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It's time for pharmacy to upgrade

Locum dispenser Benjamin D'Montigny says pharmacists should embrace technology to help the profession evolve

The pharmacy has always been on the traditional side of things. We are one of the few industries that still relies heavily on fax machines, although thankfully increasingly less so. I look forward to the day when pharmacy realises that no-one else has used a fax machine since the 1990s. Pharmacy still struggles with even the basic efficiencies.

As we progress and evolve in pharmacy, so does the technology we use. Each advance has changed the way we prepare and use medicines to provide care in our communities. However, this poses a question –  when technology becomes the core of pharmacy and is doing the bulk of the work, are the pharmacists, technicians, dispensers and healthcare assistants needed anymore?

We are like the weavers being presented with a loom for the first time. We said it will never take off, that it will never supplant the skills of a pharmacy team. Now here we are, the superannuated weavers, and those that have uptaken the loom are already miles ahead.

We are facing the dreaded “Amazonisation” of pharmacy. Is the fear of redundancy warranted? I would be lying if I said no. Simple business acumen will tell you that with automation comes a lesser need for people. Upskilling is going to be the name of the game. Will those who cannot or will not upskill survive in modern pharmacy? The aim is going to be to make yourself, ironically, indispensable. But is it all bad?

If we remove the dispensing element from pharmacies, what are we? The goalposts move. No longer are we simply people hiding away behind a dispensing bench, barely talking to a single person that graces our doors. That safety guard has gone. Now it is the time we show our compassion. Our own human element, if you will. Pharmacy becomes a service-driven profession where your social skills are just as important as your clinical ones. Is it enough to simply be a good pharmacist?

Why do you work in pharmaceutical care? I have to admit, I care less about prescription numbers and more about helping the individual in front of me. The human element initially drew me to this profession. No-one comes into this profession, be it pharmacist, dispenser, or healthcare assistant, thinking “I can’t wait to check prescriptions/stick labels/put away stock all day.” No, we are there because we want to help people.

I predict this is going to be a big year for pharmacy. With quality payments rolling out around the corner we are likely to see some massive changes. Modern technology allows us to do that. It is the time to upgrade and think about what kind of profession we want to be.

Benjamin D’Montigny is a locum dispenser working in the south of England.

25 Comments

Leon The Apothecary, Student

Yeah, least it has that group function and auto translatation of directions, I'd take bits of each PMR to make one half decent system.

Paul Dishman, Pharmaceutical Adviser

I've said before that my now fulfilled ambition was to retire before ETP came in. I remember seeing the early demonstrations and realising that there was little benefit for the pharmacy, but plenty for the GP practice who now can cut back on admin staff having transferred all the admin to the pharmacy. As Angela says, we've been lumbered with technology that benefits everyone else. It's all just the sort of thing that people who sit in offices all day would invent.

Angela Channing, Community pharmacist

The problem with technology in community pharmacy is that it seems to help everyone else. The GP, the receptionist, the prescription clerk, the pricing authority, The NHSBSA, the NHS, the government. It doesn't help us! Why am I working twice as hard in a pharmacy doing 4000 items a month where I "used to go for a rest" and now, since ETP, am working twice as hard, looking for ETP Rpt Rxs, downloading and printing and sorting, claiming, etc etc.  Same with Pharmoutcomes. Putting all the claims online, that before all this wonderful tech, I would have bundled up and sent off to some remote paper-shuffling person in an office! More work for us/me, made by technology, and this is probably how most coal-face pharmacists feel??? The latest thing seems to be taking all the repeat orders over the phone, simply because local surgeries, (without asking us!) have just told patients, they're not doing it anymore, do it via your chemist!!  Cheers!  All new jobs for no new payment! And THEN we're told to jump through a load of hoops to earn 6k a year for the likes of the Never-ending story of HLPs, which no patient really seems in the slightest bit interested in, and this with many CCGs axing their smoking services! The only "low-tech" services people seem to want is a Medi-tray and a delivery service for free, in a time-slot to suit them!  Ben, it's over to you!! :)

 

Leon The Apothecary, Student

For me that suggests we could use with a system that incorporates all these requirements into one. Because we don't have those we are forced into using a modular design. I'd also say that out software was not designed with the modern model in mind, so it uses a patchwork framework to achieve tasks that had it been in a system with all this in mind, would be a doddle. A prime example of this would be stating that a number of PMRs don't have a basic sorting feature, let alone a comprehensive one that pharmacy requires, so we make do. Even delivery methodology is somewhat outdated, with route optimisers and software available to provide the patient with up to date information, there are certainly loads of space for improvements!

Valentine Trodd, Community pharmacist

Spot on Angela! One of the things that really winds me up every month is the rigmarole of sorting paper FP10s into intricate piles in very specific order. Why, oh why do we need to do this when they are all electronically scanned and read anyway? Surely if the mighty scanner can read the prescribed items, quantity, paying or exempt then it's not too much to go the extra yard and read the doctor's name, rx type, etc? This is just one area where existing technology could relieve some of the paper-pushing burden form pharmacies. It would not surprise me one jot if the functionality is there to do this, but it's switched off... cause might as well let the pharmacy do it!

Leon The Apothecary, Student

Electronic prescriptions are like that. Paid and Non-Age Exempt in no specific order. Just need to switch the last remaining bastions of green scripts, we're getting there, eventually!

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Just as a matter of interest - did you know that dispensing doctors don't have to divvy things up? No red separators, no pressing need to even divide up the doctors - it just says 'it would be helpful if'. All you have to do is paid and exempt and thats it.

Leon The Apothecary, Student

If all we received was electronic prescriptions in a Pharmacy, our sorting method would actually be like that. Maybe surgeries should stop producing R1s and embrace R2 tokens since there is often little to no reason to not doing so?

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

For dispensing practices there is every incentive to not go onto EPS2. They could only lose by it because of 'their' prescriptions going elsewhere, and I can't see hospitals or dentists going to EPS2 anytime soon. They haven't even embraced computer generated scripts yet, so we're stuck with sorting our prescriptions for years to come I think.

EPS2 also results in a bun-fight for signups which will result in all of the independents who put patient care before profit losing out yet again. It is a tool for the multiples.

Ben Merriman, Community pharmacist

On a related note: can you think of any other profession that sends an average of 2,500 invoices with no way of checking correct payment for them to an organisation each and every month?

Leon The Apothecary, Student

On a further related note I cannot think of a single industry, other than pharmacy, that relies on a fax machine for their communication inputs!

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

You've obviously never followed the last day of the transfer window.

Matt G, Community pharmacist

you seem to have something against fax machines, when i cant think of a single negative. They are more secure than an email, if i have a document i want to send someone I would have to scan -> email where-as with a fax its scan->fax, so no difference there, unless of course you dont have a scan to email scanner, inwhich case its scan -> browser -> email ->send and is more time consuming.

I really dont see the problem, it has to be the least appropriate example of whats wrong with pharmacy. 

Leon The Apothecary, Student

Certainly there see other factors to what is wrong with pharmacy, but my strongly held belief is that a majority of them comes from holding onto relics of the past, be it processes, technology, methodology, historical stereotyping, etc.

Leon The Apothecary, Student

Oh I do! Their main issues become apparent when scale increases. Not to mention hogging a phone line, being slow, lacking a comprehensive audit trail, the basic models having confidentially sensitive waste products, documents lacking clarity which can be a real pain for R1, no protection against duplication of work, not to mention we have EPS so there no need for them. For your example there, let me pose these questions:

How do you confirm something has been sent after a few minutes? How do you confirm after a few months? Few years? What additional storage do you need to keep these clarifications? What if you need to resend your document, do you need to restart the process again? How about after a longer period of time?

There are definitely progressional advantages and once you go beyond the minimalistic view they become more apparent.

Valentine Trodd, Community pharmacist

And why is it we have to take the hit if the patient doesn't sign the back and tick the exemption? How many hours are spent in every pharmacy up and down the land at the end of the month leafing through great bundles of scripts putting scribbles in signature boxes. It's absolutely ridiculous. Pharmacy is like a parallel universe - no other profession would put up with this nonsense. 

Leon The Apothecary, Student

The pharmacy does not get paid, and the patient gets a fine. Bit of a double earner there for the PA right?

Valentine Trodd, Community pharmacist

What I meant was Billy No Job comes in for his dozen items, doesn't tick H or sign, my dispensers miss it (perish the thought, they wouldn't of course) and it gets sent to NHSBSA. We get paid alright - the dispensing fee and cost of medication - but they take 8.40 per item from us (it's 'switched' to paying)! The patient only gets fined if they are claiming an exemption they are not entitled to. If they have an exemption and don't tick the box and sign - we end up paying for them! I think in any other business the NHSBSA would be considered guilty of fraud.

Leon The Apothecary, Student

I agree with you. You'd think the fair thing would be to have the rightfully earnt money given back to the pharmacy?

Leon The Apothecary, Student

I would love to see a machine sort those out. End of the month regularly sends a collective cold sweat down people's spines.

Valentine Trodd, Community pharmacist

And ETP has made even more work for us - so much for the paperless office!

Leon The Apothecary, Student

I think it partially stems from the fact that PMRs in usage at the moment we're not made with ETP in mind, more of a bolt on piece of software in some cases. Heck, take Compass for example - that system needs a whole separate program and server to get it to be compatible.

Valentine Trodd, Community pharmacist

Right on. P*oscr*pt's implementation of ETP is a mess - it separates the ETP component entirely from the PMR - so you are constantly going back and forth. I think ETP is a bit of a mess anyway - rather than build a system from the ground up, they modelled an electronic system on the existing paper-based one! In fact they did such a good job of it that we now have an electronic system that involves us printing out scripts and sending them away at the end of the month - so we've effectively come a full circle!

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Have you ever used the EPS module on Pharmacy Manager? It's totally pointless and actually takes far longer than processing a normal script.

Leon The Apothecary, Student

I'd also agree that Proscript was one of the better PMRs out there. One of my favourites anyway.

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