The transformative potential of technology

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Against the backdrop of the Government's ambitions for a digital NHS, community pharmacy faces some pressing questions on its own technological journey. Are there enough incentives to attract innovation into the market? Do pharmacists have the tools to deliver? Do they have the collective voice to demand better? And is the NHS really investing in pharmacy’s digital future, or simply expecting the sector to keep pace without the resources to do so?

The answers that emerged from the NPA’s Pharmatech Connect parliamentary roundtable event in February, held in association with Charac, painted a picture of a sector with significant untapped potential, but one that faces structural, commercial and technological barriers to change. Here are some reflections from several of the key participants.

Current landscape

Technological development, interoperability and adoption are “vitally important and complex topics”, says Jill Loader, former deputy director of pharmacy policy and strategy at NHS England, who now works with the NPA in an advisory role. However, perhaps surprisingly, pharmacy is in a stronger position than some may assume. “In many ways community pharmacy is well developed in terms of tech and integration compared to other parts of the NHS,” she says.

Loader points out that the sector has already embedded into practice NHS Mail, read-write access to sections of the GP patient record, the Directory of Services powering NHS 111 and the Summary Care Record. Moreover, “Pharmacy First has laid important foundations for the future of clinical services”.

Those foundations include capabilities that are genuinely new territory for the sector. Pharmacists are now making clinical records of consultations like other NHS clinicians, something which means that “skills need to be developed alongside supporting tech such as AI clinical note taking”, she says.

Through GP Connect Update Record, consultation records can be transferred directly onto a patient’s GP record in near real time, and GP Connect Access Record enables pharmacists to access GP records in a way that “most other healthcare professionals are unable to”, even if, as Loader acknowledges, “few use this currently”.

The Booking and Referral Standard (BaRS), introduced for Pharmacy First, opens up further possibilities, enabling booking and referral into community pharmacy from anywhere in the NHS, covering urgent medicines, minor illness, discharge medicines and smoking cessation services, with potential for much more.

Limitations and future needs

There are, however, important caveats about how this technology was introduced. The minimum viable tech support put in place at launch to expedite Pharmacy First means it doesn’t come with what Loader calls “all the checks and balances” that people have come to expect from healthcare software systems.

A practical consequence is that pharmacists could enter a clinical record for someone who doesn’t qualify for treatment under the clinical pathway PGDs, which Loader says means that “when the NHS looks at the data, it may not be assured of clinical competence or that pharmacists are working within the terms of the PGD”.

A further structural tension shapes the whole landscape. “NHS software development is all about NHS care,” says Loader, “but the reality of community pharmacy is that there is a mix of private and NHS services – and pharmacies need systems that support both.”

Looking ahead, the NHS has commissioned some ‘discovery work’ examining the digital experience of how patients request, receive and manage their medicines, supporting the Government’s ambition for a “digital by default” service. Crucially, Loader emphasises, the aim is to ensure technology supports “new ways of working rather than historic systems and processes, which are not necessarily the most efficient for the future”.

This means areas such as repeat dispensing, medicines optimisation, deprescribing, case finding and prevention – and the broader place of community pharmacy in local population health management – will all need to be supported.

Technology development

A key question is whether there are sufficient incentives to encourage start-ups and smaller, more nimble tech suppliers to enter the pharmacy space – and whether the systems they develop are adequately tested before being rolled out at scale.

On the question of testing, Jill Loader says: “We absolutely need to test, adapt quickly and assure”, but Victoria Steele, former superintendent pharmacist at LloydsPharmacy, and founder and principal consultant of Steelier Ltd, points to a more fundamental problem. “The landscape isn’t regulated,” she says. “The sooner that appropriate clinical risk management standards, approved by the Data Coordination Board, are mandatory across all settings – NHS and private – the better.”

There is also much to learn from other countries. Australia’s system for repeat medicines, for example, “works for all repeat prescriptions and takes hours of time out of general practice,” says Loader, contrasting it with England’s electronic repeat dispensing system, which she describes as “clunky”.

The question of safety and minimum standards across all tech suppliers is also critical. Pharmacies themselves must take responsibility when using technology for private services and with that comes liability for any errors.

What do pharmacists want?

So how can NHS England and its stakeholders drive innovation in pharmacy technology – and should pharmacists themselves be taking a more active role in shaping that agenda?

Pharmacist Aditya Aggarwal, who has extensive experience in healthcare strategy and policy, as well as digital health and AI implementation, argues that the starting point must be research. “Solutions come from evidence. If we don’t have evidence, we can’t generate ideas and we can’t generate solutions,” he says.

The barriers to achieving this in community pharmacy are considerable. Unlike their hospital counterparts, community pharmacists do not have protected learning time, and without it meaningful participation in research is extremely difficult. His proposed solution is “to build protected learning time into the contract”.

Ask pharmacists what they need from technology and two themes emerge with striking consistency: seamless interoperability between systems, and a national ‘digital front door’ through which patients can directly book appointments for various pharmacy services. “Interoperability, or lack of it, is a significant barrier to progress”, says Victoria Steele. “If this was mandated, pharmacy owners would have far fewer headaches.”

Jill Loader agrees that the potential of technology is there but part of the problem lies closer to home. “There is much that is already available but not being used by pharmacy,” she says, admitting that, to be fair to system suppliers, “there is little demand from community pharmacy or incentives from the NHS”.

What is needed, she argues, is “good digital leadership in pharmacy to pull things together”, something that is particularly hard for independent contractors, who “often don’t have the headspace to consider and understand all the various developments in technology and how they interact to support their business”.

The need for a national appointment booking system for pharmacy services is one that unites voices across the sector. Ashley Cohen, owner of Pharm-Assist Healthcare, NPA board member and chair of Community Pharmacy West Yorkshire, is clear about the benefits of such a system. “It would provide an immediate platform for the sector to get patients to book direct into their nominated pharmacy for a service,” he says.

Baba Akomolafe, director of Christchurch Health Centre and founder of VideoMed Global, goes further, arguing that without such a platform, Pharmacy First, for example, cannot fulfil its potential. “Pharmacy First would function far more effectively as a true choose and-book service integrated within the NHS App or as part of a national booking service,” he says.

As things stand, the service “remains heavily dependent on GP referrals”, leaving community pharmacy “digitally excluded”.

The consequences are felt by patients and pharmacists alike. “Without a patient-led digital booking option,” says Akomolafe, “the familiar 8:30am rush for GP appointments is simply displaced to a 9am pharmacy rush. This creates failed referrals, inefficiencies, and frustration for patients, GPs and pharmacists alike.”

Concerns and caveats

The appetite for technological innovation in pharmacy is clear – but so too are the risks of moving too fast or without sufficient safeguards.

On the broader question of technology adoption, Aggarwal argues the sector needs to be more disciplined and specific in what it asks for. “If we want to get technology adopted in pharmacy in a similar way to how GPs do it, then why don’t we ask for funding for specific things like transformation of electronic patient records, or ensuring that everyone can deliver all services?” he asks.

Perhaps nowhere is the gap between ambition and reality more apparent than on the question of patient records. Pharmacists broadly agree that access to comprehensive patient records is essential, yet a true single patient record does not exist – and progress towards one is painfully slow.

Jill Loader urges the sector not to wait for the perfect solution before making better use of what already exists. Pharmacies already have write access for some advanced services, she points out, “which can be easily built upon through GP Connect Update Record”. There is also read access through GP Connect Access Record, but the latter in particular remains underused – and that has consequences. “If pharmacists don’t use it, why would anyone invest in developing it further?” she asks.

The single patient record, she adds, “will take years to be a reality”, which makes it all the more important to “make best use of existing interoperability in the meantime”.

Barriers to change

NHS England has often been considered slow to approve and accredit new pharmacy technology, but when it does, adoption by pharmacists is often equally sluggish. So where does the problem lie and what is the solution?

Jill Loader points to a fundamental challenge. “It is difficult to understand all the software systems and how they interact,” she says, adding that the NPA is actively looking at how best to support education, understanding and leadership for pharmacy owners in this field.

Aditya Aggarwal says that NHS England isn’t solely to blame. “NHSE being slow to approve things is one side of it,” he says, “but tech companies aren’t always completing the appropriate compliance and sometimes the evidence isn’t as strong as it needs to be.” At the heart of this, he suggests, is a tech sector that may not yet fully understand the rigour required to establish new systems.

A second barrier concerns the functionality of PMR systems. Are they sophisticated enough to support clinical services from pharmacies? For many pharmacy owners, switching PMR supplier is far harder than it should be, with contractual tie-ins making change difficult and costly.

Jill Loader agrees that the system needs a shake-up, “but this is for tech suppliers and pharmacies to influence”. Aggarwal, however, sees both sides. “From a supplier’s perspective, locking in contracts is a rational commercial strategy. From a pharmacy owner’s point of view, fixed costs over a defined period offer predictability – but that does not make the current situation any less of an obstacle to progress,” he says.

Affordability is another issue. “If the Government is serious about the move from analogue to digital,” says Loader, “then it needs to incentivise and support pharmacy to invest in new tech.”

Overall, it seems that the direction of technological travel in community pharmacy is right – but the pace of change needs to quicken considerably to support new ways of working.