Is pharmacy’s ‘time’ finally here?

For almost thirty years, multiple studies have suggested that community pharmacies should perform a broader role. Screeds have been written about the need for pharmacies to move away from relying on their traditional role as dispensers and to be more involved in patient care. But despite the aspirations of many, it is a fact that progress has been slow and challenges myriad. 

However, in today’s NHS with its unprecedented budgetary pressures and countless frenetic searches for ways to do more for less, could it mean that pharmacy’s ‘time’ is finally here?  Has the moment finally arrived when the pace of change will gather momentum?  Especially as it now coincides with a time when the traditional model of dispensing is threatened by the advent of new technology.

Adelphi thinks it definitely looks that way…

Pharmacy Development – in the Spotlight since Late 2013 - with NHS England Supporting Change

In November 2013, the issue came under the spotlight again when the Royal Pharmaceutical Society (RPS) published ‘Now or Never: Shaping Pharmacy for the Future’. Based upon the Society’s Future Models of Care Commission, the report was intended to provide a coherent narrative for pharmacy reform. It reported that many pharmacies were keen to develop innovative ways of delivering patient care, particularly under the banner of medicines optimisation. It also reported at least 100 examples where this had already started to happen.

NHS England supports this move and has published many documents outlining how community pharmacy can play a greater role. For example, in November 2013, it produced its vision for the future of urgent emergency services in England. The report highlighted that 20% of GP consultations related to minor ailments and suggested that these could be largely dealt with by self-care supported by community pharmacy.

The NHS Five Year Forward View also described the need to make far greater use of pharmacies not only with minor ailments but also in illness prevention and support for healthy living, in medication reviews in care homes and as part of more integrated local care models.

What sorts of additional services do some Community Pharmacies currently provide?

It is a fact that every year in England, 438 million visits are made to community pharmacy for health-related reasons¹. Around £300 million per year of medicines are wasted in primary care and between 30% and 50% of prescribed medicines are not taken as recommended¹.

There is therefore little doubt that community pharmacy is ideally placed to support the objectives of medicines optimisation. 

For example, advanced services can be provided by pharmacies upon accreditation such as Medicine Use Reviews (MURs), Appliance Use Reviews (AURs) and the New Medicine Service (NMS) – to support patients with long-term conditions who have been prescribed new medicines, and the provision of stoma and medical equipment.

MURs are consultations between the pharmacist and the patient about how they use their medicines and to find out more about the patient.  This service is supplementary to more in-depth clinical reviews conducted by GPs. There has been a steady increase in the number of pharmacies offering this service to patients.  

Most pharmacies also provide New Medicine Service (NMS) for patients that have received their first prescription for a medicine to treat the following conditions:

·                     Asthma

·                     Lung conditions (e.g. bronchitis and emphysema)

·                     Type 2 diabetes

·                     High blood pressure

·                     Blood clotting disorders

Summary of Advanced Services provided 2013-14²

These are just a few examples. There are also a range of enhanced services which might be commissioned from pharmacies by NHS England or Public Health at a local level e.g. stop smoking services, alcohol advice, sexual health checks, NHS health checks etc, etc.

Additional Models of Care

In addition, based on our extensive experience of researching this customer group, we know that many pharmacies have also extended the scope and reach of their pharmaceutical care services in a whole host of other ways in order to provide an array of patient-orientated services and care.  

Therefore, in reality, all sorts of service developments have been put in place to help CCGs to address some of the key issues facing the NHS e.g. access to out-of-hours diagnosis, care of the elderly and vulnerable people, helping people to get and stay out of hospital etc, etc. These are sometimes ‘one-off’ developments and sometimes developments which extend across a chain of regional or national pharmacies.

Overview of Models of Care 

What opportunities are there for pharma to engage with community pharmacy?

So what does all this mean for pharma? In those situations where community pharmacies have taken on a broader role as caregivers, what might pharma do to support the services that they offer?     

Is there an opportunity for pharma companies to support those that are providing models of care which impact the delivery of service or medicines in a therapy area of relevance to their portfolios?  If so, what would the support need to look like and what kinds of help would these customers most value and why?

It is fundamental to start by asking if the brand team truly understands the needs and motivations of this customer group – customers who according to the RPS have long been marginalised by colleagues in the NHS.

Adelphi suggests that developing an in-depth understanding will be critical in order to inform the development of a strategy.  This is a complex customer group.  In our experience, it is usually necessary to thoroughly explore different pharmacy/pharmacist customer segments and also ‘dig deep’ to uncover the realities. Not all pharmacies think or act the same, nor is the reality of this world necessarily what is published in the press.  Much of it is ‘closed’ because it is competitively sensitive and therefore has to be uncovered by tact, diplomacy and establishing a good rapport with respondents.  

Any primary research also needs to think carefully about which respondent types are likely to be able to provide an informed perspective of ‘the truth’.

In summary, the companies that ‘dig deep’ to truly get a handle on needs, motivations and realities before devising a pharmacy strategy will be the ones that stand the greatest chance of success.

1.  Medicines Optimisation: Helping patients to make the most of medicines. Good practice guidance for healthcare professionals in England (May 2013)

2.  General Pharmaceutical Services, England 2004-05 to 2013-14 (Nov 2014) Health & Social Care Information Centre (National Statistics)