If pharmacists can’t find the time to transform their businesses, they risk becoming irrelevant, warns Terry Maguire…
 

In our clinical future, we are frequently told, community pharmacists will spend more time providing services than supplying medicines.  For over 40 years there has been an argument that, to retain value in the network, we need to focus on services. To date this simply hasn’t happened.

The pandemic added impetus to the need for this transformation. Vaccinations, a vital public health service that brings a significant income stream into pharmacies, should be the platform to build transformation. But this impetus could be easily lost. One of the challenges of change is using our time differently but if we don’t have control of our time, how can transformation come about?

The Covid pandemic has restricted the way community pharmacies deliver services. There was an initial shutdown of clinical services, minor ailments and smoking cessation, for example, with a focus on medicine supply. In a pandemic this would be expected. However, it might also be expected that the workforce activity would eventually return to normal but, perhaps because we remain in the pandemic, the focus is still mostly on medicine supply.

A combination of changes to the ways GPs issue prescriptions and the public demand their medicines means the pharmacy workforce has a time management problem it has little control over.

In March when I started providing vaccinations I discovered that we could not give vaccinations in addition to dispensing. As a team we simply did not have the time. We quickly worked out that unless we dedicated two additional staff, properly trained, to vaccination we risked a major dispensing error.

This additional staffing was justified given the demand we experienced for the service, and allowed us the time to further crank up activity in July when the Moderna vaccine became available, and again in November when the booster programme kicked in. Time is a real barrier to transformation. Prescriptions arrive in the pharmacy all at the same time, late in the morning. This is normally accompanied by patients calling in or phoning  to ask if their prescriptions are ready.

I try to manage this. Staff who search the brick-like prescription bundle are admonished, as are those who answer the ringing phone too quickly.  These activities absorb too much time and add to inefficiency. Too many GP errors in prescription supply absorbs more time. Most telephone calls about vaccinations are from hesitants who need counselling and encouragement, but do I really have the time? To save time, perhaps I should adopt Tony Blaire’s approach and tell them that if they are not already vaccinated “they are idiots”.

There are potential solutions to our time challenges: regulatory changes on supervision, greater use of robotics, more technicians, and better use of IT, such as text messages to patients when medicines are ready for collection and automated prescription collection points. But all these options are of limited benefit or require significant investment and there is a danger that the efficiencies achieved might be pocketed rather than re-invested in transformation.

Before the pandemic, the Pharmacy Workforce Review identified some disconcerting facts about the community pharmacy workforce in N. Ireland.  Since the pandemic these facts have worsened. The Review, commissioned by the Department of Health, looked at the workforce needs over the next 10 years.

In spite of a 30 per cent increase in pharmacists since 2009, there is a predicted short-fall of some 500-to-800 by 2024, unless steps are taken to attract more into the profession and to retain those currently in post. Clearly, from a professional perspective, the expanding role of the pharmacist is a good thing. Our skills are in demand.

There has been an expansion in the number of pharmacist posts in hospital and in general practice working alongside GPs but this has been largely at the cost of the community pharmacy workforce. This has been further affected by immigration to the Republic of Ireland and Great Britain where salaries are better.

Even before the pandemic pharmacists working in community practice had a list of concerns which presented clear evidence of a time-poor, highly stressed workforce. Three-quarters felt they had no control of their workload and 78 per cent felt overwhelmed by patients’ expectations. Many feel they cannot get involved in new services as the capacity to do so just doesn’t exist, and as a result they feel that their skills are under-utilised.

Eighty per cent felt that their work is not appreciated by the Department of Health and the Health Board, and an equal number are under constant stress that they might make a mistake and, as a consequence, be sanctioned. Many identify the lack of opportunity for advancement in their careers as damaging to morale and they feel a strong sense of professional isolation.

Community pharmacists don’t have control over their time because they give others this control. GPs and patients steal our time so we can’t get on with what is important and if we don’t have time for transformation, we risk becoming irrelevant. 
 

Terry Maguire is a leading community pharmacist in Northern Ireland.