the article ever appeared. Remarkable, when you consider the gravity of the points I was making at the time.

I feel strongly that pharmacists need to be on the premises at all times. It really does hack me off when I here that we can no longer stay in the pharmacy “counting tablets”.

I am not in favour of the “Responsible Pharmacist” legislation as I mentioned before, a large number of independents do not fulfil their MUR quota because they realise that it is impossible to safely run the dispensary whilst hurriedly performing a MUR. A recent pole in the C&D also quotes than nine out of ten pharmacists will not use the responsible pharmacist absence option. Without doubt, you need a second pharmacist to abandon the dispensary in these ways. Why then was this forced upon us in such a stressed environment? What happened to “Ask your pharmacist for advice”? The real advantage of a well run independent pharmacy is the bond that is built with patients. The last thing you want is to vacate the premises so that you are unavailable.

If the Government wants more involvement of pharmacists away from the dispensary, why not fund additional pharmacists to perform these activities co-ordinated on a local basis within the existing pharmacy model. This would stop short-changing patient access to instant health care advice and retain the essential “on site” expertise and safety that pharmacists have always provided to the dispensing process, as well as just letting us “count tablets”.

EPS is a threat for the future of pharmacy in the following areas. As mentioned, it plays into the hub and spoke method of dispensing. This will integrate into the large pharmacy companies IT and distribution systems. However, who will perform the same process for the independents? It will certainly cost them more.

The greatest danger is that EPS is a threat to the existing pattern of script distribution. Geographical positioning relative to your surgery will not be as important as it is at present. Once EPS release 2 allows nominated scripts to be transmitted to their nominated pharmacy, the eventual winners will be supermarkets. EPS transmitted repeats will arrive in the pharmacy well in advance of the patient and as such should be dispensed and waiting for the patient. Stock control will be easier as the stock can be ordered in advance of the patient arriving too. Add into this the fact that most people visit a supermarket regularly and find adequate free parking, and then I believe they will be the long term winners. They even have a door to door distribution system for their customers in place. Isn’t it strange how the 100 hour pharmacy legislation happened at just the right time for them to develop a nationwide network of pharmacies.

EPS is a threat in that hub and spoke dispensing will drive down the profit per dispensed item. This again will disadvantage the independents more than the supermarkets or large company chains. Supermarkets are geared to high volume low profit models and are more than happy to have increased foot fall and give over valuable space from selling baked beans to products than make more profit!. They will be in a very strong position to play the long game and freeze out opposition.

A change of government may well scupper the NHS IT model. However, EPS does offer the NHS a complete picture of what was prescribed and what was actually dispensed. The DM+D data base has been integrated into the system to ensure a total understanding of the processes occurring in the dispensing environment. This can only spell long term problems as the NHS will have a much more accurate insight into dispensing profits. As I have mentioned before, this will affect all businesses large and small. Politicians in general are too dumb to grasp the fine detail, but civil servants within the NHS are not. I would be surprised if the NHS were to abandon software already designed at no cost by the pharmacy system suppliers and not try to retain this element of IT.

Throughout my time in pharmacy, PSNC has appeared to be as useful as a chocolate teapot. From the loss of on cost, it has been a downward spiral which I can’t see any escape from. To be fair, it’s not their fault as you can only bargain if you have something to bargain with. Unlike the GP’s, who managed to hoodwink the government out of out of hours work for a loss of only six thousand pounds annual income, our negotiating committee does not seem to possess such guile. The doctors walked away with embarrassingly high salaries, no Saturday morning surgeries, which even their negotiators didn’t believe they could get away with. We walk away with reduced income, additional stress caused by attempting to integrate MURs into an already busy and stressful environment and a promise of never never land!

We are contractors to the NHS and as such are expendable. Many will wax lyrical about the marvellous services we could provide, yet we have waited in vain for any real initiatives from central government or PCTs to evolve. Indeed, in the C&D this week there is a report stating that only one in four pharmacist prescribers working in community pharmacy are using their qualifications. Wait until you start competing locally to provide services to the local surgeries. The competent GP’s will train their own nurses and undercut your projections and pocket the monies themselves.

Having spent twenty years building up my business from scratch, I stood back and took stock of the positives and negatives facing an independent pharmacy business in future years. My solution was to take full advantage of the goodwill value and advantageous capital gains offered at that time and sold up. I am no longer stressed by having to work like a hamster in a wheel. I haven’t woken up one day since and regretted my decision and have seen no sign of the future of pharmacy having improved since taking this action. Instead I have embarked upon working with resistant materials as one of our contributors suggested!

I know that I am very lucky in being able to take such action. I have taken the time to explain my concerns so that those of you in positions of authority can at least ruminate about the way in which the future of pharmacy is being steered. I genuinely fear that the future of independent pharmacy is in jeopardy unless their interests are robustly defended.

[Pharmanaut]

OK - Devil's advocate here.
Centralisation of services like dispensing will make the operation too inflexible. How can 'big remote pharmacy Ltd' respond to a hospital discharge to a nursing home at short notice? Or an dose change to an MDS?
If as you say there will be downward pressure on dispensing fees, this combined with the inevitable downward pressure on category M takes out the rewards for dispensing.
Factor in the transport costs for delivery and I'm not sure anyone would take on the responsibility of dispensing for a few pence per item.
Also I can't see how nomination and delivery increases footfall in any pharmacy?
I'm also thinking that a large scale delivery operation of dispensed prescriptions will need to be very efficient and so tightly run every minute of every day to be credible. Communicating the prescription message will be the easiest thing to do. Getting the stuff delivered correctly and on time is the difficult bit.

The good thing about the future is that it hasn't happened yet. It probably won't be anything like your or I can predict as every decision has unintended consequences.
I hope so anyway. <g>

[Rafael]

copied and pasted from another poster. what you are going to read now is the most important and dangerous scenario related to adjusting the current systems before the introduction of remote supervision.

BPC 2009 (supplement) | PJ Online
go straight to page B12.

[gmorris291]

I've visited and been demonstrated a similiar system in Germany in December 2006. Booth on high street linked to robotic dispenser. Pharmacist was able to provide out of hours service from the comfort of his own home.

gmorris291