I sit at the panel of a pharmacy control room. Although 450 miles away, I watch on the external camera as two patients approach the pharmacy, causing the automatic doors to open. Sensing entry, the lights increase power to full intensity as they walk to the dispensing booth. The tactile floor measures their weight and stride length, calculating body mass index (BMI) and dexterity through their gait. Facial recognition at the booth identifies them as Mr and Mrs Clarke.
“Greetings Mr and Mrs Clarke,” says the robot Dispenhsa – the ‘Digital Interface Supporting Pharmacy-Enhanced NHS Activities’. “Good morning Dispenhsa,” replies Mr Clarke. “Are my metformin tablets ready to pick up?”
From the floor, two seating pods rise and a display screen appears. “Please be seated,” says the disembodied voice, “so that we can optimise your treatment.”
Once the Clarkes are seated, Dispenhsa picks and labels a packet of that month’s cheapest branded generic metformin and presents it from a small chute. “Now Mr Clarke, let us talk about your lifestyle. I have recorded an increase in your BMI since your last prescription – that will result in a poorer health outcome. Also the perspiration analyser in the arm rests of your chair indicates you have not successfully quit smoking – that will result in a poorer health outcome…”
This may not be what Day Lewis co-director Jay Patel envisaged when he talked about “leveraging” the technology that exists in community pharmacy to “smooth the flow of information” between the sector and general practice. But all the technology I have described is available now, and it would take just a small change in pharmacy supervision law to interest both the NHS and shareholders of multiple pharmacy chains.
The irony is, of course, that the most beneficial use of technology is to increase communication and interaction.
I work in both my pharmacy and a local surgery, and I know how stressful and busy both environments can be. I also recognise the antagonism felt on both sides: by the community pharmacists who feel their surgery colleagues are perceived as better, “clinical”, pharmacists who have been poached from their company to cut their dispensing income; while surgery pharmacists feel the retail chemists are belligerent, profit-driven, and resistant to change. Better technology needs to facilitate better communication between the two.
For example, in Bath there is a medicines optimisation service that pays community pharmacists £30 for simple optimisation recommendations. These suggestions are discussed with the patient – perhaps in a medicines use review for yet another fee – then sent via the secure technology of PharmOutcomes to a practice pharmacist, who actions the change if appropriate and forwards the referral for payment. The community pharmacists like it because it’s a decent fee for an important, but comparatively simple, service. The clinical commissioning group likes it because it’s an outcome-based payment saving over £20,000 per year, and the practice pharmacists like it because it supports their surgery’s medicines optimisation work.
It’s the secure communication of PharmOutcomes, not extra pharmacists, that means everyone wins. That’s how technology should be used.