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Can Professional Services and Chemist Shops Co-exist?

Stephen Carbonara
From an Independent Professional Pharmacist Perspective

Issue 77: November 2008
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Is it likely that professional pharmacist services will be able to become an “additional” service within the current model of community pharmacy?
The automatic answer most of us would say is: Yes!
However, the question is not: can we?
Rather, is it: likely?
I’m sure there is no doubt that it is possible in the future for professional pharmacist services (PPS) to be integrated into the current community pharmacy model; however I believe that in order to do so, a major shift in traditionalist attitudes must occur before we have any hope of constructing this as a viable option.
As a matter of probability, I believe that the profession as a whole (sadly) will not embrace such a move any time soon, as traditionalism tends to still be the major driving force of pharmacy practice above innovation.

Think about PPSs such as medication reviews, confidential counselling, disease state management, medication profile generation, and medication assistance counselling.
These types of services are currently able to be employed in community pharmacies; however (Government funding aside) the will of community pharmacies to embrace these services appears to be seriously lacking.
This I believe is largely due to community pharmacy’s significant inability to generate its income from anything but the provision of goods.
It is this sales-based reliance on cash flow that is the proverbial nicotine addiction of the community pharmacy, which is central to the unlikelihood of PPS delivery.
We need to quit this habit!

Traditionally pharmacists, once qualified, (with a few exceptions) will have the desire to own a pharmacy.
This desire carries an inherent inclination towards generation of a sales-based income and is traditionally what most would-be pharmacists like about pharmacy as a career.
We often hear about the ~35% owner population dictating the terms of pharmacy practice for the majority; however out of the remaining (silent) ~65%, I believe a significant proportion of these strive to become one of the ~35% (ie. the owner wannabes!).
So, without knowing any concrete figures, can we assume that only maybe 20% or 10% of the pharmacist population have a mindset that isn’t traditionally skewed towards goods-based income?
The development of PPS in community pharmacy will therefore be a significant challenge for most.

Take medication reviews for example. How many pharmacies have a medication review report generator integrated into the dispensing software?
Is there at least provision for MR reports to be scanned into the dispensing software and stored in the patient’s database?
Do pharmacies have a system of accurately recording requests for HMRs either to patients or GPs?
Do all pharmacists at a pharmacy take the time to read every HMR report that is generated for their customers?
Are resultant GP management plans read and/or stored in the computer file?
Are HMR reports relied upon by pharmacists to provide ongoing care and management of the patient at subsequent presentations to the pharmacy?
Do pharmacy owners take the initiative to employ and maintain these provisions?
Or are we just all too busy checking scripts and selling Mersyndol???

If community pharmacies can’t seem even slightly interested in employing these provisions for medication reviews; then how can in-house systems be implemented for further, more advanced types of PPS?
Will community pharmacies ever have an appointment schedule for private pharmacist consultations?
Will consultation notes ever be routinely entered into the patient’s computer database?
Will a record of all interventions be kept?
Will a copy of all medical certificates be retained?
Will referrals to other healthcare providers be documented?

I realise that some owners might feel as though “times are tight” and it would therefore be foolish to experiment with a services-based source of income rather than the ol’ tried-and-tested sales-based income.
However if the profession doesn’t drive change; the consumer won’t because they don’t know any other system, the GPs won’t because they feel as though they’re having their toes trodden on, and the Government won’t because they are unlikely to commit funding to an un-tested system!
This therefore leaves us with perpetual tradition; which in answer to the initial question, is it likely?
The answer will unfortunately be: No!

In this context, the way in which community pharmacy is perceived by others is vitally important to our level of realised professionalism.
The type of pharmacy which is hopelessly dependent on volume-based sales is doomed to failure in the long-run.
Eventually the Government will release Colesworth et al from the dungeon and they will immediately proceed to swallow or tread on them; which will, in one fell swoop, render us all as in the aforementioned 10-20% group of PPS-minded individuals who were deemed to be so unpopular not so long ago!

It will be at this eventual point that the future of the professional pharmacist will be decided.

Stephen Carbonara.

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