Community pharmacies can struggle to find the time to deliver additional services. Without extra funding, how can they manage a rising number of scripts, while also trying new initiatives, and without burning out their teams?

Cadham Pharmacy in Glenrothes, Fife won C+D’s Independent Pharmacy of the Year Award 2019 for achieving just that. A key part of contractor Bernadette Brown’s 10-year plan for the business was to introduce automation, enabling her to roll out a smorgasbord of services while reducing pressure on staff.

“My dream was creating a clinical pharmacy health centre, where the public would have a reason to choose pharmacy first,” Ms Brown tells C+D during a pharmacy visit. Her focus on clinical activity is apparent on entering the premises from the enormous screens advertising services (pictured below) to the absence of retail shelves. The small seating area in front of the dispensing counter is a hubbub of patients attending appointments.

When Ms Brown purchased the pharmacy in 2013, it was in a different condition. It was “in survival mode”, and she worked with no days off, battling to earn enough to pay the bills and her staff, she says.

The purchase of the first robot was a crucial part of keeping the pharmacy afloat. In 2014, she had to fight an application for a new pharmacy contract 100m away. A key part of her case to NHS Scotland for why the contract should not be permitted was her plan to expand dispensing capacity by getting a robot. That year, she fitted a Robotik Technology robot for dispensing Nomad blister pouch packs (pictured below). The team called it “Mac”, for “medicines and care”.

Keen to embrace more automation, in 2017 Ms Brown bought another dispensing robot for packaging medicines (pictured below), from BD Rowa, with the help of a government grant.

The pharmacy relaunched the same year as a “health centre”. The team was “trying to make what we do a lot slicker and easier”, Ms Brown says, while increasing the number of monthly items dispensed, which they have done by 12% over the last four years.

Click and collect

Not satisfied with two robots, Ms Brown has since purchased two PharmaSelf24 self-service prescription machines, which the team call “Connie One” and “Connie Two” (pictured below).

“They’ve been an absolute success for us in terms of releasing time for our reception staff, so they’re not spending all day long collecting packages,” she says.

The two robots have helped modernise the pharmacy in line with patient expectations. “From a public perspective, Connie One and Connie Two are linked to the ‘click and collect system’,” Ms Brown says.

Each one has a capacity of around 200 items, she says, and together they dispense products for around 500 patients a week.

“The automation has allowed us the time to do that, so we actually spend more time with the patients talking to them about their medicines,” she says, adding that it makes life “a lot easier” for patients.

“We don’t want patients coming into our pharmacy constantly when they’re well just to collect their prescriptions.” The robots give patients more privacy, while reducing stress on staff, Ms Brown says.

The fifth robot was installed in August and its job is to scan the pill pouches, which she says is “a very time-intensive job” for her staff.

This may be the last machine investment she makes while she pays each one off over five years. The most recent one cost approximately £47,000. “That’s going to be everything that I should ever need to make [the business] as slick and as automated as I can.

“It will release more pharmacist time, they will never have to check these pill pouches again. That’s not our job anymore, let’s just look after the public.”

Family-facing

The robots are also part of Ms Brown’s strategy to attract families to her pharmacy. “We’re looking holistically at the whole family from babies right through to grannies,” she says. Automation gives them greater flexibility to offer services to “suit every single generation”.

Cadham Pharmacy runs clinics in travel, asthma, and yellow fever. It also has an aesthetics centre and employs a dental hygienist. All the team members are trained in consultations for conditions ranging from urinary tract infections (UTIs) to impetigo.

“We know babies from when they’re born, it’s like an old-fashioned doctor. The pharmacy is very modern to look at, but with old-fashioned values of seeing the person, continuity of care, and an easy-to-access walk-in health centre.”

Easing pressure on GPs

The pharmacy also aligns with doctors by addressing a gap in GP services in the area. In Glenrothes, three of the seven GP practices have closed their lists to new registrations, Ms Brown says. On top of this, some doctors are retiring and recruiting new ones has proven difficult.

Cadham Pharmacy has attempted to pick up some of the slack by launching an advanced minor ailments service in partnership with NHS Fife and supported by all the local GP surgeries, who can refer patients to the pharmacy.

The pharmacy pioneered a two-year pilot of the service, the success of which resulted in the service launching in February.

Conditions the pharmacy can assess and treat under the service include UTIs, respiratory infections, sinusitis, scabies, gout and eye infections. They receive £150 from the NHS for every 10 consultations.

As a result of the service, the pharmacy “is finding our books are full and seeing people all day long, every day”, Ms Brown says.

“Slick” app

The pharmacy has also answered patients’ needs through giving them the option of booking services through the Healthera app (pictured below). It enables patients to make repeat prescription orders, which they can then pick up from the pharmacy.

Patients can also message the pharmacy directly with any medication queries and book appointments via the app.

“We are blown away by the functionality. It’s like having your friend in your pocket,” Ms Brown says. The app helps the pharmacy to offer a “slick service”, while keeping it personal, she adds.

“All pharmacists start off with clinical degrees, but to truly thrive we need to embrace the changing desires of the public for easy access to medicines.”

Four-day weeks  

Alongside patients, a key priority for Ms Brown is looking after her staff. C+D witnesses one aspect of this when the pharmacy closes for an hour’s lunch break. The shutters are pulled down and the work halts. A patient who tries to enter is told politely, but firmly, that they will have to return later.

Work-life balance is a priority at Cadham Pharmacy. In a policy that began three years ago, Ms Brown offers all staff the opportunity to work a four-day week. Only one member of the 23-strong team works full-time. “We’re all about the health and wellbeing of the staff. Our absence rates are exceptionally low.”

She also works a four-day week, as she has achieved her goal of enabling the pharmacy to function at full throttle without her in the building. With two other members of staff trained as independent prescribers, “I can go and enjoy my grandchildren”, she says.

“I’m happy. I’ve done my best with investment for the public, it’s up to them now to keep choosing me. I hope they value what I‘ve done for them.”

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