The end is nigh (of 2012) so I thought I’d get in early with some pharmacy predictions for 2013, and given how much uncertainty the NHS will be in from April I’m expecting to be as good as the Mayans in getting this right. 

Starting from April the biggest changes will obviously affect our colleagues currently in primary care: the lucky ones will end up being part of a Commissioning Support Unit (CSU), the really lucky ones will be in a Clinical Commissioning Group (CCG). Many won’t be lucky and there’s a real risk that some great talent that may be lost from pharmacy altogether: at a certain level in PCT-land you’re not clinical enough to keep your banding in a hospital, and you’re earning too much to go straight into retail.  Pharma is one option, but they’re not a safe bet if your mortgage depends on it.

For the lucky ones their work will be dependent on how focussed and forward thinking their CCGs are: there are some real opportunities to make a difference to patients and their medicines, but I fear that most of their work in 2013 will be nickel & diming.

Sticking with the NHS, let’s consider our hospital colleagues. Again money dominates: acute trust funding, FT or not, is going to get a kicking especially when CCGs try to squeeze tariffs or pull activity via referral reduction or re-commissioning work into the community. In this instance, retention will be about specialisation – focus on a speciality disease area, be super clinical on it and prove you make a difference; my money’ll be on cardiovascular and endocrine.  Other opportunities will exist though for those in trusts who hold vertically integrated community services….

Community services pharmacy is, I think, where the exciting stuff will start to happen: whether CFT, FT or independently based these services are being seen as the answer (wrongly) to the NHS’s ‘troubles’ and will need to really innovate to deliver outcomes on restricted budgets.  Where better to show the value of pharmacists? If Medicines Optimisation has a natural home then this will be it.  Hand in hand with this are our colleagues in mental health services: the new Health Secretary’s focus on dementia will play well here as funding will follow – again another good place for medicines optimisation to thrive.

Retail pharmacy: my roots and love in all of pharmacy.  I think 2013 will be a holding year for retail with little changing, but I suspect that it’ll be the calm before the storm of self-selection and remote supervision in 2014.  The difficulty will come from a lack of proven outcomes for what is done already, a squeezed budget from central NHS coffers and a lack of a cohesive plan for more commissioned clinical services.  An influx of pharmacists from PCT-land may also add pressure to the workforce, and staff may find (as locums are now) that remuneration and T&Cs are adversely affected.  And if that’s not bad enough you’ll all still be selling homeopathy.

Academia: I have no idea! You’ll have to speak to Messer’s Bush and Cox (no seriously, they’re called that, and they aren’t a late-night Channel 5 comedy duo: go follow @josephbush and @drarcox  to find out)

Industry – err. Dunno?!

Overall? 

There will be opportunities to do some innovative things in 2012 but it’ll be small-scale, patchy and uncoordinated; if experienced pharmacists have the balls then they’ll start up their own provider company (no CQC registration needed remember) and approach CCGs with ideas on what they can do to makes medicines count for patients.

In retail, the opportunities will be outside the NHS and with Local Authorities, using their key geographical positions, extended opening hours and enviable reach and footfall to place themselves at the forefront of what’s left of public health. But if anything, pharmacists are the most business-minded of healthcare professionals and in this current climate that is a huge strength.

But then again the best laid plans of mice and men and all that…

Roll on the New Year…

This month I joined a secret pharmacy club.  A pharmacy club is so secret I can’t tell you its name let alone its rules.

During my initiation conversation the topic got onto the concept of branding and the benefits it brings. I’m not talking red-hot bits of metal, but the shiny boxes and snappy logos that pharmacists are well versed in: explaining to patients that ibuprofen in a 16p pack is the same quality as the stuff in a £3 box of Nurofen and all that, though if people say they’re happy with the cheaper one it appears that when you’re not looking they’re snapping up the expensive stuff.

This conversation got me thinking why is branding so influential, and importantly, what is the brand power of ‘pharmacists’?

If we take the advertising wizard David Ogilvy‘s definition of a brand, it’s

The intangible sum of a product’s attributes: its name, packaging, and price, its history, its reputation, and the way it’s advertised.

So if we put aside physical attributes – name, packaging and price – and bluntly try to apply the rest of this definition to a profession, what do you get?  Ask this about doctors and the public ‘brand’ them as the most skilled and focused of professionals and consistently rate them highly on trust.

In healthcare, trustworthiness is arguably the most important perception we can ask for, however whether this continues to apply to doctors after 2013 when they become the front of NHS cuts and service closures is not certain.  Throw into the mix their industrial action over their pensions and an ineffective mixed stance on the NHS Act, then unfairly or not could this see the start of full-scale public distrust of doctors and destruction of their ‘brand’?

Personally I doubt it, but some reputational damage is probably unavoidable and so it begs the question who will become the new most trusted profession in healthcare – and can pharmacists step in here?

It’s hardly surprising that our largest retail pharmacy chain currently uses trust as its strap-line, but is this the pharmacist’s ‘brand’ or just corporate marketing?  A true brand requires many things, but firstly it requires a unified approach to how it’s presented.   Research suggests that pharmacists perceived as an ‘expert’ have improved patient satisfaction and loyalty, but it appears we have a long way to go before we’re fully there and can push things forward.  I’ve blogged before that pharmacy needs to be more unified than it currently is, and I wonder whether this fragmentation is a reason for the current mixed perception of pharmacists. 

So do we need to reconsider how we advertise our ‘brand’?  Or should we instead ask whether our profession exhibits ‘expertise’ to our varied consumers each day?

In fact should we start with each pharmacist asking that same question of themselves?  

*First posted as a guest blog via the excellent @MrDispenser*

I’m taking advantage of being a guest blogger to do something that doesn’t always come naturally, and that’s to admit that I’m wrong. Actually more than that, I’m confessing that I’ve been exactly wrong for more than the last year.

A couple of weeks back I was at an intimate strokey-beard meeting on commissioning with various representatives from the DH, NHS Commissioning Board and such, and it was there I realised just how wrong I’ve been.  The meeting was tabled as a discussion on the place in the new NHS of Local Professional Networks – designed in principle to be pools of subject experts that could be pulled upon by the NHS CB for input into the commissioning process – but it transpired that for various reasons they no longer exist in the new NHS framework:  a three-in-the-morning decision if ever there was one.  This, and the recent news that pharmacy commissioning representation in the Local Area Teams of the same Board is absent, made me realise my folly.

Because right now, who will commissioners go to for pharmaceutical advice?  More importantly, who will champion the role of pharmacists so that commissioners even know that they are a viable option?  Some may seek support from their emerging CSU, others will house some expertise in their CCG. But how many of them fully understand the breadth of pharmacist’s potential and the services that can be offered by pharmacists, and more so in the easily accessible sites that are retail pharmacies? 

Perhaps some of you will suggest our governing body the GPhC. Well personally I’m not so sure, after they responded to my P-medicine self-selection query.  So what about Pharmacy Voice? The PSNC perhaps? The AIMp? The legendary Chemist and Druggist Senate? The NPA then? The CCA? The PDA? The UKPCA? No? OK, surely the PCPA? The GHP?  The PPRT?

And herein lays my concern: there are too many organisations that ‘represent’ parts of pharmacy, and too few that represent ‘pharmacists’.

In 2010 I decided that the Royal Pharmaceutical Society wasn’t worth my money, mainly after hearing a local (then) RPSGB branch member say that the cleaving of professional and regulatory functions wouldn’t actually change anything other than their logo.  But now in late 2012 I know that was the wrong decision based on someone else’s flawed attitude.

From my experience so far the RPS has changed. It is not always the speediest or responsive of organisations (their statement on 3-for-2 offers was praise-worthy, but I think we’re still waiting to hear their position on salbutamol by PGD?) and their coverage doesn’t extend fully to all sectors including my own speciality in community services, but that’s down to individual members, and the pharmacy ‘representatives’ above, to influence.  But what they do deliver on is media engagement, and this is important for three reasons.

I thought that my first blog-proper would be a pending guest post for the excellent Mr Dispenser, but an e-mail today from the General Pharmaceutical committee (GPhC) has forced my hand.

Some of you may have seen my Twitter rant when I first heard that self-selection of Pharmacy-only medicines was to be allowed as part of the GPhC’s overhaul of the standards for registered pharmacies.  After reading the detail of their consultation response report, I couldn’t understand why the decision was made, so I asked them for clarification via an e-mail.

Today’s response e-mail from them contained a word document embedded with seventeen PDFs most of which I’ve uploaded for your reading pleasure (all well worth a read: there are some gems in there).

Firstly, a sincere doff of the hat to the GPhC for responding swiftly and in full: this level of transparency is both welcome and refreshing following RPSGB days. 

However, I’m still left unconvinced by the decision on self-selection and fail to see what the benefits to patients will be, and what the evidence or risk/benefit balance is to support the move.

The bottom-line is that the GPhC wants to be a light touch regulator, allowing pharmacies to manage themselves within a framework of professional standards that focuses on patient safety and outcomes, so they can focus their regulatory efforts on risky practices or services.  So, given there isn’t a law actually prohibiting self-selection of P-medicines, the view is that maintaining the existing RPSGB prohibition would be an inconsistent hands-on regulatory approach.  With my community services hat on I can see this is exceptionally CQC-esq: I can only hope they’ve learnt lessons from such existing regulators especially as they recognise this approach runs the risk of losing confidence (ref 650), a theme that has already been raised on this particular issue.

So can I see it from their perspective? Well, yes I can: they want to be hands-off, the law doesn’t prohibit self-selection, so they won’t get involved in restricting it.  It also appears some justification is to match internet pharmacies, where the argument is that consumers are free to browse P-medicines online so why not in store? To me this is a fragile comparison, and given previous problems exposed with this sector I don’t think it’s the best benchmark, and against the context of their approach and the detail of the standards, I don’t think it quite fits and may cause unintended conflict.

The GPhC go on to make continued references to their move away from a prescriptive rules based approach, to an outcome-focused set of standards which sit under four principles and include examples of how pharmacies can evidence compliance.  These standards are mandatory, and the pharmacy owner or superintendent “must satisfy inspectors how they have met the outcomes.”

Self-selection sits predominantly under Principle 4, Standard 4.4 which can be paraphrased as ‘the health, safety and wellbeing of patients and the public are safeguarded as medicines are stored securely and are safeguarded from unauthorised access’ .  The GPhC suggest that owners and superintendents can evidence this by “[considering] where medicines are displayed, including whether medicines should be available for self selection or not”.

At this point I have two worries. Firstly, copying CQC methodology, ‘considering’ self-selection is not a patient-safety focussed outcome, it’s a ticked-box action, and if it’s the standard that is meant to also be an outcome, then this will be hard to demonstrate. Secondly, superintendent implementation of self-selection may not be compatible with one of the GPhC’s other aims of encouraging “pharmacists to use their professional judgement” let alone principle two of the GPhC’s standards of conduct, ethics and performance.  Professionally I feel it is inappropriate to allow self-selection of codeine based products, but if my superintendent has implemented self-selection what are my options as responsible pharmacist?  Throw in 3-for-2 promotions and the GPhC’s assertion that medicines are ‘not normal items of commerce’ doesn’t stand up to scrutiny.

The GPhC then go on to list the five ‘for’ arguments, again which seem fragile:

1. “Should be safe to rely on the professional judgement of pharmacists who decide what medicines should be on display”.
   We know this decision can only be made by owners or superintendents so that a tiny proportion of registered pharmacists will be dictating how otehr retail pharmacists will practice.
2. “Cost and time benefit”
   To whom? What is the benefit? What evidence is there to support this?
3. “Reflects that one size doesn’t fit all”
   Huh?!
4. “Supports informed decision making”
   Picking something up off a shelf and having someone run through WHAMM questions is not ‘informed decision making’: talking to someone about options based on the symptoms you present is. 
5. “Encourages collaboration and dialogue”
   Well doesn’t all of pharmacy, including the current arrangements prohibiting self-selection? If not, we’re probably already screwed as a profession. 

But in the end does it matter? I dare say probably not.

The position of the GPhC will not change and given that only 298 pharmacists responded to this consultation apathy to change remains abound in the majority of the profession.

I still believe this move is not in the best interests of patients or the professionals working in retail pharmacy, and safeguards should be introduced to allow the responsible pharmacist to remove self-selection items if they think it is professionally right to do so.  I’m sure we can all envisage how wrong this could go, so if given the opportunity I will be responding to any future consultation on the necessary GPhC draft compliance guidance: I hope other pharmacists will consider the options and comment below – and then go on to respond to any consultation.