Electronic repeat dispensing has long been touted for its efficiency benefits, which were fully realised by Chagford Pharmacy when the COVID-19 pandemic hit.

A quiet pharmacy in a rural Devon town, the eponymously-named Chagford Pharmacy suddenly saw its phones ringing off the hook in March, its shelves bare of paracetamol and a noticeable increase in prescriptions to process – “definitely not double, but a lot more than normal,” pharmacy manager Emma Bisson tells C+D.

At the same time, an influx of students and elderly relatives returning to the county for lockdown meant dealing with a whole set of new customers and having to retrieve prescriptions from surgeries elsewhere.

But the pharmacy had done a lot of the legwork for its regular customers already.

“We have taken up electronic repeat dispensing in a massive way, so actually we have everyone’s prescriptions here and we [prepare them] all in advance,” says Ms Bisson. “That for us was a bit of a saving grace. Maybe that’s a good handle for other [pharmacies] to start doing it as well, because it really does help.”

A “drive-by” system

The pandemic also meant that Chagford Pharmacy adopted some temporary systems. With continued demand for over-the-counter products from people shielding and self-isolating, the pharmacy set up a “drive-by” service, where patients would order items from the pharmacy over the phone and pay online after collecting them – “just like a tab”. 

“We don’t have the facility to take payment over the phone, so they would come and get the goods, we would give the bank details and then check they’d paid,” Ms Bisson explains.

“Luckily, we know most people anyway here, but that took up a lot of time, as well as having to go around the [pharmacy] to do their shopping while on the phone to them.”

Before COVID-19, the pharmacy had never operated a delivery service, Ms Bisson adds. But when the national pandemic medicines delivery service was launched in April, the team had to adapt quickly.

They used the NHS volunteering service via the GoodSAM app to deliver the medicines, which Ms Bisson says has worked “incredibly well” on the occasions they’ve used it.

“The volunteers have all been amazing and local people that we know, which is quite nice because pharmacies have been worried about giving out medicines [in this way] and getting them to the right people,” she says.

HRT shortages

Medicine shortages have been more of a problem than usual for Chagford Pharmacy during the pandemic, with inhalers and paracetamol among the worst-affected items. The longstanding issues with hormone replacement therapy (HRT) products are also ongoing, Ms Bisson says, with many still unavailable.

“We’ve got quite a good relationship with our surgery and normally if something is out of stock, I would request an alternative and get it done for the patient.

“But, when it’s been really busy, I haven’t had the time to do that. I’ve had to send patients back to the surgery and get them to sort it out, which isn’t ideal.”

Counselling for pharmacy teams

Months on from when the UK lockdown came into force, the phone is still ringing. Chagford Pharmacy is starting to see an increase in footfall again as the restrictions ease, although overall the pharmacy is returning to its usual, quieter pace.

Sue Taylor, chief officer of Devon local pharmaceutical committee, says pharmacy demand is starting to get back to normal. Contractors are opening for regular contractual hours again, having made use of the flexibility offered by changes to the community pharmacy standard operating procedure.

But the burden placed on pharmacies in the early weeks of lockdown left staff “stressed, anxious and frightened”, Ms Taylor says, to the point that she was approached several times by contractors about access to counselling.

“We managed to secure access to the local NHS counselling support programme for our pharmacy teams, which was a real boost,” she says.

Temporary closures

The wellbeing of staff has been a key factor behind some temporary closures, Ms Taylor says, as pharmacies have struggled to get hold of adequate personal protective equipment (PPE). “I’m aware of some contractors that had to apply to close for one or two days to have the headspace and give the staff a bit of a break,” she explains.

One pharmacy had to close for a week after the pharmacist came into contact with a staff member at the adjacent GP practice who had tested positive for COVID-19, Ms Taylor says. This meant an emergency supply of repeat medicines had to be commissioned by NHS England locally, but the pharmacy was able to buddy with another nearby pharmacy and transfer the care of vulnerable patients.

“We’ve been fortunate not to have similar experiences across the county, but it emphasised the importance of having a robust business continuity plan in place,” she says.

Security guards

Abuse towards pharmacy staff has increased since March – a C+D survey published in May found almost two thirds (64%) of 859 respondents had experienced an increase in abuse from patients as a direct result of COVID-19.

Devon has not escaped the problem. Ms Taylor says the way people have behaved when their prescription wasn’t ready or there were stock shortages has been an issue. She has heard of one contractor who had to ban four patients from the pharmacy on the same day.

“Some contractors have also had to contract with security personnel to manage the queues outside. I don’t know if that’s still in place, but in the first couple of months people were having to employ security guards to help,” she says.

Looking ahead, Ms Taylor says contractors are starting to find out how they can get services like medicines use reviews and the new medicine service up and running again, but her anxieties about not being able to access PPE remain.

“There does seem to be a more streamlined approach [to PPE] now but I do know the cost is going up, and I’ve had independents in particular reporting that they are getting out-of-stock messages from their wholesalers again,” she adds.

Thankfully, back at Chagford Pharmacy this has been less of an issue. Ms Bisson says they’ve managed to make their initial stocks of PPE last and the installation of a Perspex screen early on helped to reassure staff.

“Everyone says, ‘oh, the pharmacists are brilliant’, which is really nice, but the counter staff are the frontline in this, and without they screens they are vulnerable.”

“Everyone has got their own families and their own worries about the risks [of COVID-19] and perhaps childcare issues, but our staff have been amazing,” she adds. “They just got on with it.”