With pharmacy funding cuts starting to bite, community pharmacies need to accelerate making efficiencies and look for new revenue urgently. In Avicenna’s 24 pharmacies, teams have been trying out new ideas, working with head office, with a view to sharing their successes through the group and with Avicenna’s 1,300 independent pharmacy members.
“Driving efficiencies is important for dealing with the NHS cuts. Consider whether using you are using your labour and teams efficiently,” says Ms Meghji, Avicenna's head of retail. “I’m a great believer in training people.”
The group decided early on that they would not reduce staffing as a result of the government cuts. But that does mean making changes to the way things are done, and looking at staff training and roles.
“Overall, I think, don’t get too depressed about the current environment – I actually think that community pharmacy is going through an exciting time. Make changes and bring the team along with you, as well as your patients.”
This has worked for Avicenna, who are currently above national growth levels, at seven per cent year-on-year for items. “But it’s not all about the targets, you are always doing it for patients,” she says.
The first place to look for efficiency is in the pharmacy dispensary, where the largest proportion of the pharmacy’s work is done, suggests Ms Meghji.
These are some of her suggestions:
Prescription processes – “We introduced a numbered retrieval system for prescriptions, where the prepared prescriptions are filed alphabetically in draws. Staff simply open the draw and get the bag out, and there’s no running around trying to find it. They only enter the dispensary if a prescription is not in the draw.”
Organising MDS preparation – Preparing dosette boxes is a lengthy task, and requires the utmost concentration. “We now have a log to divide the workload, so staff only spend half a day on it and are not doing this all day as they were before.”
Relocate the PMR - “By moving the PMR out of the dispensary we have encouraged the pharmacist to be at the counter. Our pharmacists say they get much more job satisfaction on the counter.”
Changes to staff roles – A focus on staff training has enabled a range of significant changes. All Avicenna pharmacy staff are now trained up to NVQ level 2 and are taking on new roles.
Independents need to give their staff an MOT, she suggests. “It’s amazing how much people can do. Ask staff to do new things and it adds to their job satisfaction.”
For example, with the PMR at the counter, staff can download the EPS scripts, prepare the label, and pass the label to the dispensing team.
This winter, staff on the counter have filled out the forms for flu vaccination and then picked the flu vaccine from the fridge with the other equipment ready for the pharmacist to administer the injection. The patient’s visit may also be an opportunity for an MUR or for a free blood pressure test.
Other steps include giving each staff member an OTC category that they will be responsible for.
Streamline stock levels – The teams worked at driving down stock levels, but taking care that it doesn’t affect the service to patients. “Stock replenishment is automated, so when you reach a minimum, for example two packs, you automatically get new stock ordered. This improves cash flow, to release funds that can be reinjected into other areas.”
Grow OTC sales – “We want the image that pharmacy drives health and positions the pharmacist as the expert in the community.” Staff had extra training on P, OTC and GSL medicines, and were encouraged to suggest linked products, offering a range of options. The stores have focused particularly on health-related products, such as BP monitors and mobility aids.
Drive services – Avicenna has asked pharmacy teams to focus on driving services, where appropriate for patients. The company has also been tendering for new services on a local basis. “We need to increase the money coming in and the best way to do this is to drive services, such as flu, MUR and NMS, and improving efficiency helps create space for us to carry out more services.”
Business administration – Most paperwork is done by head office, which helps to relieve pressure in the branches.
Talk about targets – “We have a weekly meeting in the pharmacies, using a dashboard showing how they are performing within a set of KPIs. I suggest that all independents put together a simple Excel sheet to compare year-on-year sales.”
Cost control – “Make sure that you have control over your costs: switch off lights and don’t put the heating on too high. Orders from our pharmacies have to be authorised, and head office changed suppliers to save money.”
Make sure that pharmacy teams are on board with your plans – Take your teams on a journey, says Ms Meghji. “Try to get the team to understand why you are making the changes, and that it’s not necessarily going to cover the loss [from funding cuts], but that it’s necessary to protect jobs.”
Involve the team as much as you can in any plans for efficiency and improvement, she urges. “It’s surprising how much useful feedback staff can give. Our ideas box is getting bigger and bigger, and we make sure that we respond to each one we receive.”