Rethinking pharmacy

The Covid-19 crisis has seen community pharmacies develop new working practices at breakneck pace. While stress and burnout have hit teams, some also speak of a newfound confidence in their abilities. Pharmacy Magazine got in touch with readers up and down the country to learn what changes in their practice they want to keep and where they think there is further potential for innovation.

Spurred change

During this crisis, pharmacies have had to battle high demand alongside new working restrictions. “There is no doubt that this has been a challenging time for community pharmacy,” says Matt Barclay of Community Pharmacy Scotland, but this has spurred change – much of it needed.

“There were aspects that we have waited on which were suddenly switched on quickly to improve patient care,” he says, such as the roll-out of SCR access in Scotland.

Victoria Mills of Bunny Hill Pharmacy in Sunderland, one of Avicenna’s retail stores, says her team has worked to support vulnerable patients with renewed vigour, helping them to order their prescriptions and delivering household essentials on top of their vital medicines. She hopes this ethos will be maintained in any ‘new normal’.

Social distancing measures have forced the sector to take new approaches to old problems. How can pharmacists offer patients the confidential service they are entitled to without use of a consultation room, for example?

Doncaster, Rotherham and Nottinghamshire LPC secretary Nick Hunter says he asked patients requesting EHC to go back to their car and phone the pharmacy to go through the consultation. “This isn’t rocket science,” he says, but nonetheless offered a creative way to maintain service levels while upholding safety.

Greater Manchester LPC chair Aneet Kapoor says the shift to delivering some serbices remotely has been the biggest change for team in his region. “We worked swiftly to ensure EHC provision and MAS were agreed to be provided remotely and did not require the patient to be present.”

The crisis has also sped up the move towards paperless, he says, with good progress made on NRT provision and inhaler technique services next in his sights.

Communication

Change hasn’t been confined to the dispensary. Rhiwbina pharmacist manager Vicky Cornelius, who works for LloydsPharmacy, says communication between care providers has seen a marked improvement to the benefit of patients.

“During this pandemic I have noticed a significant increase in all care sectors working collaboratively together, from hospitals and surgeries to health boards.”

“Furthermore, different community pharmacies have been working closely together and supporting each other,” she says. “I would love to see this continue.”

Matt Barclay says pharmacies’ efforts have earned the sector respect and goodwill from the public and policymakers. “Being front and centre to the primary care response has not been lost on many and while being viewed as a panacea has its risks, it is a great opportunity to push boundaries.

“Instead of asking ‘Can I?’, pharmacists were enabled at times by regulators and Government to change that to ‘I can’,” he adds.

“We would want to continue with the renewed confidence and skills during the pandemic that helped pharmacies provide more immediate and urgent care – but we need to make sure that safety or quality is not compromised,” says Lindsay & Gilmour managing director Phil Galt.

England is often thought to lag behind the devolved nations in terms of ministerial recognition of the sector’s importance, but Kingston & Richmond LPC CEO Mike Keen thinks change could be afoot.

“For too long NHSE&I has taken a wrong and rather dim view of community pharmacy; now they can see the benefits we bring.” A medium to long-term strategy to further integrate community pharmacy into the wider health service is due now, he says.

Future change

Are there further changes that could benefit the sector? “Better collaborative working within the NHS,” says Kent LPC chief executive Shilpa Shah. Pharmacies on her patch have been included in daily primary care system calls, she says, meaning the different providers have a better understanding of the challenges they each face.

“I think that we should be utilising clinical skills more in community pharmacy,” Shah says. For example, she feels that community pharmacists could make a difference for care home patients who require structured medication reviews.

We should be allowed to use our professional judgement more in supplying alternatives to prescribed medications in case of shortages, says Phil Galt.

“Pharmacists have the knowledge and expertise to do this safely and effectively.”

Galt also thinks pharmacies in Scotland should make greater use of technology to deliver remote consultations, noting that many patients are “anxious about attending in person”. Vicky Cornelius would like to see pharmacists “offer even more services in a community setting to improve patient care and maximise our value”.

Numark managing director Jeremy Meader says pharmacies need to look to where demand has risen during the pandemic and develop a business offering around that. “The growing appetite for ease and convenience has been reflected in the rise of home delivery requests. Pharmacies should look at the sustainability of this service where possible to continue to meet the demands of modern day patient care.”

He adds: “It also goes without saying that the increase in safe hygiene and cleaning practices serves as a vital best practice moving forward.”

Older patients and those who are more vulnerable due to a pre-existing condition have been a major focus for healthcare professionals in recent months. Aneet Kapoor believes pharmacies should be enabled to offer these patients structured support through commissioned services, such as MDS referrals.

Kapoor reels off a number of services he think pharmacies should be looking to deliver in the medium to long term, including psychosocial support for substance misuse patients; including cancer detection in pharmacy screening programmes and widening the vaccination programme to ACWY.

Claire Anderson, chair of the Royal Pharmaceutical Society in England, believes the crisis has demonstrated that pharmacists need medication-switching powers that go beyond the Serious Shortage Protocols.

“Amid continued uncertainty around future medicine supplies, the law should be changed so community pharmacists can make simple substitutions when a medicine is out of stock, without the patient having to go back to the prescriber.”

Scrapped

As well as new practices being adopted, pharmacies have had to put a number of existing services on hold. Is there anything that needs to be scrapped completely?

Victoria Mills says she’s glad NHS 111 has started making telephone referrals the norm rather than sending patients directly to the pharmacy: “Many patients are referred to pharmacy for conditions that need to be referred to a walk-in centre or GP… this wastes patient time.”

For Matt Barclay, it is about ensuring old restrictions – real or perceived – on pharmacists’ professional capacity are left in the past. “I am not advocating wholesale changes in practice but I want pharmacists in all areas to feel empowered to do the right thing.”

Others point out some of the red tape requirements that have been dropped during the pandemic. Says Claire Anderson, “the reduction in paperwork and some of the audits ahs meant one less thing to worry about for pharmacists who would rather be focusing on looking after their patients”

Michael Keen says he is keen to keep “overly burdensome governance requirements and ICO needs” in the past – “slim them down and let’s be sensible!”

Anything else? A final succinct word from Nick Hunter: “Freebies.” Free services should not be resumed after Covid as they rarely add value and can be “destructive” for the sector, he argues.