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Which online companies are most likely to disrupt community pharmacy?

Alexa can’t order repeat prescriptions…yet

As part of C+D’s internet pharmacy week, NHS Digital’s Mohammed Hussain considers whether the Amazon takeover is round the corner

Amazon’s virtual assistant Alexa can do many things, including laughing randomly, which is sure to freak people out. Each week, the company sends out an update email to show the latest skills Alexa has learned. As yet, Alexa can’t order your repeat prescription.

Amazon has, however, signaled an entry into the pharmacy and healthcare sectors. The company is exploring providing distribution and fulfillment of orders, pharmacy licensing to comply with regulation, and has even introduced its own-brand over-the-counter pharmacy line. Is pharmacy about to be ‘Amazonised’?

Here are three reasons why it could be:

  1. Other, similar, industries have all been disrupted by digital technologies: groceries, book shops, video rental and banking, to name a few.

  2. Citizens are increasingly moving online for services. They expect to be able to conduct digital interactions and not have to receive services on a solely face-to-face basis.

  3. Citizens expect to have 24/7 ability to interact with a provider, both synchronously (phone, chat, Skype) and asynchronously (NHS mail, app messaging).

If this were the whole picture, then pharmacy would have already been significantly disrupted. This has not been the case, so this is not the whole picture.

Why pharmacy may not be ‘Amazonised’:

  1. Pharmacy services are much, much more than a simple transactional interaction. Pharmacy provides access to a trained and regulated health professional, adds clinical value, ensures safety, and provides tailored help and advice – all with or without the supply of a product.

  2. It has not happened yet – which underlies that healthcare is different. The regulatory environment in healthcare is complex and has not yet fully kept pace with technology.

  3. The digital infrastructure is not sufficiently mature in pharmacy. This constrains the ability for software to deliver the service. A decade on from the launch of the electronic prescription service, it is clear this has been less transformational and more foundational for disruption. A structured, computer-readable dose syntax has not been developed. Sharing of data is still hard, and interoperable systems remain in their infancy.

  4. Medicines are not just another commodity. A medicine is not like a book or loaf of bread. Although they can be ordered and shipped, they are fundamentally different. Safeguards to prevent abuse or harm need to be included, and individual wants have to be balanced against protecting the individual and the wider public interest. Inappropriate use of medicines, such as antibiotics, can have a population-level effect and, as such, additional care is needed to ensure the wider public health interest is considered.

Amazon will undoubtedly enter the pharmacy sector in some capacity. However, my own judgement is that the greater disruption will come from [prescription ordering] pioneers such as Echo and Dimec, as they bring in new business models with two-sided network effects that are more rapidly scalable.

Two-sided networks are platforms where two sets of users can conduct transactions with one another, and the value of the platform grows in a 'virtuous circle' as providers and consumers grow. Examples include Airbnb (hosts and guests), app stores (developers and purchasers), and Uber (drivers and riders).

While we wait for the disruptive models to scale, the one thing that can’t be outsourced (yet) is exercise: “Alexa – start my seven-minute workout!”

Mohammed Hussain is senior clinical lead of operations and medicines at NHS Digital

All this week C+D is exploring the world of online pharmacies. Read all the coverage so far here.


Adam Hall, Community pharmacist

The younger generations don't care about safeguards - if they did, how do you explain the number of people who take random "pills" at festivals (just this week, two more lost out to Darwinism) - so won't care about the human heart/interaction you speak - not, at least, until they actually need health services but by that time, it will be too late (and if that is the case, it is difficult to have any sympathy with them)

H W, Community pharmacist

Appreciate this is quite off topic but what an awfully ageist and ignorant comment. The younger generation have more information than any before them at their fingertips and are more likely to research what they are using themselves - educationatal standards have not kept up with the increase in information available and the skills required to disseminate this information. 

I would expect better from a pharmacist in that it is not the ignorance of these people rather it is the archaic structure we have placed around illicit substances - as shown by multiple models of decriminalisation and legalisation around the world

Z ZZzzzz, Information Technology

As soon as GPs are incentivised financially by the likes of Amazon the sooner the correct technology will suddenly appear within primary care to allow the Amazonification of prescription supply. Bye bye then to the current ancient inefficient system suffered by the public.

Leon The Apothecary, Student

I mean...we still use fax machines. Pharmacy is single-handily keeping that piece of technology selling for years!

Gavin Birchall, Community pharmacist

An insighful article, which it's pleasing to see, looks at both push and pull factors. The push factors are powerful and are the predominant focus for many worrying about this issue. The pull factors however, are also strong as they stand without any co-ordinated action by the pharmacy profession to slow or prevent this kind of wholesale disruption. Actions of Echo and Dimec etc accepted.

An additional pull factor, one would hope, would be the negative effect on the livelihoods of many tens of thousands of people who currently deliver care through the pharmacy network. 

We need to unify and compete. Yes, we compete internally but the real competiton is outside of the profession. This is becoming increasingly clear to see.

Correct use of medicines relies on good communication. The powerful bioactive chemicals we are guardians of can do harm as well as good. At times even face to face communication is insifficient support to ensure optimum use by some patients.

While the finacial and logistical benefits are clear, the barriers to effective communication that removing human contact could raise are substantial and almost certainly will effect pharmaceutical care and patient outcomes.

Leon The Apothecary, Student

The human heart element of community care. If the distribution of medication became an automated process, how are we as a society looking after those individuals, some of which may be vulnerable, in our communities?

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