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Good getting better, poor getting worse

By Outsider

It’s time to bring in the harvest and batten down the hatches. The evenings are getting shorter, raincoats are out, and there’s just a hint of apprehension as you look to the sky and take that first step out of the door in the morning. 

Winter is coming, as someone once said. But for pharmacy, the hard work is still to come. The crop – if you will – is still in the field. The pandemic may have messed with everyone’s sense of where precisely we are in the year, but autumn is still the season of vaccination, and winter will bring its traditional spike in workload.

Walk around your local pharmacies today and the variation is astounding. On the corner of one street, you will find a thriving pharmacy, the heartbeat of its community. It’s been running Covid vaccination clinics for the past year and is already smashing last year’s flu numbers. The pandemic has caused problems, but they have a strong, resilient and experienced team, many of whom have worked there for double-digit years.

Yet for every pharmacy like that there will be another not so far away suffering inexplicable decline. No, that’s not true, the decline is perfectly explainable and often specific. The pharmacy looks tired, unloved. You’ve got more chance of balancing their CD register than finding a genuine ‘happy to be at work’ smile on any of the team’s faces. There’s no blaming them. Constantly berated for prescriptions not being ready, or being the last port of call for a patient bounced from one NHS front-end to another, when pharmacy is the only place a real-life healthcare professional can be found standing. There’ll be no long service awards at this pharmacy.

Exaggerations? Perhaps, but built on truths. And the truth that should be concerning us is that the variation between pharmacies seems to be widening. The good ones are really good, and getting better. The bad ones? Well, certainly not getting better. The level of variation is huge. Or to put it more succinctly, the consistency of quality is really, really poor.

Why is the experience from one pharmacy to the next so inconsistent?  How does the sector manage to deliver great care for one community while at the same time failing another? One hypothesis might be that pharmacists just aren’t good at running businesses, but immediately, you can look around and see that’s not empirically true.  There’s a Venn diagram to be drawn with pharmacists on one side, good business people on the other and a healthy crossover in the middle, just as in every profession. Even for the group that aren’t good at business, they are still intelligent people. There should be enough awareness of their limitations to go get decent advice or have someone else manage that side of things.

the truth that should be concerning us is that the variation between pharmacies seems to be widening

The trick about reaping a good harvest is that by the time the combine is needed, all the hard work has already been done – months, even years before. The same is true in pharmacy. The good pharmacies have not got there by accident, they’ve planned it. They’re able to run vaccination clinics because they recognised that the strange local service pilot on flu vaccination six or seven years ago might not make them any money then, but it was worth giving up a weekend for.  

They made the same value judgement when they invested in funding their dispenser to become a registrant and an accuracy checker. Instead of replacing the ageing cosmetics concessions, they played the long game and improved their consultation space, creating the capacity to deliver more face-to-face consultations, when everyone around them in primary care is doing fewer.

Planning ahead successfully, whether decisions are big or small, depends on how confident you can be about the outcome. If you’re a farmer about to order seed for next season, you need to know your soil conditions, the likely market demand and a decent weather forecast for key points in the process.  

It’s not so dissimilar in pharmacy, but it’s much harder to find the information needed to be confident in those decisions. Contract developments are still too opaque, especially with regard to funding. That’s before you get to the transition money cliff edge. Moreover, the one mechanism in the contract with the capability to address this – the Pharmacy Quality Scheme – has so little funding attached compared to the rest that engagement in it cannot be used meaningfully as a bellwether.

An estate of over 11,000 pharmacies with 3,700 different owners will always have variation, but that doesn’t mean it can’t have great national leadership and planned investment.

Outsider is a community pharmacist




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