Supply chain problems and the use of automation to free pharmacists' time were the hot topics on the agenda on day two of C+D's Conference in Birmingham last week, reports Jennifer Richardson

No prizes for guessing what Mike Holden was talking about, introducing the Big Debate at C+D’s Conference in Birmingham last week. “The situation is worsening and the problem is not being resolved. What we need to do now is stop talking and find solutions.”

Medicines shortages have overshadowed community pharmacy life for over a year now, with pharmacists each spending several hours every week chasing around 50 vital drugs needed by patients.

Unfortunately, though, if the talking is anything to go by, the solutions could yet be some time coming, as the debate made clear that key players still cannot agree on the main cause of the problem.

One thing community pharmacy, wholesalers, manufacturers and dispensing doctors all agree is that there is a problem. And they also appear to agree with Dispensing Doctors’ Association (DDA) chief executive David Baker that the problem is “multi-factorial”. The problem arises when it comes to defining the relative roles of those factors. No one disagrees with Dr Baker that “the major problem is the fall in the value of the pound”, but this is not something within their control.

For big pharma representative David Fisher, the most important issue to resolve is the amount of medicines intended for British patients that are exported to Europe. “The first step is to stabilise the system,” said the commercial director of the Association of the British Pharmaceutical Industry (ABPI). “That means that when we supply medicines for UK patients, that at every point in the system the main aim is to get those UK medicines to UK patients.”

But community pharmacy representatives reacted angrily to the implication that the problem was mainly caused by contractors, even a small minority, parallel trading for profit. It was “slightly disingenuous” to try to pin the blame on pharmacy, said NPA chairman Ian Facer from the floor. Mr Fisher responded: “There’s nothing disingenuous about sharing our opinion. Community pharmacy is where the best data is and where the issue has been quantified; that’s not to say it’s the only issue.”

For Community Pharmacy Scotland’s head of corporate affairs Alex MacKinnon, who estimated that just 5 to 6 per cent of Scottish contractors were exporting, the bigger problem was changes to the supply chain and manufacturer-imposed quotas. And, he added: “What I don’t understand is how on earth some contractors who are exporting can get so much stock when others can’t get one pack.”

The Independent Pharmacy Federation’s Graham Phillips agreed manufacturer-led supply deals were causing problems, estimating that the introduction of Pfizer’s direct to pharmacy scheme two years ago had cost his Hertfordshire chain £10,000. “Is there a net increase in patient safety?” he asked. “I hardly think so.”

However, in the wholesalers’ corner, Alliance Healthcare managing director Jeremy Main backed the motives behind manufacturer-led supply deals. “My personal view is that [manufacturers] have brought them in to make sure there’s continuity of supply to patients,” he said. “The absolute fact is that where we are involved in newly configured supply chain models they do provide better levels of service.” He also supported Mr Fisher’s assertion that manufacturers were supplying plenty of product for the UK market.

Therefore, said Mr Fisher, manufacturers could not simply provide more product. “There’s no lack of recognition that this is a serious problem,” he insisted. “It’s annoying, it’s time-consuming, and it’s downright dangerous. But I think we have to think carefully about the solution because simply releasing more product is not a sustainable answer. We still have leakages in the system that are stopping you getting that medicine on a sustainable basis.”

Dr Baker called for all stakeholders to put aside money in trying to solve medicines shortages. “It’s got to be the patient before commercial consideration,” he said. “Once we get that right at all levels of the supply chain, it will work; until we get that, it won’t.” But this jarred with Jeremy Main’s assertion that “where there’s an opportunity to make money, people will take it – that’s a fact”, and the discussion predictably moved to funding.

Daniel Lee, managing director of online chemist Pharmacy2U, suggested from the floor that one solution was to reduce pharmacy’s reliance on supply chain profit and instead remunerate the sector for quality of service. And Mr Phillips and Mr Turk agreed. “It seems to me that the system is now so broken as to be not fixable,” said Mr Phillips. “We need a completely new vision of contract funding that puts patients first and rewards pharmacy for its clinical value. When we move in that direction this problem will almost solve itself.”

A blueprint for success

Get ready to embrace technology. Whether you’re a gadget whizz or more comfortable with books than bytes, it’s time to bring community pharmacy up to date with robotics and online tools. According to Lloydspharmacy managing director Richard Smith, these will be “key drivers” of the sector for the future. Both automation and the internet will feed into the task at the top of Mr Smith’s to do list for community pharmacy; inspiring consumers’ trust in the sector. “What pharmacists have got and what they need to build on is the confidence of the consumer,” he told the C+D Conference in Birmingham last week.

“Automation I think is an absolutely key driver,” Mr Smith said, “whether that’s automation in the pharmacy or outside of a pharmacy.” Robotic dispensers may be viable in some high prescription volume pharmacies, but it’s the possibilities posed by automation outside the pharmacy that Lloydspharmacy appears to be exploring with the greatest interest. As previously reported, the multiple has already supplied over one million items through the ‘hub and spoke dispensing model’, with 100 of its community pharmacies acting as ‘spokes’ to central dispensing ‘hub’ pharmacies (C+D, October 17, p10).

The importance of this is in freeing up pharmacists’ time, which Lloydspharmacy is trying to do as much as possible because, Mr Smith said, “time is the biggest issue” in developing pharmacy for the future. “We have been very busy removing certain checks and tasks that aren’t customer-related to try to increase the time our pharmacists can spend with customers,” he said.

“What we have to do is find a reason why somebody would want to come to pharmacy. Supermarkets can be cheaper – I know because I worked there,” Mr Smith continued, referring to his almost three decades at supermarket chain Somerfield. “They have got economy and they have got scale.” And for Mr Smith, what will set community pharmacy apart and allow it to compete is face-time with, and advice from, health experts without the inconvenience of having to make an appointment.

But as well as finding the time to make this a reality, Mr Smith also believes the sector needs to “get our act together” and ensure quality. Last year’s infamous Which? report, which found a third of advice given over pharmacy counters was “unsatisfactory”, was, Mr Smith said, “a huge embarrassment”.

Accordingly, he added: “A huge amount of investment goes into our staff training. We have to be clinical experts; we have to invest in training; we have to have all our staff who face the customer being able to give them confidence.”

Funding continues to be a problem, Mr Smith vociferously argued (C+D, October 17, p5), with the dream of the sector being remunerated for service rather than volume still just that. But, he added, “perhaps if we get our act together as an industry, the tide may just be turning”.

“This must be an opportunity for the Department of Health to use pharmacy cost-effectively to help reduce the rest of the burden on the NHS in the future.
“If we get the funding right I believe we have the opportunity to meet the demands of the consumer in the community.”

Making the most of the internet will also be critical to positively boosting pharmacy’s profile in the 21st century, Mr Smith believes. Lloydspharmacy has tapped into this potential with the launch and ongoing development of its online doctor initiative, in which internet surgery DrThom diagnoses and prescribes for a growing list of conditions and Lloydspharmacy supplies the prescription items.
And Mr Smith suggested it could take this one step further with Lloyd, an online personality for the Lloydspharmacy brand – a Lloydspharmacy avatar, for those familiar with the technological parlance – getting pharmacy face-time with consumers even when they’re not in the pharmacy. “Whatever the consumer wants, when they want it, we need to provide it,” Mr Smith said.

But that’s certainly not to say technology can take pharmacists’ place – far from it. Instead, Mr Smith believes it will allow them to prove the added value they can give to the traditional medicines supply service. One C+D Conference delegate asked Mr Smith what one thing she should do to take pharmacy into the future. His advice: “Get the pharmacist away from that task and be out front just to talk to consumers all the time.”