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The Area Manager: Make the most of what we’ve got

"The system is what it is, and we should get behind it by using it properly and making it the system we want it to be"

Whatever we think of the system, it is what we have and we should get behind it, says The Area Manager

This week, I met a couple of locums who were engaged to work in one of my pharmacies. Neither of them possessed an electronic prescription service (EPS) smartcard, or seemed remotely concerned that they didn’t have one – they perceived it as hassle and unnecessary.

This surprised me somewhat, because I consider being able to access the Spine a crucial part of being a community pharmacist. Are we really in a place where someone presenting for work in a community pharmacy still thinks it is acceptable not to have a smartcard?

 I was fortunate enough to attend, as an observer, a recent national pharmacy conference. There was a guy – a brave guy from the NHS EPS team – presenting to the assembled pharmacists.

He gave a great presentation, in the face of a typically hostile pharmacy audience, about EPS and the Spine. He talked a lot of sense, and saw through the usual gripes about technical issues unrelated to the Spine.

Whatever we think of the system, it is what we have, and we should get behind it by using it properly. All our feedback and usage data helps make it better – and, crucially, will make it the system we want it to be.

The audience however, was more keen to tell him why they didn’t like it at all, and why they didn’t support it because it wasn’t what they’d wanted at the start.

It made me reflect on what I consider to be one of my great frustrations with community pharmacy. Why do we struggle to make the most of the services and opportunities we already have?

Why do we instead choose to moan because we don’t have what we believe we want, or deserve?

There are loads of examples within community pharmacy practice that highlight this problem – medicines use reviews (MURs), local minor ailment schemes and the new medicine service (NMS) to name a few.

Of course, there are ways that all of these services could have been differently designed. But we should be mindful of spending so much time complaining about what they are that we fail to deliver them consistently.

I’m sure if everyone in community pharmacy was fully – and publicly – behind what we have, and delivered it brilliantly and consistently no matter who they worked for or where, we’d all get much closer to getting the things we ultimately want.

The Area Manager has worked for all of the large multiples

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We want to hear your views, but please express them in the spirit of a constructive, professional debate. For more information about what this means, please click here to see our community principles and information

28 Comments

Jon Flitcroft, Community pharmacist

How a pharmacist can turn up without a smartcard slightly baffles me. However the process for obtaining one needs to be improved. Our RA wont come to us to take picture and verify identity unless we have 3 or more staff needing a smartcard. Otherwise it involves a 10 mile round trip to their office and most of the morning away from the pharmacy. EPS is a good system and in my pharmacy the positives have far outweighed any negatives. However there are many small things which really upset the process causing problems for both us and the patients. We have had numerous GP's turn up without smartcards causing paper scripts to be generated for patients who have happily been receiving electronic rxs for months. Lack of training/knowledge has caused paper rxs to be generated instead of electronic due to incorrect assumptions by GP receptionist staff. A lot of patients are losing faith in the system for these reasons. I'm not saying my pharmacy staff are perfect, but things aren't helped by the PMR system we use which seems to make the simplest takes long winded and confusing. This can lead to mistakes and misinformation especially when faced with a shop full of people wanting their meds as quickly as possible. Will GP practices be receiving these training workshops that are being offered to pharmacy teams? PMR systems, I agree, are on the whole not fit for purpose. A few changes could vastly improve the whole process, making it much more efficient, easier to trace electronic rxs etc. etc. I am constantly feeding back to my supplier what needs to be changed and giving ideas, but software development is not a quick process, especially when there are so many 'players' involved. Look at CD's via ETP, according to HSCIC website NO progress has been made since legislation was changed back in July??!! This one change would save countless trips to the surgery and deliveries to patients homes. We are constantly reminding patients to let us know when they have ordered a CD as well as regular meds so we can get from surgery but most of the time we find out is when they phone asking where their Tramadol is. Changing a PMR system is not the easiest process, especially when demo software cannot show anything EPS related. You may well have the opportunity to visit a pharmacy that uses your intended software, but i have been unable to visit any that do the volume of Rx's we do with the volume of ETP rxs. So it is very hard to make a judgment, we ended up staying with our existing supplier, more a case of 'better the devil you know'. A completely updated version is due next year, and from the demo i have seen looks very promising, but we shall have to wait and see if it works in the 'real' world. If not come end of contract we may well have to make the decision to move elsewhere.

Pillman Uk, Non Pharmacist Branch Manager

I must admit that I too can fall in to the trap of wishing for what could have been, rather than utilising what we have, but I have to agree we do need to engage with our services and either prove they need alteration or improvement, or learn to accept that they are the status quo. We will always be given "systems" that we feel aren't right for us, but the most successful individuals I've seen are those who take these as the starting point and really push at the edges. Any ambiguity is used as an opportunity rather than an hindrance, any issue undefined is taken as a green light. I really admire these types of people As for not needing area management, I'm sad to hear that's your opinion formed from obviously poor interactions. In my role I try to play to people's strengths, know when I need to encourage them to develop themselves even if it means I loose them from my teams. I try to show them how they and their efforts fit in to the bigger business picture, I try to smooth and deal with the "interactions" of teams, that some individuals feel uncomfortable in dealing with, I try to show they how they can deal with issues. But yes sometimes I have to make them aware of the stark reality of business, which surprisingly, many seem oblivious of. I steal no one's thunder and I take my portion of blame when it goes wrong. That's my style.

Paul Dishman, Pharmaceutical Adviser

It seems to me that the further you go up a multiple's management structure and therefore the further you get away from the people actually working in the pharmacies, the more likely are you to come out with BS ideas and excuses. I'll bet that Area Managers appear in a branch, spout off management newspeak like an Apprentice candidate, then disappear when there are scripts to dispense and patients to talk to. I was glad to escape from pharmacy just before EPS was widely used locally, it was obvious a decade ago that it was going to be an enormous headache and the potential for disaster was all too apparent. The GPs must be delighted with a system which takes a massive of amount of clerical work away from their staff and dumps it squarely on the pharmacist who then has pay out for the hardware, software and consumables to run the system. The entire unholy mess is down to the PSNC who throughout my thirty years as a contractor have proved to be completely unable to negotiate their way out of a paper bag let alone support a sensible contract that would enable pharmacists to provide a first class service. Instead of which workplace pressures are enormous and the profession is under the cosh and disillusioned.

Farm Assistant, Community pharmacist

Bang on the money

Mark Boland, Pharmaceutical Adviser

EPS is a small off-shoot of the largest IT project failure in recorded history. Please read the offical report, the estimated write-off of 12 billion pounds is the largest in history. The report describes a scandle where it was known very early on that a complete failure was likely. In the report it describes how negative analysis and warnings by contractors were ignored and how the disaster was preventable had these warnings been heeded. Of course everybody was told to be blindly positive and to get behind the project, the prescient sceptics being considered the 'problem'. A typical British farce where expertise and practical experience is made subordinate to rank and the keeping of face.

John Urwin, Community pharmacist

Your comments are correct, but do NOT apply to EPS, a small off-shoot of the largest IT project failure in recorded history. As I have stated above it does work well if you have the right software. Could EPS have been delivered more easily and cheaply? Almost certainly. But it would still have required the suppliers of pharmacy PMR systems to produce good software to work effectively with the system and that is the source of the problems that many pharmacies experience with EPS.

Mark Boland, Pharmaceutical Adviser

I think most community pharmacists would accept that there is a theoretical basis for believing EPS to be superior to hard copy. As a generalisation, PMR software is indeed poor and innovation in this this area has been absent. Your proposition that it is the PMR software that is the weakest link, is in my opinion at least, true. Then in addition, the chains have failed to modify their dispensaries and train their staff adequately, further compounding the software problem. This merely describes root cause anaylsis, and as important as this is for solving the problem, it does not relate to the premise of the article. The premise of the article is that pharmacists must accept what they are given and make the best of it. But what we are very often given is the inadequacies and incompetence of senior management and making the best of this is all consuming. The article proposes an anti-elitist corporate culture based on the subservient acceptance and maintenance of poor design and implementation. Nobody of any intelligence, education, expertise or enthusiasm, could accept this as right, but it is the reality of much of community pharmacy.

John Urwin, Community pharmacist

It is my practical experience rather than theoretical belief that EPS is a good thing. I do not have a corporate background and cannot comment on that side of things. I do agree with a lot of what the Area Manager writes. We need to accept the reality of the current state of things within community pharmacy and do our best to make it work whilst at the same time fighting for improvement.

Farm Assistant, Community pharmacist

Just like a WW1 general......"carry on chaps" as he toddles back to his own little world. Not having an EPS smartcard is inexcusable but so is the quality of nearly every PMR system. One day they are all going to go tits up but at least my coffee won't go cold.

Chemical Mistry, Information Technology

Following on my post, just to say i am no luddite, and would love to know about a utopian pharmacy that exist somewhere except in KR,DR et al ivory towers and there is many forward thinking pharmacist and pharmacies in the country such as the Green light pharmacies in London and think practice pharmacists are a good thing but again seems rushed and get the impression the pharmacist will be a glorified lackey to sort out repeats etc but this far from what the job is about and when put into practice correctly it is beneficial to both parties i just hope the rush for practice pharmacist works out well for everybody. Like most decent hard working pharmacists if we have a service we believe in and in the interest of the patients then we will make it a success eg flu vaccination no matter how much the area manager pressurises and pushes us but then again they devalue it by making a target to reach since we all work in the NHS it not always about targets yes we must make a profit but it will not and should not be at the sake of my sanity.

Angela Channing, Community pharmacist

I agree with you re: sanity! If you go back 20 years, you never heard of workplace stress in community pharmacy. Yes, there were a few busy places, but they tended to be well-staffed and well-organised. I'm starting to worry about the mental health of some of the staff now, particularly relating to ETP and how the public are getting angry, and taking it out on the assistants. Many of them are on minimum wage and don't deserve all the aggro.

London Locum, Locum pharmacist

Just a question. Is patient safety put before the pharmacist's own health/sanity? Should it be ?

Ho-Shun Chik, Community pharmacist

The truth in this article is that this is the current system that we have. Whether we should get behind it, is another thing. Its not that all pharmacist feel that EPS is a bad thing; its just not designed very well. The cries of those complaining about its flaws are a good thing. It is feedback. Valuable feedback about the system on how it could be improved. You can't be selective on the feedback that you hear and only try to implement those. We moan to get the service/system that we belive we need, not what somebody else thinks that we need.

John Urwin, Community pharmacist

I'm sorry but you are wrong. EPS IS DESIGNED VERY WELL. It works incredibly with a well designed and implemented pharmacy PMR system. However, as the speaker at the LPC conference suggested, most PMR systems are old systems with EPS loosely bolted on. With a good PMR system (and there is probably only one at the moment) EPS and EPS Repeat Dispensing are a joy to use. One of my pharmacies dispenses 8000 items per month. 80% are EPS2 with a lot of Repeat Dispensing. When your supplier tells you "the spine is down" and yet the surgery is having no difficulty uploading scripts, that is not an EPS problem. It is an implementation problem that your competitor down the road is not experiencing. Do complain about the flaws in your EPS experience but point your complaints in the right direction. Put pressure on your software supplier, or change supplier!

John Blake, Retail Management

My worst example of an area manager with a large multiple was the one who had been the lead drummer in a pop group then went onto become a window dresser for the multiple. This 'experience' was rewarded with an area manger role. He hated coming into the dispensary and he looked distinctly out of place there - knowing nothing about what we were doing. J.B. Retired Locum.

James Mac, Community pharmacist

MURs should never have been paid for on a one-fee-per-mur basis. It just turned it into a target chase, and when that happens, quality doesn't become the chief concern, volume does. The quickest way to get into trouble, and farmed out to a deadbeat branch a guaranteed 50-minute commute away, was to slacken in your MUR output and go "not performing" when your non-pharmacist boss comes in to have an "honest conversation" with you about how they'd do your job if they were you. The should be paid to provide the service and submit a token amount for valuation a year. The same goes for GPs, QoFs and QALYs and all that nonsense stop doctors being free to react to the patient in front of them, and leads to more target chasing on their part. But I doubt it'll happen.

Chemical Mistry, Information Technology

Giss a job!! giss a job !!! I can do that as yosser hughes used say!

Mark Boland, Pharmaceutical Adviser

So if something is badly designed, poorly implemented, inadequately maintained, inappropriately incentivised, untested and unproven, we should blindly get behind it? There can only be two possible explanations for this sort of thought: 1) The person thinking it is too stupid to realise the stupidity of their thought 2) The person doesnt think it, but makes the expression of belief because it makes their life easier and their chances of promotion more likely. In either case, it is what one would expect from the typically anti-elitist, anti-competitive, anti-science, politics speaking community pharmacy establishment

London Locum, Locum pharmacist

They all know MURs etc.... are a complete waste of time. Only an idiot wouldn't. It's a charade that must be maintained in a lazy attempt to disguise their real objective. GET THE MONEY.

Chemical Mistry, Information Technology

Ps all pharmacist should have a working smartcard if not do not book them simples maybe area manager should have a word with booking clerk?

Z ZZzzzz, Information Technology

Agreed

Chemical Mistry, Information Technology

Message to the the editor, I get this rubbish all the time from my employers I do no want to read this brainwashed rubbish ! Maybe majority of pharmacist can see through the rubbish that is Murs and nms no evidence to show they improve compliance in patients and are really just another way for contractors to get the monies taken from the global sum that's why target driven and minor ailments scheme mainly for free loading customers unwilling to pay for 60p for a pack of paracetamol whilst the contractor gets the dispensing fee from the minor ailment scheme plus cost of product so again costing more money to the NHS that's why in a lot areas does not exist and why government will not allow PSNC allow a national scheme God forbid ! whilst if refused most customers will buy the product when dressed head to tail in designer clothes sprayed tanned with lovely nails but cannot be bothered to buy a bottle of paracetamol for their sprog ! Most people come to the pharmacy is because they want their prescription dispensed quickly and accurately as possible no other bullshit but is looked down by most leaders of pharmacy but they would soon find out such as when a mistake occurs and the grief you get from customers as well as how bad the pharmacist feels as well and the most popular pharmacies are those that do this is not shoes where you can wait upto 30minutes for 28 thyroxine it is only living on past glories if not follow their Twitter feed for all the complaints. So message is get rid of this day Day Lewis manager now please apologies for the rant but had area manager visit who was ex area manager of pub chain.

Angela Channing, Community pharmacist

I totally agree. A colleague once had an area manager, (non-pharmacist), who used to work in the motor industry and tried to liken MUR provision to selling tyres!

geoffrey gardener, Community pharmacist

Thing is you only go to buy tyres when you need them, I don't think I have ever had a patient say to me I'm feeling a bit flat, please can you do me an MUR asap

London Locum, Locum pharmacist

Once again you hit the nail on the head. These clever people at the top are simply squeezing as much money as possible for themselves before the ship goes down. An inevitability which they are well aware of.

Z ZZzzzz, Information Technology

I think it is time one of the tick boxes we complete when registering with the GPhC every year should state: I have a valid and working smartcard. In fact I believe the GPhC should take over as the RA for all pharmacists and qualified technicians. It might introduce a consistent approach which doesn't happen between different RAs with some letting us use the Care ID online service to order smartcards for new staff or pharmacists while others still insist on having to attend for a face to face with suitable ID - crazy!

London Locum, Locum pharmacist

You sound like the type of idiot that makes Community pharmacy the joke that it is. Good luck to you.

Harry Tolly, Pharmacist

Does Pharmacy need Area Managers ? Waste of space and money which could be used on frontline staffing ?

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